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Vitamin D Deficiency vs Nursing Home Mortality

Posted Feb 17 2012 3:00am
While we may not agree on how to measure vitamin D , we've reached consensus that vitamin D deficiency leads to bone disease.  However, there's still disagreement whether vitamin D is related to cancer, cognitive impairment, depression, diabetes & heart disease since all the evidence thus far is observational (and at times contradictory).  On the other hand, the wealth of studies which I've been able to accumulate all point towards an association between vitamin D deficiency and greater mortality risk .

The latest example to be published in April in the Journal of Clinical Endocrinology & Metabolism is a prospective cohort study of 961 female nursing home residents avg 84yo w/median 25OH vitamin D (25OHD) 17.5nmol/L (7ng/dL) followed for over 2 years.  Those in the lowest quartile w/25OHD <14.0nmol/L (5.6ng/dL) had a 49% greater relative risk of all-cause mortality compared to those in the highest quartile with 25OHD >25.5nmol/L (10.2ng/dL), even after taking into account the usual confounders.

What's amazing to me is that the average 25OHD was so low for all.  I suppose we could explain this by considering that most institutionalized patients rarely venture outdoors.  Don't forget to look at a meta-analysis of 50 trials involving 94,148 participants avg 74yo published by Cochrane Collaboration last August  in which vitamin D3 supplementation over 2 years was responsible for 6% decrease in mortality while D2 made no difference.

Regardless, given the safety and low risk of toxicity as well as the potential benefits from vitamin D supplementation, it seems reasonable to test our nursing home patients and consider supplementing those who are either deficient or insufficient using the same lab (machinery) each time for each patient.
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