The importance of parathyroid hormone and vitamin D status in the treatment of osteoporosis and renal insufficiency.
Suboptimal vitamin D status is common in sick, elderly patients and is associated with secondary hyperparathyroidism, increased bone turnover, and accelerated bone loss. Nutritional supplementation of elderly patients with vitamin D and calcium has been associated with a reduction in fractures and falls. Recently, the National Kidney Foundation (NKF) recommended screening parathyroid hormone (PTH) levels in those with glomerular filtration rates (GFR) less than 60 mL/min. The PTH target range increases as renal failure progresses because of skeletal resistance. When PTH levels are above the target range, measurement of serum 25-hydroxyvitamin D (25-OH-D) is recommended. If the 25-OH-D level is less than 30 ng/mL, supplementation with vitamin D is recommended. Practitioners should consider supplementing most residents with vitamin D and calcium or follow NKF guidelines.
Drinka
Paul J
PJ
Wisconsin Veterans Home, King, WI 54946-0620, USA. Paul.Drinka@dva.state.wi.us
D015652:25-Hydroxyvitamin D 2 / Q000097:blood*; D000368:Aged; D005919:Glomerular Filtration Rate; D006707:Homes for the Aged / Q000592:standards; D006801:Humans; D006961:Hyperparathyroidism / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D009735:Nursing Homes / Q000592:standards; D010024:Osteoporosis / Q000188:drug therapy* / Q000209:etiology; D010281:Parathyroid Hormone / Q000097:blood*; D012307:Risk Factors; D014481:United States; D014807:Vitamin D / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy
D010281:Parathyroid Hormone; D014807:Vitamin D; D015652:25-Hydroxyvitamin D 2