Muscle weakness and bone fragility ...

Muscle weakness and bone fragility likely are responsible for the age-related increase in falls and fractures in somewhat old persons. Even slightly decreased vitamin D on a levels may have a negative consequence on bone metabolism and muscle power Elderly persons have reduced exposing to sunlight and dietary vitamin D intake, and equal persons with normal serum vitamin D plains (more than 12 mcg through L [30.3 nmol per L]) may have 1,25-dihydroxyvitamin D3 deficiency because of a variety of metabolic factors. Previous studies have shown the value of vitamin D supplementation in institutionalized or osteopenic somewhat old women. Dukas and colleagues performed a community-based, randomized, double-blind, placebo-controlled trial to investigate whether supplementation with alfacalcidol, a prodrug of calcitriol, remodels falls in community-dwelling elderly men and women

A total of 191 women and 187 men were included in the intention-to-treat analysis, with 192 participants randomized to alfacalcidol and 186 to placebo. The number of fallers rather than the number of falls was compared as a primary result although results for number of falls also were instanted Muscle strength, balance, blood hurry and bone quality were measured as secondary issues Participants kept a diary of falls and were told to inform the investigation center of their falls within 48 hours. A detailed medical history that included comorbidities and dietary calcium intake was obtained from all participants. kin samples were drawn at each visit. 1,25-dihydroxyvitamin D3 and intact parathormone (iPTH) serum concentrations were measured at baseline and at weeks 12 and 24

assign places tos were similar at baseline. Of the 378 participants, 321 complet the contemplation (158 women [82.7 percent] and 163 men [872 percent]) In the multivariate-adjusted logistic regression analysis, treatment with alfacalcidol through the whole extent of 36 weeks was associated with fewer fallers than placebo, if it were not that the difference was not significant. In subgroup analysis, however, calcium intake affected the alfacalcidol collection Participants who consumed more than 512 mg of calcium daily and took alfacalcidol had significantly fewer falls than sway patients with the same calcium intake (odd ratio, 045) The impact was the same in the couple men and women.

on a levels of iPTH decreased significantly in all alfacalcidol-treated patients, regardless of calcium intake. Alfacalcidol treatment also was associated significantly with increased serum calcium on a levels compared with placebo.

Supplementation with alfacalcidol for 36 weeks change intos the number of fallers and falls in an somewhat old community-based population when the minimum daily calcium intake is 512 mg or more. It also increases serum calcium evens and decreases parathyroid hormone secretion. The application of mind suggests that there is a synergistic event of calcitriol and calcium, which is likely to mediate the drift of vitamin D on muscle. Findings from other studies hint that iPTH is an independent risk factor for decreased muscle might and falls, but this contemplation indicates that a benefit from decreased iPTH requires a specified minimal calcium intake.

CAROLINE WELLBERY, MD Dukas L et al. Alfacalcidol renders the number of fallers in a community-dwelling somewhat old population with a minimum calcium intake of more than 500 mg daily. J Am Geriatr Soc February 2004;52:230-6

COPYRIGHT 2004 American Academy of Family Physicians

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