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Vitamin D is a pleitropic hormone that regulates Ca-P, bone metabolism, and many other functions. The main source is cutaneous synthesis from solar radiation. Vitamin D deficiency (VDD) is common in advanced age, mostly due to insufficient sunlight exposure. VDD represents the essential cause of secondary hyperparathyroidism (SHT), which affects a variable proportion of older adults, has a multifactorial pathogenesis, and is associated with increased frequency of fractures, falls, loss of muscle strength, and frailty. The criteria to define optimal serum levels of 25(OH)D (≥ 30 ng/mL) and the clinical manifestations and evaluation depending on the severity and duration of VDD are detailed. Severe VDD (25(OH)D The relationships among the extraskeletal action of vitamin D, mortality, and VDD are described. Nowadays, no causal relationship has been established between VDD and frequent nonskeletal diseases of advanced age. The preventive recommended doses of vitamin D2 or D3 and a calcium element are outlined as well as considerations on dietary and supplemental calcium. Vitamin D3 is the most recommended form of vitamin D for oral administration, in clinical practice guidelines. Vitamin D3 is the one that has demonstrated to improve the final treatment goals, namely, the intestinal absorption of calcium, bone fractures and falls. Vitamin D3 doses are quite variable depending on multiple individual factors. Repletion and maintenance doses of Vitamin D3, for vitamin D insufficiency and deficiency in the elderly, are also detailed. Controversy about dosage, and monitoring and the safety of vitamin D3 treatment are also described. Treatment with oral calcidiol and calcitriol should be limited to special clinical settings that we specify. |
