Appeal for Vitamin D Therapy

Stefan Schilling reported that most geriatric patients in a rehabilitation facility had severe vitamin D deficiency (1).

Our observations in women in nursing homes are rather similar (2). Although the optimal 25-hydroxyvitamin D (25[OH]D) concentrations and the potentially multiple health benefits of vitamin D are the subject of intense discussions, the general consensus is that 25(OH)D concentrations below 10 ng/mL (25 mmol/L) affect the skeletal system and require immediate treatment. In view of the fact, however, that 25(OH)D concentrations in most patients in care homes are below 10 ng/mL (25 mmol/L) and meta-analyses of randomized, placebo controlled studies have shown that vitamin D supplementation results in a significant reduction in bone fractures, we wish to point out that existing guidelines actually recommend a daily vitamin D supplementation of 800 IU in such patients.

In agreement with Stefan Schilling we therefore wish to make an appeal for introducing vitamin D supplementation as a routine treatment in care homes. This recommendation is also supported by a meta-analysis of randomized, placebo controlled trials, which shows a significant reduction in mortality as a result of vitamin D supplementation (3).

Although the many questions surrounding vitamin D remain unanswered, and although what we know about vitamin D is likely to be modified in the future, we now carry the responsibility to treat according to the current best evidence, which says very clearly that vitamin D deficiency in the elderly patients described above should be treated.

DOI: 10.3238/arztebl.2012.0359a

PD Dr. med. Stefan Pilz
Universitätsklinik für Innere Medizin,
Abteilung für Endokrinologie und Stoffwechsel,
Medizinische Universität Graz, Österreich
Department of Epidemiology and Biostatistics and EMGO
Institute for Health and Care Research,
VU University Medical Center,
Amsterdam, The Netherlands
stefan.pilz@chello.at

PD Dr. med. Andreas Tomaschitz
Dr. med. Katharina Kienreich
PD Dr. med. Astrid Fahrleitner-Pammer
Universitätsklinik für Innere Medizin,
Abteilung für Endokrinologie und Stoffwechsel,
Medizinische Universität Graz,

Österreich

Prof. Dr. med. Winfried März
Clinical Institute of Medical and
Chemical Laboratory Diagnostics,
Medical University of Graz, Graz, Austria

Synlab Academy, Synlab Services LLC,
Mannheim, Germany

Mannheim Institute of Public Health,
Ruperto Carola University Heidelberg,
Medical Faculty Mannheim, Mannheim,

Germany

Conflict of interest statement
Dr Fährleitner-Pammer has received honoraria as well as conference and travel expenses from Amgen, Eli Lilly, Nycomed, Novartis, Roche, MSD, Genzyme, Servier, and Darichi.

The remaining authors declare that no conflict of interest exists.