Vitamin D and Rehabilitation: Improving Functional Outcomes

Nutrition in Clinical Practice - Tập 22 Số 3 - Trang 297-304 - 2007
Leonid M. Shinchuk1, Michael F. Holick2
1Spaulding Rehabilitation Hospital and
2Boston University Medical Center, Boston, Massachusetts

Tóm tắt

Vitamin D inadequacy is pandemic among rehabilitation patients in both inpatient and outpatient settings. Male and female patients of all ages and ethnic backgrounds are affected. Vitamin D deficiency causes osteopenia, precipitates and exacerbates osteoporosis, causes the painful bone disease osteomalacia, and worsens proximal muscle strength and postural sway. Vitamin D inadequacy can be prevented by sensible sun exposure and adequate dietary intake with supplementation. Vitamin D status is determined by measurement of serum 25‐hydroxyvitamin D. The recommended healthful serum level is between 30 and 60 ng/mL. 25‐Hydroxyvitamin D levels of >30 ng/mL are sufficient to suppress parathyroid hormone production and to maximize the efficiency of dietary calcium absorption from the small intestine. This can be accomplished by ingesting 1000 IU of vitamin D3 per day, or by taking 50,000 IU of vitamin D2 every 2 weeks. Vitamin D toxicity is observed when 25‐hydroxyvitamin D levels exceed 150 ng/mL. Identification and treatment of vitamin D deficiency reduces the risk of vertebral and nonvertebral fractures by improving bone health and musculoskeletal function. Vitamin D deficiency and osteomalacia should be considered in the differential diagnosis of patients with musculoskeletal pain, fibromyalgia, chronic fatigue syndrome, or myositis. There is a need for better education of health professionals and the general public regarding the optimization of vitamin D status in the care of rehabilitation patients.

Từ khóa


Tài liệu tham khảo

10.4065/81.3.353

10.1007/s11914-996-0028-z

10.1093/ajcn/80.6.1678S

10.1201/9781420019322.ch10

10.1126/science.505004

10.1093/ajcn/80.6.1689S

10.1136/bmj.330.7490.524

10.1016/j.apmr.2006.03.009

10.1097/01.phm.0000242622.23195.61

10.1111/j.1445-5994.1995.tb01526.x

10.1093/ajcn/77.6.1478

10.1056/NEJM199204303261802

Dawson‐Hughes B, 2006, Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism., 257

10.1080/07315724.2003.10719287

10.1002/jcb.10423

10.1002/jcb.10338

10.1016/j.jsbmb.2004.03.004

Simpson RU, 1985, Identification of 1,25‐dihydroxyvitamin: D3 receptors and activities in muscle, J Biol Chem., 260, 8882, 10.1016/S0021-9258(17)39433-4

10.1023/A:1017535728844

10.1042/cs0560157

10.1055/s-2001-14831

10.1359/jbmr.2003.18.2.343

10.1001/jama.291.16.1999

10.1007/s00198-005-1867-7

10.1007/s001980050030

10.1210/jc.2004-2364

10.1093/ajcn/80.6.1706S

10.1007/PL00022725

10.1056/NEJM198912283212602

10.1172/JCI112134

10.1016/S0140-6736(89)91124-0

10.1016/S0140-6736(82)90214-8

Matsuoka LY, 1995, Compensation for the interracial variance in the cutaneous synthesis of vitamin D, J Lab Clin Med., 126, 452

10.1001/archderm.1991.04510010104011

10.1210/jcem-64-6-1165

10.1210/jcem-67-2-373

10.1007/s00198-006-0069-2

10.1016/j.jsbmb.2006.12.010

10.1053/gast.2001.29686

10.1093/ajcn/72.3.690

10.1172/JCI21867

10.7861/clinmedicine.4-5-431

10.1191/0961203303lu1097oa

10.1016/j.jada.2005.03.002

10.1016/S0002-9343(02)01091-4

10.1093/ajcn/76.1.187

10.1056/NEJM199803193381201

10.4065/78.12.1463

10.1016/j.amjmed.2003.12.029

10.1007/BF02672505

10.1359/jbmr.2001.16.8.1408

10.1093/ajcn/74.2.206

10.1056/NEJM199709043371003

10.1056/NEJM199212033272305

10.1136/bmj.330.7498.1003

10.1016/S0140-6736(05)63013-9

10.1056/NEJMoa055218

10.1111/j.1532-5415.1999.tb04581.x

10.1359/jbmr.2002.17.5.891

10.1001/jama.293.18.2257

10.1046/j.1365-2796.2000.00595.x

Gloth FM, 1991, Can vitamin D deficiency produce an unusual pain syndrome?, Arch Intern Med, 151, 1662, 10.1001/archinte.1991.00400080144029

10.1385/JCD:1:2:201

10.4065/78.12.1457

10.1007/s002230010085

10.1093/ajcn/51.6.1075

1997, Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride., 250

10.1002/jbmr.5650030303

10.1056/NEJM198507113130202

10.1016/j.jsbmb.2004.03.038

10.1093/jn/135.2.317

10.1016/S0140-6736(05)78933-9

10.1056/NEJM200107053450115

10.1093/ajcn/69.5.842

10.1034/j.1600-0781.2001.170405.x

Thông tin
Thông tin xuất bản

Nutrition in Clinical Practice

Tập 22 Số 3

297-304

Thông tin tác giả