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Ernährung & Medizin 2015; 30(03): 103-110
DOI: 10.1055/s-0035-1558482
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Haug Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG Stuttgart

Vitamin D im höheren Lebensalter

Bedeutung für die muskuloskeletale Funktion
Alexander Ströhle
Institut für Lebensmittelwissenschaft und Humanernährung
,
Andreas Hahn
› Author Affiliations
Further Information

Publication History

Publication Date:
18 September 2015 (online)

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Zusammenfassung

Eine adäquate Vitamin-D-Versorgung ist entscheidend für die Prävention von Stürzen und Frakturen. Für eine effektive Fraktur- und Sturzprophylaxe gilt ein Zielwert von mindestens 50 nmol Calcidiol/l, besser ≥ 75 nmol Calcidiol/l. Gleichzeitig ist auf eine ausreichende Calcium- und Proteinzufuhr zu achten. Allerdings ist die Vitamin-D-Versorgung gerade bei älteren Personen häufig nicht sichergestellt. Aufgrund der unsicheren Versorgungssituation von Senioren in Alten- und Pflegeheimen wird bei dieser Bevölkerungsgruppe zur generellen Gabe eines Vitamin-D-Präparats (25 µg/Tag) geraten.

Schlüsselwörter

Muskelfunktion – Frakturprävention – Vitamin D – Senioren
 

  • Literatur

  • 1 Aloia JF, Dhaliwal R, Shieh A et al. Vitamin D supplementation increases calcium absorption without a threshold effect. Am J Clin Nutr 2014; 99: 624-631
    CrossrefPubMedGoogle Scholar
  • 2 American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommendations abstracted from the American Geriatrics Society Consensus Statement on vitamin D for Prevention of Falls and Their Consequences. J Am Geriatr Soc 2014; 62: 147-152
    CrossrefPubMedGoogle Scholar
  • 3 Annweiler C, Beauchet O. Questioning vitamin D status of elderly fallers and nonfallers: a meta-analysis to address a ‚forgotten step‘. J Intern Med 2015; 277: 16-44
    CrossrefPubMedGoogle Scholar
  • 4 Avenell A, Mak JC, O‘Connell D. Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev 2014; 4: CD000227-CD000227
    PubMedGoogle Scholar
  • 5 Beaudart C, Buckinx F, Rabenda V et al. The effects of vitamin D on skeletal muscle strength, muscle mass, and muscle power: a systematic review and meta-analysis of randomized controlled trials. J Clin Endocrinol Metab 2014; 99: 4336-4345
    CrossrefPubMedGoogle Scholar
  • 6 Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 2009; 339: b3692-b3692
    CrossrefPubMedGoogle Scholar
  • 7 Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC et al. Effect of Vitamin D on falls: a meta-analysis. JAMA 2004; 291: 1999-2006
    CrossrefPubMedGoogle Scholar
  • 8 Bischoff-Ferrari HA, Giovannucci E, Willett WC et al. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 2006; 84: 18-28
    CrossrefPubMedGoogle Scholar
  • 9 Bischoff-Ferrari HA, Orav EJ, Willett WC, Dawson-Hughes B. The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes. Lancet Diabetes Endocrinol 2014; 2: 363-364
    PubMedGoogle Scholar
  • 10 Bischoff-Ferrari HA, Shao A, Dawson-Hughes B et al. Benefit-risk assessment of vitamin D supplementation. Osteoporos Int 2010; 21: 1121-1132
    CrossrefPubMedGoogle Scholar
  • 11 Bischoff-Ferrari HA, Willett WC, Orav EJ et al. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med 2012; 367: 40-49
    CrossrefPubMedGoogle Scholar
  • 12 Bischoff-Ferrari HA, Willett WC, Wong JB et al. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 2005; 293: 2257-2264
    CrossrefPubMedGoogle Scholar
  • 13 Bischoff-Ferrari HA, Willett WC, Wong JB et al. Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med 2009; 169: 551-561
    CrossrefPubMedGoogle Scholar
  • 14 Bischoff-Ferrari A, Zittermann HA. Frakturen. In: Deutsche Gesellschaft für Ernährung, Hrsg. Stellungnahme: Vitamin D und Prävention ausgewählter chronischer Krankheiten. https://www.dge.de/fileadmin/public/doc/ws/stellungnahme/DGE-Stellungnahme-VitD-111220.pdf Bonn: Deutsche Gesellschaft für Ernährung; 2011: 21-24
    PubMedGoogle Scholar
  • 15 Bischoff-Ferrari HA. Optimal serum 25-hydroxyvitamin D levels for multiple health outcomes. Adv Exp Med Biol 2014; 810: 500-525
    PubMedGoogle Scholar
  • 16 Bolland MJ, Grey A, Gamble GD, Reid IR. Vitamin D supplementation and falls: a trial sequential meta-analysis. Lancet Diabetes Endocrinol 2014; 2: 573-580
    PubMedGoogle Scholar
  • 17 Bolland MJ, Grey A, Gamble GD, Reid IR. The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis. Lancet Diabetes Endocrinol 2014; 2: 307-320
    PubMedGoogle Scholar
  • 18 Boonen S, Lips P, Bouillon R, Bischoff-Ferrari HA et al. Need for additional calcium to reduce the risk of hip fracture with vitamin d supple-mentation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab 2007; 92: 1415-1423
    CrossrefPubMedGoogle Scholar
  • 19 Bruyère O, Cavalier E, Souberbielle JC et al. Effects of vitamin D in the elderly population: current status and perspectives. Arch Public Health 2014; 72: 32
    PubMedGoogle Scholar
  • 20 Busse B, Bale HA, Zimmermann EA et al. Vitamin D deficiency induces early signs of aging in human bone, increasing the risk of fracture. Sci Transl Med 2013; 5: 193ra88-193ra88
    PubMedGoogle Scholar
  • 21 Ceglia L, Niramitmahapanya S, Silva Morais M da et al. A randomized study on the effect of vitamin D₃ supplementation on skeletal muscle morphology and vitamin D receptor concentration in older women. J Clin Endocrinol Metab 2013; 98: E1927-1935
    CrossrefPubMedGoogle Scholar
  • 22 Cranney A, Horsley T, O‘Donnell S et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep) 2007; (158): 1-235
    PubMedGoogle Scholar
  • 23 Daly RM. Independent and combined effects of exercise and vitamin D on muscle morphology, function and falls in the elderly. Nutrients 2010; 2: 1005-1017
    CrossrefPubMedGoogle Scholar
  • 24 Dobnig H, Pilz S, Scharnagl H et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 2008; 168: 1340-1349
    CrossrefPubMedGoogle Scholar
  • 25 Dawson-Hughes B, Mithal A, Bonjour JP et al. IOF position statement: vitamin D recommendations for older adults. Osteoporos Int 2010; 21: 1151-1154
    CrossrefPubMedGoogle Scholar
  • 26 Deutsche Gesellschaft für Ernährung (DGE). Referenzwerte für die Nährstoffzufuhr. Calcium. Neustadt a.d. Weinstraße: Neuer Umschau Buchverlag; Ausgabe 2015
    Google Scholar
  • 27 DIPART (Vitamin D Individual Patient Analysis of Randomized Trials) Group. Patient level pooled analysis of 68 500 patients from seven major vitamin D fracture trials in US and Europe. BMJ 2010; 340: b5463-b5463
    CrossrefPubMedGoogle Scholar
  • 28 DVO Leitlinie Osteoporose. Prophylaxe, Diagnostik und Therapie der Osteoporose bei Männern ab dem 60. Lebensjahr und bei postmenopausalen Frauen. S3-Leitlinie des Dachverbands der Deutschsprachigen Wissenschaftlichen Osteologischen Gesellschaften e.V.. http://www.dv-osteologie.org/uploads/Leitlinie%202014/DVO-Leitlinie%20Osteoporose%202014%20Kurzfassung%20und%20Langfassung%2018.%2009.%202014.pdf
    PubMedGoogle Scholar
  • 29 Gillespie LD, Robertson MC, Gillespie WJ et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012; 9: CD007146-CD007146
    PubMedGoogle Scholar
  • 30 Guo JL, Tsai YY, Liao JY et al. Interventions to reduce the number of falls among older adults with/without cognitive impairment: an exploratory meta-analysis. Int J Geriatr Psychiatry 2014; 29: 661-669
    CrossrefPubMedGoogle Scholar
  • 31 Heaney RP. Health is better at serum 25(OH)D above 30ng/mL. J Steroid Biochem Mol Biol 2013; 136: 224-228
    CrossrefPubMedGoogle Scholar
  • 32 Hintzpeter B, Mensink GB, Thierfelder W et al. Vitamin D status and health correlates among German adults. Eur J Clin Nutr 2008; 62: 1079-1089
    CrossrefPubMedGoogle Scholar
  • 33 Holick MF, Binkley NC, Bischoff-Ferrari HA et al. Endocrine Society Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96: 1911-1930
    CrossrefPubMedGoogle Scholar
  • 34 Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-281
    CrossrefPubMedGoogle Scholar
  • 35 Hollis BW. Assessment and interpretation of circulating 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in the clinical environment. Endocrinol Metab Clin North Am 2010; 39: 271-286
    CrossrefPubMedGoogle Scholar
  • 36 Institute of Medicine (IOM). Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Ross AC, Taylor CL, Yaktine AL et al., eds. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academies Press; 2011 http://www.ncbi.nlm.nih.gov/books/NBK56070
    PubMedGoogle Scholar
  • 37 Joshi D, Center JR, Eisman JA. Vitamin D deficiency in adults. Aust Prescriber 2010; 33: 103-106
    PubMedGoogle Scholar
  • 38 Kanis JA, McCloskey EV. Johansson H; Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF) et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2013; 24: 23-57
    CrossrefPubMedGoogle Scholar
  • 39 Kalyani RR, Stein B, Valiyil R et al. Vitamin D treatment for the prevention of falls in older adults: systematic review and meta-analysis. J Am Geriatr Soc 2010; 58: 1299-1310
    CrossrefPubMedGoogle Scholar
  • 40 Kressig RW. Warum altert die Muskulatur? Aktuel Ernahrungsmed. 2009; 34: 259-262
    PubMedGoogle Scholar
  • 41 Linseisen J, Bechthold A, Bischoff-Ferrari HA et al. Zusammenfassung und Schlussfolgerung. In: Deutsche Gesellschaft für Ernährung, Hrsg Stellungnahme: Vitamin D und Prävention ausgewählter chronischer Krankheiten. Bonn: Deutsche Gesellschaft für Ernährung; 2011: 39–44. https://www.dge.de/fileadmin/public/doc/ws/stellungnahme/DGE-Stellungnahme-VitD-111220.pdf
    PubMedGoogle Scholar
  • 42 Max Rubner-Institut Hrsg. Nationale Verzehrsstudie II. Ergebnisbericht, Teil 2 2008 http://www.mri.bund.de/NationaleVerzehrsstudie
    PubMedGoogle Scholar
  • 43 Murad MH, Elamin KB, Abu Elnour NO et al. Clinical review: The effect of vitamin D on falls: a systematic review and meta-analysis. J Clin Endocrinol Metab 2011; 96: 2997-3006
    CrossrefPubMedGoogle Scholar
  • 44 Priemel M, von Domarus C, Klatte TO et al. Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. J Bone Miner Res 2010; 25: 305-312
    CrossrefPubMedGoogle Scholar
  • 45 Richter K, Breitner S. Webb AR; KORA Study Group et al. Influence of external, intrinsic and individual behaviour variables on serum 25(OH)D in a German survey. J Photochem Photobiol B 2014; 140: 120-129
    CrossrefPubMedGoogle Scholar
  • 46 Richy F, Dukas L, Schacht E. Differential effects of D-hormone analogs and native vitamin D on the risk of falls: a comparative meta-analysis. Calcif Tissue Int 2008; 82: 102-107
    CrossrefPubMedGoogle Scholar
  • 47 Rizzoli R, Stevenson JC. Bauer JM; ESCEO Task Force et al. The role of dietary protein and vitamin D in maintaining musculoskeletal health in postmenopausal women: a consensus statement from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Maturitas 2014; 79: 122-132
    CrossrefPubMedGoogle Scholar
  • 48 Rolland Y, Souto Barreto P de. Abellan Van Kan G; French Group of Geriatrics and Nutrition et al. Vitamin D supplementation in older adults: searching for specific guidelines in nursing homes. J Nutr Health Aging 2013; 17: 402-412
    CrossrefPubMedGoogle Scholar
  • 49 Schilling S. Epidemic vitamin D deficiency among patients in an elderly care rehabilitation facility. Dtsch Arztebl Int 2012; 109: 33-38
    PubMedGoogle Scholar
  • 50 Seitz S, Koehne T, Ries C et al. Impaired bone mineralization accompanied by low vitamin D and secondary hyperparathyroidism in patients with femoral neck fracture. Osteoporos Int 2013; 24: 641-649
    CrossrefPubMedGoogle Scholar
  • 51 Souberbielle JC, Body JJ, Lappe JM et al. Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice. Autoimmun Rev 2010; 9: 709-715
    CrossrefPubMedGoogle Scholar
  • 52 Ströhle A, Hadji P, Hahn A. Calcium and bone health – goodbye. calcium supplements? Climacteric 2015 Apr 08.04.2015; 1-13. [Epub ahead of print]
    PubMedGoogle Scholar
  • 53 Ströhle A, Wolters M, Hahn A. Nährstoffsupplemente – Möglichkeiten und Grenzen. Teil 3: Supplemente im höheren Lebensalter Med Monatsschr Pharm 2013; 36(9): 324-340; Quiz 341–342
    PubMedGoogle Scholar
  • 54 Ströhle A. Vitamin-D-Bedarfsdeckung durch Sonnenlicht? Med Monatsschr Pharm. 2011; 34(10): 388-389
    PubMedGoogle Scholar
  • 55 Ströhle A. Die aktuellen Empfehlungen des US-amerikanischen Institute of Medicine (IOM) für die Vitamin-D-Zufuhr. Eine kriti-sche Würdigung Med Monatsschr Pharm 2011; 34(8): 291-298
    PubMedGoogle Scholar
  • 56 Theodoratou E, Tzoulaki I, Zgaga L, Ioannidis JP. Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ 2014; 348: g2035-g2035
    CrossrefPubMedGoogle Scholar
  • 57 Thomas MK, Lloyd-Jones DM, Thadhani RI et al. Hypovitaminosis D in medical inpatients. N Engl J Med 1998; 338: 777-783
    CrossrefPubMedGoogle Scholar
  • 58 Tomlinson PB, Joseph C, Angioi M. Effects of vitamin D supplementation on upper and lower body muscle strength levels in healthy individuals. A systematic review with meta-analysis J Sci Med Sport. 11.08.2014;
    PubMedGoogle Scholar
  • 59 der Wielen RP van, Löwik MR, den Berg H van et al. Serum vitamin D concentrations among elderly people in Europe. Lancet 1995; 346: 207-210
    CrossrefPubMedGoogle Scholar
  • 60 Volkert D, Bischoff-Ferrari HA. Präventive Wirkung von Vitamin D – Stürze und Funktionalität des Bewegungsapparates.. In: Deutsche Gesellschaft für Ernährung, Hrsg. Stellungnahme: Vitamin D und Prävention ausgewählter chronischer Krankheiten. Bonn: Deutsche Gesellschaft für Ernährung; 2011: 11-20 https://www.dge.de/fileadmin/public/doc/ws/stellungnahme/DGE-Stellungnahme-VitD-111220.pdf
    PubMedGoogle Scholar
  • 61 Volkert D, Kreuel K, Heseker H, Stehle P. Energy and nutrient intake of young-old, old-old and very-old elderly in Germany. Eur J Clin Nutr 2004; 58: 1190-1200
    CrossrefPubMedGoogle Scholar
  • 62 von Domarus C, Brown J, Barvencik F et al. How much vitamin D do we need for skeletal health? Clin Orthop Relat Res. 2011; 469: 3127-3133
    PubMedGoogle Scholar
  • 63 Zittermann A, Gummert JF. Nonclassical vitamin D action. Nutrients 2010; 2: 408-425
    CrossrefPubMedGoogle Scholar
  • 64 Zittermann A. Vitamin D in der Präventivmedizin. Bremen: Uni-Med 2010
    PubMedGoogle Scholar
  • 65 Zittermann A. Vitamin D in preventive medicine: are we ignoring the evidence? Br J Nutr. 2003; 89: 552-572
    PubMedGoogle Scholar
  • 66 Zittermann A, von Helden R, Grant W, Kipshoven C, Ringe JD. An estimate of the survival benefit of improving vitamin D status in the adult German population. Dermatoendocrinol 2009; 1: 300-306
    PubMedGoogle Scholar