Calcium and vitamin D in the elderly
Special considerations for calcium and vitamin D in the elderly
Elderly persons are at increased risk for calcium and vitamin D insufficiency. There are also several alterations in body functions that can contribute to calcium loss from bone, and hence increased risk of osteoporosis.
With ageing there is:
- A decrease in dietary calcium intake, usually as a result of decreased overall dietary energy intake (e.g. poorer appetite, intercurrent illnesses, social and economic factors)
- A decrease in the intestinal absorption of calcium (exacerbated if vitamin D status is low)
- A decrease in the capacity of the intestinal cells to adapt to a low calcium intake, and increase their absorptive capacity
- Less frequent exposure to sunlight (e.g. elderly who are housebound, or institutionalized, or have reduced mobility), hence poorer vitamin D status
- A decrease in the capacity of the skin to synthesize vitamin D
- A decrease in the efficiency with which the kidneys can retain calcium, leading to increased calcium loss in the urine
- A decrease in the capacity of the kidneys to convert vitamin D into the most active form, 1,25-dihydroxyvitamin D
Calcium and vitamin D supplements
With age, our ability to absorb calcium from food diminishes. For older adults, particularly the frail elderly with reduced appetite, low activity levels or medical conditions, supplements may be required upon a doctor's recommendation. Persons at risk of vitamin D deficiency should consult their physicians about taking supplements. People at risk may include pregnant and breastfeeding mothers, the elderly (see list above), and also people with certain medical conditions, for example liver or kidney problems that affect vitamin D metabolism. In patients diagnosed with osteoporosis and receiving a drug treatment, calcium and vitamin D supplements are also usually prescribed, to ensure adequate intakes and also maximum effectiveness of the drug therapy. The types of supplements available vary by country, so consult with your physician for the one best suited to your individual needs.
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