Pharmacy columnThe Value of Vitamin D3 over Vitamin D2 in Older Persons
Section snippets
Vitamin D Pharmacology
Vitamin D is available as D2 (ergocalciferol) and D3 (cholecalciferol). Ergocalciferol and cholecalciferol were thought to be processed similarly and to be equally effective in the body.14 With the advent of serum 25-hydroxyvitamin concentration as the functional indicator of vitamin D status, the question of bioequivalence has been reexamined.14 Only a few studies have directly examined the relative potency of vitamin D2 and D3 using contemporary assays. Vitamin D3 is now known to be more
Vitamin D in Fall and Fracture Prevention
In older persons, vitamin D is believed to slow bone loss and improve both muscle strength and balance mediated through highly specific receptors in muscle tissue.1 Study results are mixed but suggest that high enough doses of vitamin D may reduce the risk of falling in older persons.2 In one meta-analysis, the number-needed-to-treat (NNT) to prevent any nonvertebral and hip fracture was 27 to 45.1 Ingestion of vitamin D in older women (>70 years) living in residential or nursing care is
Summary
Vitamin D has gained critical importance as our understanding of its role in cellular function has expanded. With new information about the relative differences in vitamin D substrate potency and minimally effective doses, nursing home practitioners should reevaluate their use of ergocalciferol and low-dose vitamin D supplements. To achieve maximally beneficial effects of vitamin D on fall and fracture prevention, a minimum of 800 to 1000 IU of vitamin D3 (cholecalciferol) should be given as a
BARBARA J. ZAROWITZ, PharmD, FCCP, BCPS, CGP, is chief clinical officer and vice president of professional services Omnicare, Inc., and adjunct professor of pharmacy practice, College of Pharmacy and Allied Health Sciences, Wayne State University.
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BARBARA J. ZAROWITZ, PharmD, FCCP, BCPS, CGP, is chief clinical officer and vice president of professional services Omnicare, Inc., and adjunct professor of pharmacy practice, College of Pharmacy and Allied Health Sciences, Wayne State University.