Vitamin D deficiency does occur in the elderly and shows increased incidence in people who live in northern latitudes (Utiger 1998, Semba et al. 2000). The main function of this vitamin is in calcium homeostasis.
Individuals with osteoporosis frequently have a deficiency in vitamin D (Mezquita-Raya et al. 2001). With increasing age, vitamin D and calcium metabolism increase the risk of deficiency. Studies show a clear benefit of vitamin D and calcium supplementation in older postmenopausal women. Supplementation results in increased bone density, decreased bone turnover, and decreased non-vertebral fractures as well as decreases in fall risk and body sway (Malabanan and Holick 2003).
Hypervitaminosis D can occur with high doses of the vitamin. Symptoms include nausea, vomiting, loss of appetite, polydipsia, polyuria, itching, muscular weakness, joint pain, and in severe cases may lead to coma and death (Higdon 2003). In order to prevent the syndrome, the Food and Nutrition Board has set an upper limit of supplementation at 2,000 IU/day for adults (Food and Nutrition Board 1997).
The cardiac patient taking calcium channel blockers may present to the operating room while taking supplemental vitamin D and calcium. The combination of vitamin D and calcium may interfere with calcium channel blockers by antagonizing its effect. Hypercalcemia exacerbates arrhythmias in patients taking digitalis. A state of hypercalcemia may be induced by the concomitant use of thiazide diuretics with vitamin D which may lead to these complications. Conversely, anticonvulsants, cholesterol-lowering medications, and the fat substitute olestra may decrease the absorption of vitamin D (Vitamins 2000).
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