Abstract

Vitamin D and Calcium intake have been hypothesized to have a direct effect on bone density, mass and reduce bone loss. Studies have focused on emphasizing the results with an extended analysis of how Vitamin D and calcium impact osteoporosis. However, there have been differential understanding of how Vitamin D and calcium impact bone mass and density. Majority of studies on vitamin D and calcium have fixated on the impact that increased intake has on bone loss and repairment. Studies have proven that Vitamin D and calcium are obligatory for bone improvement and reduced bone loss. However, limited studies are illuminating the affiliation between vitamin D also calcium intake among older adults. The following paper illuminates on the topic focusing on one derivative study by Larsen, Mosekilde, and Foldspang on Vitamin D and Calcium Supplementation Prevent Osteoporotic Fractures in Elderly Community Dwellers Residents. The main paper objectives are to provide a non-biased analytical review on the study with references to other peer-reviewed articles and journals on the same topic. The results of the survey reveal that there are counter studies on Larsen, Mosekilde and Foldspang’s research about vitamin D and calcium supplement intake.

On the other hand, some studies correlate with the results obtained from Larsen, Mosekilde, and Foldspang. However, there are a lot of loopholes concerning the studies in determining how Vitamin D and calcium are biologically related to osteoporosis. Moreover, there is limited information relating to how other factors such as domestic environment relates to increased fractures and falls among the elderly.

Introduction

Statistical review on increased bone fractures and falls among the elderly is on the rise. It is estimated that nearly twenty percent of the elderly population that suffers from a hip fracture dies within the initial year. The statistics have received scientific attention with researchers determining nutritional interventions to diminish the risk of bone fractures and falls among the elderly. A cluster-randomized pragmatic intervention study conducted by Larsen, Mosekilde, and Foldspang evaluated recommended dietary interventions that seek to improve bone performance among the elderly. The researchers’ primary objective was to determine whether the combination of Vitamin D and calcium mineral would improve the pharmaceutical treatment of osteoporotic fractures among the aged between 66 years of age and above.

Osteoporosis is a bone phenomenon where the bone mass decreases with age causative to the loss of bone strength. From a biological perspective, it is documented that bone strength relies directly on the use of Vitamin D and calcium supplementation. The case is that high levels of Vitamin D and calcium constituents, the more elevated the bone strength. Whereas, the lower the concentrations of Vitamin D and calcium constituents, the lower the bone strength. The setback to the latter is the association of bone fractures which tend to increase among elderly individuals with a few records among young adults.

Additionally, the biological perspective is subject to muscle strength and rigidity. As people age, muscle strength reduces. Therefore, the theoretical premise is that low nutritional intake of calcium and Vitamin D can lead to decreased renal functionalism in the production of calcitriol and cutaneous Vitamin D production which increase the risks of falls.

According to the investigation by Jackson et al. (670) on Vitamin D and calcium benefits among the elderly, increased calcium intake combined with exposure to Vitamin D intake increases bone strength. Jackson et al. (671) concur with Larsen, Mosekilde, and Foldspang on causes of osteoporosis. As such, Larsen, Mosekilde and Foldspang’s study investigated the effects of provision of Vitamin D and calcium among the elderly to evaluate the improvement of bone strength in line with pharmaceutical treatment.

Research Methodology and Results

Larsen, Mosekilde and Foldspang study focused on the elderly population with its sample size at 9, 605. The population age ranged from sixty-six years of age and above. The community comprises of women (5, 771) and men (3, 834) with a median age of 74 years. The population, however, was blocked with those living in nursing homes excluded from the research as well as elders living in sheltered homes and with mental deformities. The parameters of the study entailed elders diagnosed with osteoporosis. Based on the study osteoporosis comprised of low-energy fissures ranging from the proximal humerus, distal forearm, cervical femur, intertrochanteric femur, vertebral column, and pelvic femur.

The research’s design comprised of four comparable blocks where the subjects were randomly selected in the Municipal social service centers. The researchers collected information as well as providing healthcare services including advising the elderly on how to take care of themselves. The advice guaranteed that the elderly only consumed the types of the calcium supplied and the researchers secured that the subjects did not receive any other form of calcium during the study. Based on the blocks, the first block (n=4957) presented with calcium and vitamin D, the second block (n=2116) were offered no intervention thus, was the control population, and the last block (n=5063) were obtained environment and wellbeing program. Data collection method was through interviews and questionnaires where the subjects were contacted at least twice throughout the study. Also, the researchers utilized the online central population registry which contains a serial number provided to each inhabitant. The figures provided quantitative data on any hospital admissions on osteoporosis basis of the subjects under study.

The outcomes of the study proved that vitamin D and calcium complement reduced the risks of osteoporosis on subjects confined within the health program as compared to those who were not. The baseline control (control group) recorded no improvement in levels of serum and plasma levels ideal for calcium and Vitamin D absorption and production. However, the researchers identified bilateral and indirect factors that influenced increased fractures among the subjects. For example, Widows and widowers experienced more falls and fractures compared to elderly married couples. Also, fractures among the subjects increased with age. However, social and domestic factors such as mortality and program participation had made a serious significant difference on the impact of the results — utilization of additional pharmaceutical products such as cardiovascular medications and respiratory medications. The effects of the medicines were substantial due to increased calcium intake provided within the drug. On the other hand, the researchers, Larsen, Mosekilde and Foldspang, determined that other diseases did not have a noteworthy effect on the calcium intake and Vitamin D on the subjects.

The authors Larsen, Mosekilde, and Foldspang determined that there is a need to understand the effects of Vitamin D and calcium intake from a biological perspective. In summary, Vitamin D and calcium supplements have an active metabolic influence on bone métier and muscle purpose as well as other biological conditions.

Critique

Vitamin D is regarded as a necessary supplement in the human body. Its importance is linked to a reduction in falls and fractures. According to an investigation by Kerrie et al. (1815), the researchers determined that vitamin D is critical in minimizing breaches. The study was a double-blind placebo-controlled experiment involving nearly 2, 256 women at the age of 70 years and above. The subjects recruited for the study were considered highly prone to fractures and falls. The objective of the study was to control whether a single dose of cholecalciferol administered orally would have an impact on the reduction in falls and fractures. In summarization, the investigation revealed that women using the Vitamin D dosage had reduced instances of falls and fractures compared to those under the placebo study. The survey by Kerrie et al. (1821) concurs with statements from Larsen, Mosekilde and Foldspang’s study. However, the limitation of the former study is based on the determination that Vitamin D may not be the only reduction agent when it comes to falls. This is ascertained by the inconsistencies reported in Kerrie et al.’s study (1821). Viljakainen et al. (840) present similar findings on Vitamin D. According to the double-blind placebo-controlled study, Viljakainen et al. (840) Vitamin D increase bone functionalism and strength in elderly individuals compared to young adults. However, the rates of recovery were not as equally successful as presented in other studies. As such, the confidence in vitamin D coupled with calcium supplements is dictated as more rewarding.

Porterhouse et al. (1003) proved that vitamin D does not work better in the presence of calcium supplements. Based on the pragmatic open randomized controlled trial, Porterhouse et al. (1003) measured increased hip fractures in women aged from seventy and above. The researchers discovered that there was no indication to sustenance that calcium and vitamin D supplementation reduced clinical fractures. Aspects of quality of life were determined to have a direct impact on fracture occurrences among the elderly. A study conducted by Record Trial Group (1621) recorded similar results indicating that calcium intake and no calcium intake did not have a direct effect on low-fracture occurrences in elderly patients. It seems that these studies contradict Larsen, Mosekilde and Foldspang’s study. Meyer et al. (710) confirm that admission of vitamin D and calcium or individually does not affect fracture occurrence through a randomized controlled trial test. It should be noted that Meyer et al. (711) and Record Trial Group (1621) provided different quantities of Vitamin D and calcium with the former providing a low dosage whereas the latter a lower dose.

The metabolic events concerning Vitamin D and calcium are hyperthyroidism in nature. Chapuy et al. (257) indicate that calcium and vitamin D encourage the production of serum (25-hydroxyvitamin D) and reduced production of serum parathyroid hormone. The advantage of this is that mineral density increases due to the positive pharmacodynamic effects (Bakhtiyarova 441). The effect nonetheless, can be devastating in women compared to men. De Boer et al. (710) elucidate that women experience drop-in hormone levels faster compared to men. The alteration in normalcy based on hormone change can have an impact on bone density (Harwood et al. 45). But, Trivedi, Doll, and Khaw (469) suggest otherwise indicating that vitamin D supplements with calcium have an equal effect on both senior men and women. The randomized, double-blind trial study used a higher quantity of vitamin D compared to Meyer et al. (711) and Record Trial Group (1621). The hypothesis is that dosage levels may have a direct effect on resultant reduction of accidents and fractures in older adults.

There may be other factors that contribute to fractures and falls in older adults that may explain the increasing phenomenon (Lips et al. 400). The statement agrees with the study done by Lyons et al. (811). The research conducted a pragmatic double-blind, randomized controlled study in three years. The outcomes of the investigation determined that vitamin D and calcium intake did not affect fractural statistics among the elderly. But different statistics were recorded based on domestic environment, type of injury and age in patients.

The theoretical perspective on the type of injury resonates with the natural philosophy that injuries on the upper extremities increase whereas, those on the lower extremities reduce (Salovaara et al. 1487). The inclination is that vitamin D and calcium intake improves on bone densities on the upper extremities and not on the lower ones.  Larsen, Mosekilde and Foldspang’s study provided a generalized look on what osteoporosis is and failed to take into account differentiation in body bone structures. It is suggested that this may have provided a different outlook on the significant differences witnessed in elderly patients. Pfeifer et l. (1113) concur that the upper extremities record increased incidences of fracture compared to lower extremities. According to the study by Dawson-Hughes et al. (670) increased intake of calcium supplements together with vitamin D improved bone density and reduced bone loss. This confirms Larsen, Mosekilde and Foldspang’s study are fortifying the theoretical premise on vitamin D and calcium benefits. But, Dawson-Hughes (670) discuss that vitamin D and calcium intake affect bone based on position. A randomized control trial study by Reid et al. (777) resolve that vitamin D and calcium are ideal for improved hip, waist and humerus bone density compared to other extremities in osteoporosis.

The impact of vitamin D and calcium from an organic perspective has not been analyzed yet.   According to a review study by Houston et al. (1861), most studies have focused on determining if vitamin D and calcium have a direct effect on reduced fractures. Dale also confirms that other factors contribute to falls and fissures which are associated with osteoporosis. The studies do not contradict Larsen, Mosekilde and Foldspang’s study. Instead, they formulate a fundamental understanding from a theoretical perspective and biological framework of how vitamin D and calcium impact fractures and falls in older adults. There are a lot of loopholes when it comes to an analytical understanding of Larsen, Mosekilde and Foldspang’s study. A study conducted by Jastrzębski (57) concluded that other parameters within the human body as well as its environmental impact osteoporosis and vitamin D and calcium intake. The profundity within the study indicates that vitamin D and calcium may not be directly inclined to osteoporosis and fractures among the elderly. There needs to be an in-depth analysis of different aspects.

Conclusion

Vitamin D supplements with calcium have presented an argumentative understanding of the impact on bone density and bone loss in older adults. The paper has provided a critical review of the topic. The report has focused on the paper by Larsen, Mosekilde and Foldspang on vitamin D and calcium supplement effects on incidences of osteoporosis falls and fractures. A two-pronged discussion has been documented and provided with enough evidence supporting the two claims. As such, the paper concludes that the study by Larsen, Mosekilde, and Foldspang may not be sufficient in approving the theoretical premise that vitamin D and calcium increased intake has a direct effect on bone density and loss.

Work Cited

Jackson, Rebecca D., et al. “Calcium plus vitamin D supplementation and the risk of fractures.” New England Journal of Medicine 354.7 (2006): 669-683.

Larsen, Erik Roj, Leif Mosekilde, and Anders Foldspang. “Vitamin D and calcium supplementation prevent osteoporotic fractures in elderly community-dwelling residents: a pragmatic population‐based 3‐year intervention study.” Journal of Bone and Mineral Research 19.3 (2004): 370-378.

Sanders, Kerrie M., et al. “Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial.” Jama 303.18 (2010): 1815-1822.

De Boer, Ian H., et al. “Calcium plus vitamin D supplementation and the risk of incident diabetes in the Women’s Health Initiative.” Diabetes Care 31.4 (2008): 701-707.

Viljakainen, Heli T., et al. “A Positive Dose-Response Effect of Vitamin D Supplementation on Site‐Specific Bone Mineral Augmentation in Adolescent Girls: A Double‐Blinded Randomized Placebo‐Controlled 1‐Year Intervention.” Journal of Bone and Mineral Research 21.6 (2016): 836-844.

Porthouse, Jill, et al. “Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care.” Bmj 330.7498 (2015): 1003.

RECORD Trial Group. “Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomized placebo-controlled trial.” The Lancet 365.9471 (2005): 1621-1628.

Meyer, Haakon E., et al. “Can vitamin D supplementation reduce the risk of fracture in the elderly? A randomized controlled trial.” Journal of Bone and Mineral Research 17.4 (2012): 709-715.

Chapuy, M. C., et al. “Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study.” Osteoporosis International 13.3 (2012): 257-264.

Bakhtiyarova, S., et al. “Vitamin D status among patients with hip fracture and elderly control subjects in Yekaterinburg, Russia.” Osteoporosis International 17.3 (2016): 441-446.

Harwood, Rowan H., et al. “A randomized, controlled comparison of different calcium and vitamin D supplementation regimens in elderly women after hip fracture: The Nottingham Neck of Femur (NONOF) Study.” Age and Aging 33.1 (2014): 45-51.

Trivedi, Daksha P., Richard Doll, and Kay Tee Khaw. “Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: a randomized, double-blind controlled trial.” Bmj326.7387 (2003): 469.

Lips, Paul, et al. “Vitamin D supplementation and fracture incidence in elderly persons: a randomized, placebo-controlled clinical trial.” Annals of Internal Medicine 124.4 (2010): 400-406.

Lyons, Ronan Anthony, et al. “Preventing fractures among older people living in institutional care: a pragmatic randomized, double-blind placebo-controlled trial of vitamin D supplementation.” Osteoporosis International 18.6 (2007): 811-818.

Salovaara, Kari, et al. “Effect of vitamin D3 and calcium on fracture risk in 65‐to 71‐year‐old women: A population‐based 3‐year randomized, controlled trial—the OSTPRE‐FPS.” Journal of Bone and Mineral Research 25.7 (2010): 1487-1495.

Pfeifer, Michael, et al. “Effects of a short‐term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women.” Journal of Bone and Mineral Research 15.6 (2000): 1113-1118.

Dawson-Hughes, Bess, et al. “Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older.” New England Journal of Medicine 337.10 (2010): 670-676.

Reid, Ian R., et al. “Randomized controlled trial of calcium in healthy older women.” The American journal of medicine119.9 (2006): 777-785.

Houston, Denise K., et al. “Delivery of a Vitamin D Intervention in Homebound Older Adults Using a Meals‐on‐Wheels Program: A Pilot Study.” Journal of the American Geriatrics Society 63.9 (2015): 1861-1867.

Archer, Dale. “Vitamin D deficiency and depression.” Psychol Today (2013).

Jastrzębski, Zbigniew. “Effect of vitamin D supplementation on the level of physical fitness and blood parameters of rowers during the 8-week high-intensity training.” Facicula Educ Fiz şi Sport 2 (2014): 57-67.