Vitamin D Deficiency in Residents of Academic Long-Term Care Facilities Despite Having Been Prescribed Vitamin D

Objectives

Vitamin D is vitally important in maintaining skeletal health. A low plasma vitamin D concentration is associated with increased parathyroid hormone secretion, increased bone turnover, osteomalacia, and osteoporosis. As a result, vitamin D deficiency is associated with a higher incidence of hip and other fractures. Although Vitamin D deficiency has been reported in long-term care facilities, optimal methods of replenishment have not been defined. The objective of the present study was to identify the pattern of calcium and vitamin D supplementation in nursing home residents and to identify vitamin D deficiency in residents already on supplement therapy.

Design

Retrospective chart review.

Setting

Five academic nursing homes staffed by faculty from the University of Arkansas for Medical Sciences.

Participants

Elderly residents aged 65 and older receiving calcium and vitamin D supplements.

Measurements

Data on dose, frequency, and levels of calcium and vitamin D were collected. The medication list and creatinine levels were also recorded.

Results

Forty-four (40%) residents were receiving 1000 mg, 48 (44%) were receiving 1200 mg, and 9 (8.2%) were receiving 1500 mg of calcium carbonate. Similarly, 79 (72%) residents were on 400 IU, 13 (12%) were on 600 IU, and only 8 (7%) were on 800 IU of vitamin D3 (cholecalciferol). Low levels of Vitamin D 25 (OH) D (values <30 ng/mL) were identified in 49.4% of residents; 16% were found to have deficiency (<20 ng/mL).

Conclusion

Despite clear benefit, nursing home residents were not supplemented adequately with calcium and vitamin D.

Keywords: Vitamin D deficiency, long-term care, elderly