vitamin-d-2 and Malabsorption-Syndromes

The objective is to present an update on the diagnosis and treatment of hypovitaminosis D, based on the most recent scientific evidence.. The Department of Bone and Mineral Metabolism of the Brazilian Society of Endocrinology and Metabology (SBEM) was invited to generate a document following the rules of the Brazilian Medical Association (AMB) Guidelines Program. Data search was performed using PubMed, Lilacs and SciELO and the evidence was classified in recommendation levels, according to the scientific strength and study type.. A scientific update regarding hypovitaminosis D was presented to serve as the basis for the diagnosis and treatment of this condition in Brazil.

Topics: Bariatric Surgery; Brazil; Calcifediol; Calcium, Dietary; Cholecalciferol; Databases, Bibliographic; Ergocalciferols; Evidence-Based Medicine; Humans; Hyperparathyroidism; Malabsorption Syndromes; Osteoporosis; Osteoporotic Fractures; Parathyroid Hormone; Risk Factors; Vitamin D Deficiency

The objective was to develop evidence-based clinical care guidelines for the screening, diagnosis, management, and treatment of vitamin D deficiency in individuals with cystic fibrosis (CF).. The guidelines committee was comprised of physicians, registered dietitians, a pharmacist, a nurse, a parent of an individual with CF, and a health scientist, all with experience in CF.. Committee members developed questions specific to vitamin D health in individuals with CF. Systematic reviews were completed for each question. The committee reviewed and graded the available evidence and developed evidence-based recommendations and consensus recommendations when insufficient evidence was available. Each consensus recommendation was voted upon by an anonymous process.. Vitamin D deficiency is common in CF. Given the limited evidence specific to CF, the committee provided consensus recommendations for most of the recommendations. The committee recommends yearly screening for vitamin D status, preferably at the end of winter, using the serum 25-hydroxyvitamin D measurement, with a minimal 25-hydroxyvitamin D concentration of 30 ng/ml (75 nmol/liter) considered vitamin D sufficient in individuals with CF. Recommendations for age-specific vitamin D intake for all individuals with CF, form of vitamin D, and a stepwise approach to increase vitamin D intake when optimal vitamin D status is not achieved are delineated.

Topics: 25-Hydroxyvitamin D 2; Adolescent; Adult; Age Factors; Calcifediol; Child; Cholecalciferol; Cystic Fibrosis; Dietary Supplements; Ergocalciferols; Evidence-Based Practice; Humans; Infant; Malabsorption Syndromes; Mass Screening; Seasons; Vitamin D; Vitamin D Deficiency

Topics: Calcifediol; Clinical Laboratory Techniques; Diagnosis, Differential; Dietary Supplements; Ergocalciferols; Humans; Malabsorption Syndromes; Osteoporosis; Polymorphism, Genetic; Receptors, Calcitriol; Reference Values; Renal Insufficiency; Sarcoidosis; Sunscreening Agents; Vitamin D; Vitamin D Deficiency

A 25-yr-old black man with cystic fibrosis and cirrhosis developed symptoms of osteomalacia and hypocalcemia, hypophosphatemia, secondary hyperparathyroidism, and low circulating 25-hydroxyvitamin D (25-OHD). Serum 1,25-dihydroxyvitamin D (1,25-[OH]2D) was within the normal range. Iliac crest bone biopsy confirmed the diagnosis of osteomalacia. Oral administration of 50,000 IU of vitamin D2 failed to relieve symptoms or raise serum 25-OHD levels to normal. Intramuscular vitamin D2, 10,000 IU every 8-12 week, improved symptoms, raised serum 25-OHD to normal, and increased circulating 1,25-[OH]2D to values five times normal. Over the next 10 mo circulating 1,25-[OH]2D remained elevated despite normalization of serum calcium, phosphorus, and parathyroid hormone. Repeat bone biopsy 1 yr after parenteral vitamin D showed healing of the osteomalacia. Malabsorption of vitamin D appears secondary to profound steatorrhea due to pancreatic insufficiency and secondary biliary cirrhosis. Although extensive hepatocellular disease was present, hepatic conversion of vitamin D to 25-OHD was intact. Both high and low circulating 1,25-[OH]2D levels during active osteomalacia have been reported; initially, the level was in the normal range and higher values in this patient occurred with repletion of 25-OHD substrate. This study shows that symptomatic osteomalacia may be a major manifestation of cystic fibrosis in those patients surviving into adulthood. Measurements of serum 25-OHD in cystic fibrosis patients may identify those who should receive supplemental vitamin D.

Topics: Adult; Bone and Bones; Calcium; Cystic Fibrosis; Ergocalciferols; Humans; Hydroxycholecalciferols; Hyperparathyroidism, Secondary; Hypocalcemia; Liver; Liver Cirrhosis; Magnesium; Malabsorption Syndromes; Male; Osteomalacia; Parathyroid Hormone; Phosphorus; Serum Albumin; Vitamin D

Calcium and magnesium balance, 47Ca turnover studies, and measurements of vitamin D metabolites were performed before and after 7-10 months of vitamin D2 treatment (36,000 IU/day) in eight patients bypass-operated 3-6 years earlier for gross obesity. All patients had received a daily supplementation of calcium (27 mmol/day) since operation. Before treatment the net calcium absorption and calcium balance were normal compared with that of nine normal controls. Vitamin D metabolites were within normal limits. The endogenous faecal calcium level was increased and the faecal lag time shortened. Bone biopsies revealed osteomalacia in three of the patients. Vitamin D2 treatment induced an increase in calcium absorption and renal excretion of calcium, a reduced bone resorption rate, a more positive calcium balance, and healing of osteomalacia. Moreover, the vitamin D2 treatment induced a prolongation and normalization of faecal lag time, an increase in magnesium absorption, and a more positive magnesium balance. The effect might be mediated through 25-hydroxyvitamin D (25-OHD), which increased, whereas serum levels of 1,25-dihydroxyvitamin D (1,25-(OH)2D) and 24,25-dihydroxyvitamin D (24,25-(OH)2D) were unchanged. The results indicate that in some bypass-operated patients high-dose vitamin D2 has a beneficial effect on calcium and magnesium metabolism.

Topics: Adult; Bone and Bones; Calcium; Dose-Response Relationship, Drug; Ergocalciferols; Feces; Female; Humans; Ileum; Jejunum; Magnesium; Malabsorption Syndromes; Male; Middle Aged; Obesity; Postoperative Complications; Time Factors; Vitamin D

Histological examination of bone from 25 patients with small-intestinal resection showed that 9 (36%) had osteomalacia, which was severe in 5 and mild in 4. The serum-alkaline-phosphatase concentration was raised in all patients with severe osteomalacia, but serum calcium, phosphate, and alkaline-phosphatase concentrations were normal in the 4 patients with mild disease, 2 of whom had symptoms. Osteomalacia was diagnosed radiologically in only 3 patients. Osteomalacia appears to be commoner in patients with small-intestinal resection than has previously been thought, and bone biopsy is essential if all cases are detected. Although high-dose parenteral vitamin-D therapy is usually effective in the treatment of osteomalacia after small-intestinal resection, our findings showed that oral vitamin-D metabolites and their analogues may also be effective. This has important practical advantages.

Topics: Administration, Oral; Adult; Aged; Alkaline Phosphatase; Bone and Bones; Calcium; Crohn Disease; Ergocalciferols; Female; Humans; Ileum; Injections, Intramuscular; Jejunum; Malabsorption Syndromes; Male; Middle Aged; Osteomalacia; Phosphates; Postoperative Complications; Vitamin D

Calcium and phosphorus balance studies were performed on 13 nephrotic patients and eight patients during clinical remission of the nephrotic syndrome. Marked impairment of intestinal absorption of calcium was found among nephrotic patients, in eight of whom faecal calcium equalled or exceeded dietary calcium. The mean faecal:dietary calcium ratio of nephrotic patients, 1-06 +/- 0-23 (SD), was significantly higher (p less than 0-005) than that of patients in remission, 0-58 +/- 0-21 (SD). The mean 24-hour urinary excretion of calcium of nephrotic patients, 0-68 +/- 0-68 (SD) mmol, was significantly lower (p less than 0-005) than that of patients in remission, 3-02 +/- 1-91 (SD) mmol. Calciferol administered to three nephrotic patients in the dosage of 1.25 mg per day did not significantly influence intestinal absorption or renal excretion of calcium. There was no difference between the two groups of patients in intestinal absorption or renal excretion of phosphorus; there was net intestinal absorption in all subjects. Quantitative bone histology was studied in seven of the nephrotic patients. None had osteomalacia or osteitis fibrosa, while only one had evidence of mild osteoporosis.

Topics: Adolescent; Adult; Bone and Bones; Calcium; Ergocalciferols; Female; Humans; Intestinal Absorption; Malabsorption Syndromes; Male; Nephrotic Syndrome; Phosphorus

Topics: Adult; Aged; Aging; Animals; Calcium; Drug Resistance; Ergocalciferols; Female; Humans; Intestinal Absorption; Malabsorption Syndromes; Male; Middle Aged; Models, Biological; Osteoporosis; Rats; Vitamin D

Topics: Adult; Aged; Calcium; Ergocalciferols; Female; Humans; Malabsorption Syndromes; Male; Middle Aged; Neurotic Disorders

Topics: Calcium; Cataract; Ergocalciferols; Female; Humans; Hypoparathyroidism; Intestinal Mucosa; Malabsorption Syndromes; Middle Aged; Phosphorus

Topics: Adolescent; Bone Neoplasms; Calcinosis; Calcium; Calcium Isotopes; Ergocalciferols; Feces; Geriatrics; Humans; Hyperparathyroidism; Hypoparathyroidism; Inositol; Intestinal Absorption; Malabsorption Syndromes; Neoplasm Metastasis; Neoplasms; Osteitis Deformans; Osteomalacia; Pancreatitis; Sarcoidosis; Tetany; Urine