Should all long-term care residents receive vitamin D?

摘要

Falls and subsequent fractures represent a devastating event to residents living in nursing homes or assisted living. In a study in 47 Maryland nursing homes in which 1427 white females were followed prospectively for 18 months, more than 12.5% had an osteoporotic fracture during this period.1 In addition, approximately 20% of the residents had more than one fracture. The two factors most associated with fracture were low bone mineral density and being able to transfer independently. Osteoporosis is extremely common in nursing homes residents. Zimmerman et al. found that 63.5% of white female residents 65 to 74 years of age were osteoporotic; this percentage increased to 85.8% for women more than 85 years of age. Ekman et al.reported that 95% of institutionalized women and 51 % of men in Sweden were osteoporotic. In a group of residents with dementia in Canada, 92.5% were at high risk for osteoporosis or osteopenia using a qualitative ultrasound measurement of calcaneal bone mineral density. In 2004, the Quebec Symposium for the Treatment of Osteoporosis in Long-Term Care Institutions concluded that all patients located in long-term care institutions are at potential risk for osteoporotic fractures.Despite the clear evidence that treatment of osteoporosis is beneficial, most studies show that this is poorly done, both in community-dwelling and institutionalized older persons.