Low vitamin D status does not adversely affect short-term functional outcome after total hip arthroplasty. Impact of Anesthesia and Surgery for Congenital Heart Disease on the Vitamin D Status of Infants and Children: A Prospective Longitudinal Study A randomized, controlled trial of vitamin D supplementation upon musculoskeletal health in postmenarchal females. Effect of vitamin D replacement on musculoskeletal parameters in school children: a randomized controlled trial. Musculoskeletal Pain and Vitamin D Deficiency in Children: A Pilot Follow-up Study of Vitamin D Therapy in Musculoskeletal/Orthopedic Conditions. The Association of Serum Vitamin D Concentration with Serious Complications After Noncardiac Surgery Vitamin D supplementation in the prevention and management of major chronic diseases not related to mineral homeostasis in adults: research for evidence and a scientific statement from the European society for clinical and economic aspects of osteoporosis and osteoarthritis (ESCEO) Vitamin D supplementation after parathyroidectomy: effect on bone mineral density-a randomized double-blind study. Prevention of vitamin D deficiency in children following cardiac surgery: study protocol for a randomized controlled trial A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS). The Association between Pre-Treatment Serum 25-Hydroxyvitamin D and Survival in Newly Diagnosed Stage IV Prostate Cancer Vitamin D status in relation to obesity, bone mineral density, bone turnover markers and vitamin D receptor genotypes in healthy Saudi pre- and postmenopausal women Improving the vitamin D status of vitamin D deficient adults is associated with improved mitochondrial oxidative function in skeletal muscle. Vitamin D for health: a global perspective. The Effect of High-Dose Vitamin D Supplementation on Calciotropic Hormones and Bone Mineral Density in Obese Subjects with Low Levels of Circulating 25-Hydroxyvitamin D: Results from a Randomized Controlled Study Vitamin D and attainment of peak bone mass among peripubertal Finnish girls: a 3-y prospective study. Vitamin D Supplementation and Fracture Incidence in Elderly Persons
We prospect ively measured functional performances ( Western Ontario and McMaster Universities Osteoarthritis Index , Short Form-36 , 2-minute walk test , and timed get-up- and -go test ) of patients who underwent total hip arthroplasty ( THA )  and had serum vitamin D levels tested during the preoperative evaluation . Of 219 patients , 102 ( 46.6 % ) had low vitamin D levels ( 25-hydroxyvitamin D<30 ng/mL ) . Low vitamin D status did not adversely affect short-term function at 6 weeks after THA . In addition , there was no association between serum vitamin D levels and the within-patient changes of scores of each outcome measurement . Because this 6-week period is generally adequate to correct vitamin D deficiency , orthopedic surgeons can safely perform THA without delay . Nevertheless , because vitamin D deficiency impairs bone quality , patients with low vitamin D levels should be treated once identified Background : Vitamin D is recognized as a pleiotropic hormone important for the functioning of organ systems , including those central to critical illness pathophysiology . Recent studies have reported associations between vitamin D status and outcome among critically ill adults and children . Preoperative vitamin D status , impact of operative techniques , and relationship between immediate postoperative vitamin D levels and clinical course have not been described in the pediatric congenital heart disease ( CHD ) population . The objective of this study was to describe the impact of CHD surgery on vitamin D status and relationship between postoperative levels and clinical course . Methods : A prospect i ve cohort study was conducted from 2009 to 2011 at a single tertiary care pediatric hospital . A total of 58 children with CHD were enrolled and  blood collected preoperatively , intraoperatively , and postoperatively .  Serum 25-hydroxyvitamin D ( 25OHD ) was measured using liquid chromatography – mass spectrometry . Results : The mean preoperative 25OHD was 58.0 nM ( SD , 22.4 ) , with 42 % being deficient ( < 50 nM ) . Postoperatively , we identified a 40 % decline in 25OHD to 34.2 nM ( SD , 14.5 ) with 86 % being deficient . Intraoperative measurements determined that initiation of cardiopulmonary bypass coincided with abrupt decline . CHD patients requiring catecholamines had lower postoperative 25OHD ( 38.2 vs. 26.5 nM , P = 0.007 ) , findings confirmed through multivariate logistic regression . Lower postoperative 25OHD was associated with increased fluid requirements and intubation duration . Conclusions : Most CHD patients are vitamin-D deficient postoperatively due to low preoperative levels and a significant intraoperative decline . Interventional studies will be required to determine whether prevention of postoperative vitamin D deficiency improves outcome CONTEXT There has been a resurgence of vitamin D deficiency rickets throughout the developed world , with infants and adolescents being primarily affected . Adolescence is a crucial period for muscle and bone mineral accumulation . OBJECTIVE The aim was to determine the effect of vitamin D supplementation on the adolescent musculoskeletal system . DESIGN AND SETTING We conducted a community-based , double-blind , r and omized controlled trial in a secondary school . PARTICIPANTS Postmenarchal 12- to 14-yr-old females participated in the trial . Ninety-nine were screened , 73 were included in r and omized controlled trial , and 69 completed the trial . There were no adverse events . INTERVENTION Four doses of 150,000 IU vitamin D(2 ) ( ergocalciferol ) were given over 1 yr . MAIN OUTCOME MEASURES Dual-energy x-ray absorptiometry , peripheral quantitative computed tomography , and jumping mechanography were used . RESULTS At follow-up , 25-hydroxyvitamin D [ 25(OH)D ] status was 56.0 ± 8.9 nmol/liter in the intervention group and 15.8 ± 6.6 nmol/liter in controls . There were no effects of supplementation on bone ; however , for muscle function , efficiency of movement improved in the vitamin D-treated group . There was an interaction between baseline 25(OH)D concentration and response to vitamin D supplementation for muscle jump velocity . CONCLUSIONS Despite improvements in 25(OH)D status , treatment with vitamin D(2 ) was not shown to increase mineral accretion , bone geometry or strength , muscle force , or power . There were greater increases in jump velocity in girls with the lowest baseline 25(OH)D concentrations . Lack of effect of intervention after the period of peak mineral and muscle mass accretion suggests that earlier action is required BACKGROUND Despite the high prevalence of hypovitaminosis D in children and adolescents worldwide , the impact of vitamin D deficiency on skeletal health is unclear . METHODS One hundred seventy-nine girls , ages 10 - 17 yr , were r and omly assigned to receive weekly oral vitamin D doses of 1,400 IU ( equivalent to 200 IU/d ) or 14,000 IU ( equivalent to 2,000 IU/d ) in a double-blind , placebo-controlled , 1-yr protocol . Areal bone mineral density ( BMD ) and bone mineral content ( BMC ) at the lumbar spine , hip , forearm , total body , and body composition were measured at baseline and 1 yr . Serum calcium , phosphorus , alkaline phosphatase , and vitamin D metabolites were measured during the study . RESULTS In the overall group of girls , lean mass increased significantly in both treatment groups ( P < or = 0.05 ) ; bone area and total hip BMC increased in the high-dose group ( P < 0.02 ) . In premenarcheal girls , lean mass increased significantly in both treatment groups , and there were consistent trends for increments in BMD and /or BMC at several skeletal sites , reaching significance at lumbar spine BMD in the low-dose group and at the trochanter BMC in both treatment groups . There was no significant change in lean mass , BMD , or BMC in postmenarcheal girls . CONCLUSIONS Vitamin D replacement had a positive impact on musculoskeletal parameters in girls , especially during the premenarcheal period PURPOSE OF THE STUDY The prevalence of vitamin D deficiency in pediatric population s is high . In the present study we analyzed associations between vitamin D therapy and pain , mobility , fatigue , and daily functioning in children with musculoskeletal/orthopedic conditions suffering from chronic and recurrent pain , but also diagnosed with vitamin D deficiency . MATERIAL AND METHODS Children with different musculoskeletal/orthopedic conditions and vitamin D deficiency were prescribed to receive vitamin D over 6 months . Thirty-five children ( 18 males ; age 10.48 ± 3.87 years ) completed a 6-month follow-up . Self- and parent/proxy rating scales were used to evaluate pain , movement , fatigue , and daily functioning . RESULTS At a six-month follow-up assessment involving child- and parent-reported scores , worst pain intensity significantly decreased ( p ≤ 0.03 ) after vitamin D therapy , as well as functioning problems related to pain ( p ≤ 0.01 ) . The children reported better movement and balance with less fatigue . The parents reported better functioning in everyday activities of their children . CONCLUSION This pilot study showed that vitamin D therapy possibly reduces pain intensity and improves mobility and daily functioning in children with musculoskeletal/orthopedic disorders , chronic recurrent pain , and vitamin D deficiency . Further follow-up and r and omized studies are required in order to assess the validity of clinical recommendations BACKGROUND : Vitamin D deficiency is a global health problem . Epidemiological studies demonstrate that vitamin D is both cardioprotective and neuroprotective . Vitamin D also plays a substantial role in innate and acquired immunity . Our goal was to evaluate the association of serum vitamin D concentration on serious postoperative complications and death in noncardiac surgical patients . METHODS : We retrospectively analyzed the data of 3509 patients who had noncardiac surgery at the Clevel and Clinic Main Campus and had a serum vitamin D measurement . The relationship between serum vitamin D concentration and all-cause in-hospital mortality , in-hospital cardiovascular morbidity , and serious in-hospital infections was assessed as a common effect odds ratio ( OR ) by using a multivariate generalized estimating equation model with adjustment for demographic , medical history variables , and type and duration of surgery . RESULTS : Higher vitamin D concentrations were associated with decreased odds of in-hospital mortality/morbidity ( P = 0.003 ) . There was a linear reduction of the corresponding common effect odds ratio ( OR 0.93 , 95 % confidence interval , 0.88–0.97 ) for severe in-hospital outcomes for each 5 ng/mL increase in vitamin D concentration over the range from 4 to 44 ng/mL. In addition , we found that the odds versus patients  with vitamin D < 13 ng/mL ( i.e. , 1st quintile ) were significantly lower in patients with vitamin D 13–20 , 20–27 , 27–36 , and > 36 ng/mL ( i.e. , 2nd–5th quintiles ) ; the corresponding estimated ORs were 0.65 ( 99 % confidence interval , 0.43–0.98 ) , 0.53 ( 0.35–0.80 ) , 0.44 ( 0.28–0.70 ) , and 0.49 ( 0.31–0.78 ) , respectively . However , there was no statistically significant difference among individual quintiles > 13 ng/mL. CONCLUSIONS : Vitamin D concentrations were associated with a composite of in-hospital death , serious infections , and serious cardiovascular events in patients recovering from noncardiac surgery . While causality can not be determined from our retrospective analysis , the association suggests that a large r and omized trial of preoperative vitamin D supplementation and postoperative outcomes is warranted Introduction Optimal vitamin D status promotes skeletal health and is recommended with specific treatment in individuals at high risk for fragility fractures . A growing body of literature has provided indirect and some direct evidence for possible extraskeletal vitamin D-related effects . Purpose and Methods Members of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis have review ed the main evidence for possible proven benefits of vitamin D supplementation in adults at risk of or with overt chronic extra-skeletal diseases , providing recommendations and guidelines for future studies in this field . Results and conclusions Robust mechanistic evidence is available from in vitro studies and in vivo animal studies , usually employing cholecalciferol , calcidiol or calcitriol in pharmacologic rather than physiologic doses . Although many cross-sectional and prospect i ve association studies in humans have shown that low 25-hydroxyvitamin D levels ( i.e. , < 50 nmol/L ) are consistently associated with chronic diseases , further strengthened by a dose-response relationship , several meta-analyses of clinical trials have shown contradictory results . Overall , large r and omized controlled trials with sufficient doses of vitamin D are missing , and available small to moderate-size trials often included people with baseline levels of serum 25-hydroxyvitamin D levels  > 50 nmol/L , did not simultaneously assess multiple outcomes , and did not report overall safety ( e.g. , falls ) . Thus , no recommendations can be made to date for the use of vitamin D supplementation in general , parental compounds , or non-hypercalcemic vitamin D analogs in the prevention and treatment of extra-skeletal chronic diseases . Moreover , attainment of serum 25-hydroxyvitamin D levels well above the threshold desired for bone health can not be recommended based on current evidence , since safety has yet to be confirmed . Finally , the promising findings from mechanistic studies , large cohort studies , and small clinical trials obtained for autoimmune diseases ( including type 1 diabetes , multiple sclerosis , and systemic lupus erythematosus ) , cardiovascular disorders , and overall reduction in mortality require further confirmation Patients with primary hyperparathyroidism ( PHPT ) have higher bone turnover , lower bone mineral density ( BMD ) , and an increased risk of fractures . They also have a high incidence of low vitamin D levels ( 25-OH-vitamin D < 50 nmol/L ) that could worsen the negative effect on the bone . In this double-blinded clinical trial , 150 patients with PHPT were r and omized , after successful parathyroidectomy ( PTX ) , to 1-year daily treatment with either cholecalciferol 1600 IU and calcium carbonate 1000 mg ( D+ ) or calcium carbonate alone ( D- ) . BMD was measured in the lumbar spine , femoral neck , total hip , distal and 33 % radius using dual-energy X-ray absorptiometry ( DXA ) before surgery and after 1 year of study medication . Median age was 60 ( range 30 - 80 ) years and there were 119 ( 79 % ) women and 31 ( 21 % ) men ; 76 % had 25-OH-D < 50 nmol/L before PTX and 50 % had persistent elevated parathyroid hormone ( PTH ) 6 weeks after PTX . A similar increase in BMD in the lumbar spine , femoral neck , and total hip was observed in both groups ( D+ : 3.6 % , 3.2 % , and 2.7 % , p<0.001 , respectively ; and D- : 3.0 % , 2.3 % , and 2.1 % , respectively , p<0.001 ) . Patients with vitamin D supplementation also increased their BMD in distal radius ( median 2.0 % ; interquartile range , -1.7 % to 5.4 % ; p=0.013 ) . The changes in BMD , especially in the hips , were correlated to the baseline concentrations of PTH , ionized calcium , and bone markers ( p<0.001 ) . A benefit from vitamin D substitution was observed among patients with a persistent postoperative PTH elevation , who also improved their BMD at 33 % radius and radius ultradistal ( p<0.05 ) . In conclusion , except for a minor improvement of radius BMD , our data show no beneficial effect on BMD or bone turnover markers of vitamin D supplementation after PTX . Preoperative PTH seems to have the strongest association with improvement in BMD Background Vitamin D is a pleiotropic hormone important for the recovery of organ systems after critical illness . Recent observational studies have suggested that three out of every four children are vitamin D deficient following cardiac surgery , with inadequate preoperative intake and surgical losses playing important contributory roles . Observed associations between postoperative levels , cardiovascular dysfunction and clinical course suggest that perioperative optimization of vitamin D status could improve outcome . With this two-arm , parallel , double blind , r and omized controlled trial ( RCT ) , we aim to compare immediate postoperative vitamin D status in children requiring cardiopulmonary bypass for congenital heart disease who receive preoperative daily high dose vitamin D supplementation ( high-dose arm ) with those who receive  usual intake ( low-dose arm ) . Methods / Design Eligibility requirements include age ( > 36 weeks , < 18 years ) and a congenital heart defect requiring cardiopulmonary bypass surgical correction . Enrollment of 62 participants will take place at a single Canadian tertiary care center over a period of 2 years . Children r and omized to the high-dose group will receive age-based dosing that was informed by the Institute of Medicine ( IOM ) daily tolerable upper intake level ( < 1 year old = 1,600 IU/day , > 1 year old = 2,400 IU/day ) . Children in the low-dose arm will receive usual care based on IOM recommendations ( < 1 year old = 400 IU , > 1 year old = 600 IU ) . The primary outcome measure is immediate postoperative vitamin D status , using blood 25(OH)D. Discussion Maintaining adequate postoperative vitamin D levels following surgery could represent an effective therapy to speed recovery following CHD surgery . The proposed research project will determine whether preoperative supplementation with a dosing regimen based on the IOM recommended daily upper tolerable intake will prevent postoperative vitamin-D deficiency in the majority of children . The results will then be used to inform the design of a large international RCT exploring whether preoperative optimization of vitamin D status might improve short and long-term outcomes in this vulnerable population .Trial Registration Clinical trials.gov Identifier - NCT01838447 Date of registration : 11 April OBJECTIVES To determine the effectiveness of vitamin D and home-based quadriceps resistance exercise on reducing falls and improving the physical health of frail older people after hospital discharge . DESIGN Multicenter , r and omized , controlled trial with a factorial design . SETTING Five hospitals in Auckl and , New Zeal and , and Sydney , Australia . PARTICIPANTS Two hundred forty-three frail older people . INTERVENTIONS Patients were r and omized to receive a single dose of vitamin D ( calciferol , 300,000 IU ) or placebo tablets and 10 weeks of high-intensity home-based quadriceps resistance exercise or frequency-matched visits . MEASUREMENTS The primary endpoints were physical health according to the short-form health survey at 3 months and falls over 6 months . Physical performance and self-rated function were secondary endpoints . Assessment s took place in the participants ' homes at 3 and 6 months after r and omization and were performed by blinded assessors . RESULTS There was no effect of either intervention on physical health or falls , but patients in the exercise group were at increased risk of musculoskeletal injury ( risk ratio = 3.6 , 95 % confidence interval = 1.5 - 8.0 ) . Vitamin D supplementation did not improve physical performance , even in those who were vitamin D deficient ( < 12 ng/mL ) at baseline . CONCLUSION Neither vitamin D supplementation nor a home-based program of high-intensity quadriceps resistance exercise improved rehabilitation outcomes in frail older people after hospitalization . There was no effect of vitamin D on physical performance , and the exercises increased the risk of musculoskeletal injury . These findings do not support the routine use of these interventions at these dosages in the rehabilitation of frail older people Background / Aims Emerging evidence in the literature suggests a positive association between serum 25-hydroxyvitamin D [ 25(OH)D ] , a st and ard indicator of vitamin D status , and survival in certain types of cancer . We investigated this relationship in newly diagnosed stage IV prostate cancer patients . Methods A consecutive cohort of 125 newly diagnosed stage IV prostate cancer patients underwent a baseline serum 25(OH)D evaluation prior to receiving any treatment at our institution between January 2008 and December 2011 . We used the vitamin D categories of “ deficient ( < 20 ng/ml ) ” , “ insufficient ( 20 to 32 ng/ml ) ” , and “ sufficient ( > 32 ng/ml ) ” . Cox regression was used to evaluate the prognostic significance of serum 25(OH)D after adjusting for relevant confounders . Results Mean age at diagnosis was 60 years . Of the 125 patients , 32 ( 25.6 % ) were deficient , 49 ( 39.2 % ) were insufficient and 44 ( 35.2 % ) were sufficient in vitamin D at the time of diagnosis . The median survival in deficient , insufficient and sufficient cohorts was 47.8 , 44.0 and 52.6 months respectively ( p = 0.60 ) . On univariate analysis , four variables demonstrated a statistically significant association with survival : nutritional status , bone metastasis , corrected serum calcium and serum albumin ( p<0.05 for all ) . On multivariate analysis , five variables demonstrated statistically significant associations with survival : hospital location , age , bone metastasis , serum albumin and corrected serum calcium ( p<0.05 for all ) . Serum vitamin D status was not significant on either univariate or multivariate analysis . Conclusion Contrary to previously published research , we found no significant association between pre-treatment serum 25(OH)D and survival in newly diagnosed stage IV prostate cancer patients . The lack of a significant association between serum vitamin D and survival in our study could perhaps be due to the fact that the disease was far too advanced in our patients for vitamin D levels to have any impact on prognosis Summary The various factors that may contribute to vitamin D deficiency or insufficiency were examined among healthy Saudi pre- and postmenopausal women .  Vitamin D deficiency was highly prevalent among studied Saudi women with obesity , poor sunlight exposure , poor dietary vitamin D supplementation and age as the main risk factors . Introduction The various factors that may contribute to vitamin D deficiency or insufficiency in relation to bone health among Saudi women are not known . The main objectives of the present study were to determine the factors influencing  vitamin D status in relation to serum 25-hydroxyvitamin D ( 25(OH)D ) , intact parathyroid hormone ( PTH ) , bone turnover markers ( BTMs ) , bone mineral density ( BMD ) , and vitamin D receptor genotype ( VDR ) in healthy Saudi pre- and postmenopausal women . Methods A total number of 1,172 healthy Saudi women living in the Jeddah area were r and omly selected and studied .  Anthropometric parameters , socioeconomic status , sun exposure index together with serum levels of 25(OH)D , calcitriol , intact PTH , Ca , PO4 , Mg , creatinine , albumin , and biochemical BTMs were measured . BMD was measured by a dual energy X-ray absorptiometry and VDR genotypes were also determined . Results About 80.0 % of Saudi women studied exhibited vitamin D deficiency ( serum 25(OH)D < 50.0 nmol/L ) with only 11.8 % of all women were considered with adequate vitamin D status ( serum 25(OH)D > 75 nmol/L ) . Secondary hyperparathyroidism was evident in 18.5 % and 24.6 % in pre- and postmenopausal women with 25(OH)D < 50 nmol/L. Serum 25(OH)D was lower ( P < 0.001 ) and intact PTH higher ( P < 0.001 ) in the upper quintiles of body mass index ( BMI ) and waist-to-hip ratio ( WHR ) . Multiple linear regression analysis showed that BMI , sun exposure index , poor dietary vitamin D supplementation , WHR , and age were independent positive predictors of serum 25(OH)D values . Conclusions Vitamin D deficiency is highly prevalent among healthy Saudi pre- and postmenopausal women and largely attributed to obesity , poor exposure to sunlight , poor dietary vitamin D supplementation , and age OBJECTIVE Suboptimal mitochondrial function has been implicated in several disorders in which fatigue is a prominent feature . Vitamin D deficiency is a well-recognized cause of fatigue and myopathy . The aim of this study was to examine the effects of cholecalciferol therapy on skeletal mitochondrial oxidative function in symptomatic , vitamin D-deficient individuals . DESIGN This longitudinal study assessed mitochondrial oxidative phosphorylation in the gastrosoleus compartment using phosphorus-31 magnetic resonance spectroscopy measurements of phosphocreatine recovery kinetics in 12 symptomatic , severely vitamin D-deficient subjects before and after treatment with cholecalciferol .  All subjects had serum assays before and after cholecalciferol therapy to document serum 25-hydroxyvitamin D ( 25OHD ) and bone profiles . Fifteen healthy controls also underwent (31)P-magnetic resonance spectroscopy and serum 25OHD assessment . RESULTS The phosphocreatine recovery half-time ( τ1/2PCr ) was significantly reduced after cholecalciferol therapy in the subjects indicating an improvement in maximal oxidative phosphorylation ( 34.44 ± 8.18 sec to 27.84 ± 9.54 sec , P < .001 ) . This was associated with an improvement in mean serum 25OHD levels ( 8.8 ± 4.2 nmol/L to 113.8 ± 51.5 nmol/L , P < .001 ) . There was no difference in phosphate metabolites at rest . A linear regression model showed that decreasing serum 25OHD levels was associated with increasing τ1/2PCr ( r = -0.41 , P = .009 ) . All patients reported an improvement in fatigue  after cholecalciferol therapy . CONCLUSIONS Cholecalciferol therapy augments muscle mitochondrial maximal oxidative phosphorylation after exercise in symptomatic , vitamin D-deficient individuals . This finding suggests that changes in mitochondrial oxidative phosphorylation in skeletal muscle could at least be partly responsible for the fatigue experienced by these patients . For the first time , we demonstrate a link between vitamin D and the mitochondria in human skeletal muscle It is now generally accepted that vitamin D deficiency is a worldwide health problem that affects not only musculoskeletal health but also a wide range of acute and chronic diseases . However , there remains cynicism about the lack of r and omized controlled trials to support the association studies regarding the nonskeletal health benefits of vitamin D. This review was obtained by search ing English- language studies published up to April 1 , 2013 , in PubMed , MEDLINE , and the Cochrane Central Register of Controlled Trials ( search terms : vitamin D and supplementation ) and focuses on recent challenges regarding the definition of vitamin D deficiency and how to achieve optimal serum 25-hydroxyvitamin D concentrations from dietary sources , supplements , and sun exposure . The effect of vitamin D on fetal programming epigenetics and gene regulation could potentially explain why vitamin D has been reported to have such wide-ranging health benefits throughout life . There is potentially a great upside to increasing the vitamin D status of children and adults worldwide for improving musculoskeletal health and reducing the risk of chronic illnesses , including some cancers , autoimmune diseases , infectious diseases , type 2 diabetes mellitus , neurocognitive disorders , and mortality Low levels of 25-hydroxyvitamin D ( 25OHD ) are associated with increased bone turnover and risk of fractures . Plasma 25OHD is inversely related to body mass index , and vitamin D deficiency is common in obesity . We aim ed to determine whether vitamin D supplementation affects bone turnover and bone mineral density ( BMD ) in obese subjects . Fifty-two healthy obese men and women aged 18–50 years with plasma 25OHD levels below 50 nmol/L were r and omized to 7,000 IU of cholecalciferol daily or placebo for 26 weeks . We measured plasma levels of 25OHD , parathyroid hormone ( PTH ) , and markers of bone turnover , as well as BMD at the hip , spine , forearm , and whole body . Compared with placebo , treatment with cholecalciferol  increased mean plasma 25OHD from 35 to 110 nmol/L ( p < 0.00001 ) and significantly decreased PTH ( p < 0.05 ) . BMD increased significantly at the forearm by 1.6 ± 0.7 % ( p = 0.03 ) . The bone resorption marker C-terminal telopetide of type 1 collagen ( CTX ) decreased borderline significantly in the cholecalciferol group compared with the placebo group ( p = 0.07 ) . Changes in plasma 25OHD correlated inversely with changes in plasma levels of bone-specific alkaline phosphatase ( r = −0.38 , p = 0.01 ) and CTX ( r = −0.33 , p = 0.03 ) . Changes in CTX correlated inversely with changes in spine BMD ( r = −0.45 , p = 0.04 ) . Increasing circulating 25OHD levels by cholecalciferol treatment is of importance to bone health in young obese subjects as increased levels of 25OHD are associated with a decrease in both PTH and bone turnover and with an increase in BMD at the forearm BACKGROUND Little is known about the effect of vitamin D status on bone gain in adolescents . OBJECTIVE The objective was to examine whether vitamin D status is associated with accrual of bone mineral density ( BMD ) and bone mineral apparent density ( BMAD ) . DESIGN This 3-y prospect i ve study examined the association between changes in BMD or BMAD and serum 25-hydroxyvitamin D [ 25(OH)D ] in 171 healthy Finnish girls aged 9 - 15 y.  Lumbar spine and femoral neck BMDs were measured by dual-energy X-ray absorptiometry . RESULTS Baseline 25(OH)D correlated significantly with the unadjusted 3-y change in BMD at the lumbar spine ( r = 0.35 , P < 0.001 ) and femoral neck ( r = 0.32 , P < 0.001 ) in all participants . The difference from baseline in adjusted 3-y BMD accumulation between those with severe hypovitaminosis D [ 25(OH)D < 20 nmol/L ] and those with a normal vitamin D status [ 25(OH)D > or = 37.5 nmol/L ] was 4 % ( 12.7 % , 13.1 % , and 16.7 % for the lowest , middle , and highest tertiles of 25(OH)D , respectively ; P for trend = 0.01 ) at the lumbar spine in the girls with advanced sexual maturation at baseline ( n = 129 ) . Moreover , the adjusted change in lumbar spine BMD was 27 % greater in the highest vitamin D intake tertile than in the lowest tertile in the same girls ( P for trend = 0.016 ) . CONCLUSIONS Pubertal girls with hypovitaminosis D seem to be at risk of not reaching maximum peak bone mass , particularly at the lumbar spine . Dietary enrichment or supplementation with vitamin D should be considered to ensure an adequate vitamin D status Vitamin D deficiency is common in elderly persons , especially those with hip fracture [ 1 , 2 ] . It is caused by low exposure to sunshine , decreased synthesis of vitamin D3 in the aging skin , and a diet low in vitamin D [ 3 , 4 ] . The mean vitamin D intake in elderly persons in the Netherl and s is about 100 IU/d , half that of elderly persons in the United States [ 5 ] . Most of this vitamin D comes from margarine , which is the only vitamin D-supplemented food in the Netherl and s ( 3 IU/g ) . In vitamin D deficiency , the low serum concentration of 25-hydroxyvitamin D [ 25(OH)D ] leads to a low 1,25-dihydroxyvitamin D [ 1,25(OH)2D ] concentration and then to a higher serum parathyroid hormone concentration , especially in the winter [ 6 - 10 ] . Histologically , the increased parathyroid activity is associated with high bone turnover , leading to cortical bone loss and low density bone [ 5 , 11 ] , which may lead to hip fracture . We previously studied the effects of vitamin D supplementation in residents of a home for the elderly and residents of a nursing home [ 10 ] .  Vitamin D3 , 400 IU/d , led to an adequate increase of the serum 25(OH)D concentration , to a small but significant increase of the serum 1,25(OH)2D concentration , and to a decrease of the serum concentration of intact parathyroid hormone . It was recently observed [ 12 , 13 ] that bone mineral density at the hip is positively related to serum 25(OH)D concentration in postmenopausal and elderly women . Therefore , it might be expected that vitamin D supplementation would increase bone mineral density in elderly persons deficient in vitamin D. In line with this expectation , it was shown that vitamin D supplementation prevented bone loss from the spine during the winter in postmenopausal women [ 14 ] . These results suggest that vitamin D supplementation may reduce the incidence of hip fractures , because bone strength shows a strong correlation with bone mineral density [ 15 ] . However , increasing bone mineral density through a therapeutic intervention does not necessarily lead to increased bone strength , as has been shown with sodium fluoride [ 16 ] . Bone structure and bone quality are also determinants of bone strength [ 17 ] , and falls are a risk factor for hip fractures [ 18 ] . Therefore , hip fracture should be the outcome criterion in studies on the effect of vitamin D supplementation . Intervention studies on the prevention of osteoporotic fractures necessitate large numbers of patients , because the outcome has an annual incidence of 0.5 % to 4 % in the elderly population [ 19 ] . We report the results of a large-scale , prospect i ve study on the effect of vitamin D supplementation on the incidence of hip and other osteoporotic fractures . Methods Participants The study included 2578 persons ( 1916 women and 662 men ) 70 years of age and older ( mean age SD , 80 6 years ; range , 70 to 97 years ) . Participants were recruited from general practitioners , from apartment houses for elderly persons , and from homes for elderly persons in Amsterdam and its vicinity . Persons recruited from practitioners were living independently ; those recruited from apartment houses and homes were receiving some care , but less than they would have received in a nursing home . Participants had to be reasonably healthy and able to give informed consent . Persons with a history of hip fracture or total hip arthroplasty , known hypercalcemia , sarcoidosis , or recent urolithiasis ( < 5 years earlier ) were excluded . Patients who had diseases or who used medications that influence bone metabolism ( such as thyroid disease or glucocorticoid medication ) were not excluded . The spontaneous use of vitamin D supplements and multivitamins was discouraged , but the prescription practice s of the general practitioners were not altered . All vitamin use was carefully documented . The study was approved by the Ethical Review Board of the Vrije Universiteit Hospital , and all participants gave informed consent . Study Design After checking the inclusion and exclusion criteria and obtaining informed consent , the participants were r and omly assigned to receive either active treatment with vitamin D3 or placebo . The study was double-blind , and r and omization was done in blocks of 10 per general practice , apartment house , or home . R and omization lists were made using a computerized r and om-number generator . Lists in sealed envelopes were sent to the hospital pharmacy for assignment . Each participant took either one tablet per day that contained vitamin D3 , 400 IU , or one placebo tablet per day that was identical in appearance and taste to the vitamin tablet . After enrollment , the participants received the first container of tablets ( 210 tablets ) . The container was replaced every 6 months with a full container . All participants were also advised in writing to consume at least three servings of dairy products per day ( for example , 1 glass of milk , 1 cup of yogurt , and 1 slice of cheese ) to ensure a calcium intake of at least 800 to 1000 mg/d . The study was started in August 1988 . The last participant was enrolled in December 1990 , and all participants had stopped using study medication by December 1993 . The follow-up period had been planned to last no more than 3 years , but because the number of hip fractures during the study was lower than expected , a 6-month extension was planned . The study participants thus received medication for 3 to 3.5 years ; those who received it for 3.5 years were those who consented to the 6-month extension . Total follow-up was to a maximum of 4 years . Data collected at baseline included an  outdoor activity score  ( 1 equals going outdoors less than once a week ; 2 equals going outdoors 1 or 2 times per week ; and 3 equals going outdoors 3 times per week or more ) and a score for sunshine exposure ( when outside : 1 equals in the shade as much as possible ; 2 equals sometimes in sunshine ; 3 equals much exposure to sunshine ) . These scores show a positive relation with serum 25(OH)D concentration [ 3 ] . Mobility was estimated by a walking score that ranged from 1 ( unable to walk ) to 5 ( walks independently a fair distance on any surface ) [ 20 ] . The dietary calcium intake from dairy products was estimated in a subset of 348 women by using a question naire , as described previously [ 21 ] . The participants were evaluated annually with a question naire on hip fractures , other peripheral fractures , outdoor score , sunshine exposure score , use of vitamin supplements , and walking score . Each general practitioner or caretaker was asked to immediately report change of address , hip fracture , or death . Hip fracture and death were verified by the general practitioner . All participants were followed for the maximal period of 4 years if possible , even if they had stopped using the trial medication , had sustained a fracture , or had moved to another city . To investigate possible selection bias , 267 potential participants in a home for the elderly and its adjunct apartments ( all residents of the institution ) were studied for baseline characteristics , including age , sex , sunshine exposure score , outdoor score , walking score , and reasons for nonparticipation . Compliance was checked when the tablet containers were replaced ( every 6 months ) , by question naire ( every year ) , and by measurement of the serum 25(OH)D concentration . Serum 25(OH)D concentration was measured at baseline and after 1 year in 270 persons who participated in a sub study investigating the effect of vitamin D supplementation on bone mineral density and bone turnover variables . This sub study included a nonr and om sample of participants from several apartment houses and homes for the elderly and is described in detail elsewhere [ 21 ] . In the same sub study , dietary calcium intake from diary products was assessed . Serum 25(OH)D concentration was also estimated during the third year of the study in February and March in a r and om sample of 96 participants drawn from the remaining study population . These participants received a letter giving them an appointment within 10 days ; the blood sample s were drawn at home . Serum 25(OH)D concentration was measured by competitive protein binding assay after being purified by gradient high-pressure liquid chromatography . The intra- and interassay coefficients of variation were 5 % and 6 % , respectively [ 22 ] . Statistical Analysis Baseline data of the vitamin D group and the placebo group were compared using t-tests ( age , calcium intake ) , chi-square tests ( sex , residence ) , and Wilcoxon rank-sum tests ( scores ) . The serum 25(OH)D concentrations of both groups were compared using t-tests . Data on fractures and mortality were analyzed by survival analysis using log-rank tests , Cox proportional-hazards regression , and hazard rate ratios [ 23 ] . Hip fractures are presented using the Kaplan-Meier method . All participants were kept in the study as long as possible . The data were analyzed in two ways . The intention-to-treat analysis included all r and omly assigned participants for either the total follow-up period or until fracture , death , or loss to follow-up . The active treatment analysis included the participants as long as they stated that they were using the trial medication . Thus , the participants were included in the active treatment analysis until they stopped using the trial medication , regardless of whether a fracture occurred after they had stopped . Age , sex , and residence were added in both analyses as covariates to the Cox regression model . Because outdoor score , sunshine score , and walking score were interrelated ( correlation coefficients ranging from 0.21 to 0.59 ) and were likely to indicate general health or mobility , they were averaged over the years and added up to a sum score . For this purpose , the walking score was simplified ( 1 , 2 , or 3 equals 1 ; 4 equals 2 ; 5 equals 3 ) , because the lower walking scores applied to a few participants only . The result ing total score , ranging from 3 to 9 , was entered as a covariate in the model . The level of compliance ( weekly intake as reported on
In conclusion , this review supports the hypothesis that hypovitaminosis D is associated with adverse outcomes after diverse surgical procedures .
The importance of vitamin D for musculoskeletal health has long been recognized , and awareness of significant extra-skeletal effects in health and disease is rapidly emerging .
Although it has been possible for many decades to quantify serum markers of vitamin D deficiency , and to correct deficiency at low cost and with high safety , the influence of vitamin D status on post-surgical outcomes has only recently been identified as a research topic of interest .
To the present , these data have not been the subject matter of formal review .
Accordingly , we conducted a systematic review to assess the association between perioperative vitamin D status and outcomes after surgery .