1.
Vitamin D in the new millennium.
Wimalawansa, SJ
Current osteoporosis reports. 2012;(1):4-15
Abstract
The incidence of vitamin D deficiency is rising worldwide, yet in the vast majority of patients, the condition remains undiagnosed and untreated. Current evidence overwhelmingly indicates that supplemental doses greater than 800 IU/day have beneficial effects on the musculoskeletal system, improving skeletal homeostasis, thus leading to fewer falls and fractures. Evidence is also accumulating on the beneficial effects of vitamin D on extraskeletal systems, such as improving immune health, autoimmune disorders, cancer, neuromodulation, diabetes, and metabolic syndrome. The cause-effect relationship of vitamin D deficiency with increasing incidences of nonskeletal disorders is being investigated. Published reports support the definition of sufficiency, serum levels of 25-hydroxyvitamin D [25(OH)D] greater than 30 ng/mL (75 nmol/L). To achieve this, most people need vitamin D supplementation ranging from 600 to 2000 IU/day; consumption up to of 5000 international units (IU) per day of vitamin D is reported as safe. Although light-skinned individuals need 1000 IU/day of vitamin D, elderly and dark-skinned individuals are likely to need approximately 2000 IU/day to maintain serum 25(OH)D levels greater than 30 ng/mL. Other vulnerable patients, such as the obese, those who have undergone bariatric surgery, and those with gastrointestinal malabsorption syndromes, may require higher doses of vitamin D to maintain normal serum levels and be healthy.
2.
Vitamin D in organ transplantation.
Stein, EM, Shane, E
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2011;(7):2107-18
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Abstract
Vitamin D deficiency is prevalent among patients with end-stage organ failure awaiting transplant. Low serum 25-hydroxyvitamin D (25-OHD) levels in these patients may be related to many disease-specific factors, as well as decreased sunlight exposure and limited intake of foods containing vitamin D. Low serum 25-OHD levels are also extremely common following solid organ transplantation, both during the immediate postoperative period and in long-term graft recipients. Demographic and lifestyle factors are important in determining D status in transplant recipients. Worse vitamin D status is associated with poorer general health, lower albumin, and even decreased survival among these patients. Although several studies have demonstrated that active forms of vitamin D and its analogues prevent bone loss following transplantation, the data do not show consistent benefit. These therapies may have particular utility after renal transplantation. However, given the narrow therapeutic window with respect to hypercalcemia and hypercalciuria, and the demonstrated efficacy of bisphosphonates to prevent post-transplantation bone loss, we regard these agents as adjunctive rather than primary therapy for transplantation osteoporosis. The effects of 1,25(OH)(2)D on the immune system, which are still being elucidated, may have potential for reducing infections and preventing allograft rejection after transplantation.
3.
The use of low-molecular-weight heparins in pregnancy--how safe are they?
Deruelle, P, Coulon, C
Current opinion in obstetrics & gynecology. 2007;(6):573-7
Abstract
PURPOSE OF REVIEW Low-molecular-weight heparins are in widespread use during pregnancy. As with every treatment in pregnant patients, concerns have been raised about the safety of Low-molecular-weight heparins. The purpose of the present article is to review recent advances, published during the past year, that have studied the maternal, fetal, and neonatal safety of Low-molecular-weight heparins in pregnant women. RECENT FINDINGS Low-molecular-weight heparins do not increase the risk of maternal bleeding during pregnancy. Closed management is needed during the peripartum period, and discontinuing Low-molecular-weight heparins at least 12 h before delivery seems sufficient to prevent post-partum haemorrhage. The incidence of Low-molecular-weight heparins-induced immune reaction is low. Fondaparinux or danaparoid may be used as an alternative option in pregnant women with heparin-induced thrombocytopenia. Long-term Low-molecular-weight heparins therapy may be associated with osteopenia. Calcium vitamin D supplementation during pregnancy may reduce the risk of Low-molecular-weight heparins-induced osteoporosis. As Low-molecular-weight heparins do not cross the placenta, no fetal or neonatal complication has been reported. Beyond the safety question, Low-molecular-weight heparins have the potential to improve the live-birth rate in high-risk pregnancies (antiphospholipid syndrome, thrombophilia, or recurrent fetal loss). SUMMARY Recent studies have confirmed the safety of Low-molecular-weight heparins therapy during pregnancy. The risk of potential side effects is low for both the mother and the neonate.