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Presented by : Asmaa
• Vitamin D is a group of fat-soluble vitamins. • Vitamin has several important functions in the body:
• It helps to absorb dietary calcium and phosphorus from the intestines. • It suppresses the release of parathyroid hormone, a hormone that causes bone resorption. • Vitamin D may have other benefits, such as improving muscle and immune function.
Sources of vit D:
• 1. skin source
• 2. nutritional source:
Vit D deficiency
Vitamin D deficiency is caused by:
• decreased exposure to the sun, • an inability of the body to absorb vitamin D, • or a lack of vitamin D in the diet.
• Risk Factors for vit d deficiency:
• • • • • • • • Dark Skin Intestinal malabsorption Inflammatory Bowel disease Gastric bypass No sun exposure Osteomalacia/Fragility Fractures Renal Disease Old age
Symptoms of Vitamin D deficiency:
• Many people have no symptoms of vitamin D deficiency until complications are present. Symptoms may also be mild. • Symptoms of vitamin D deficiency include: Bone pain , muscle cramps, weakness and tingling, loss of height. difficulty standing up or climbing stairs
Complications of vitamin D deficiency:
Complications of vitamin D deficiency:
• • • • Rickets, Osteomalacia, and osteoporosis . tetany
• other possible complications include: hypertension, depression, cardiovascular disease, and an increased risk of cancer
a. diagnosis :
management of vit d deficiency:
often missed signs and symptoms develop slowly or are nonspecific.
normal values in adults :
1. A normal level :25OHD concentration > 30 ng/mL 2. Vitamin D insufficiency 25OHD concentration =20 to 30 ng/mL 3. Vitamin D deficiency 25OHD level < 20 ng/mL
Diagnosis may be suspected based on any of the following:
1.A history 2.Symptoms and signs of rickets, osteomalacia, or neonatal tetany 3.Blood test of 25(OH)D (D2+D3) levels the best way to diagnose deficiency 4. Characteristic bone changes seen on x‑ray 5.serum levels of Ca, alkaline phosphatase, PTH
1. summer day sun
treatment of vit D deficiency:
2. artificial UVB radiation 3. human Oral vit D
Oral vitamin D treatment is more difficult than treatment with UVB light
1. unexpectedly high doses of vitamin D may be needed to achieve adequate serum 25(OH)D levels 2. the amount of vitamin D needed varies with body weight, body fat, age, skin colour, season, and sunning habits. 3. unlike sun exposure, toxicity is possible with oral supplementation
available forms of vitamin D supplements are : • ergocalciferol (vitamin D2) • cholecalciferol (vitamin D3). Vit D3 is better than vit D2: 1. vitamin D3 is the naturally occurring form 2. ergocalciferol is not human, and its consumption results in metabolic by-products not normally found in humans 3. vit D2 is also two- to four-times less effective than vit D3
• dose of vit d therapy depends on: – age – body weight – skin colour – patients with malabsorbtion syndrome.
Vit d deficiency in the elderly:
1. The production of vitamin D from the skin decreases with age. reduced levels of 7-dehydrocholesterol, 2. Housebound elderly people often do not get adequate exposure to sunlight. 3. Decreased dietary intake, impaired intestinal absorption, and impaired hydroxylation in the liver and kidneys
Causes of vit d deficiency in the elderly:
Consequences of vit d deficiency in the elderly:
1. high bone turnover, bone loss, mineralization defects, and hip and other fractures. Less certain consequences include myopathy and falls. 2. osteomalacia: 3. osteoporosis: 4. Cancer 5. cardiovascular diseases:
1. high bone turnover, bone loss, mineralization defects, and hip and other fractures. Less certain consequences include myopathy and falls.
2. osteomalacia: Osteomalacia is the softening of the bones due to defective bone mineralization. • • • • • Signs and Symptoms: Bone weakness and pain Muscle weakness Easy fracturing Hypocalcaemia
• Biochemical findings The serum calcium is low Urinary calcium is low Serum phosphate is low Serum alkaline phosphatase is high • Radiological appearances include: Pseudo fractures, also called Looser’s zones. Protrusio acetabuli, a hip joint disorder • Treatment
• is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of proteins in bone is altered.
The effect mechanisms :
regulation of the cell cycle, stimulation of differentiation, impairment of growth stimuli, inhibition of angiogenesis and increased apoptosis of malignant cells. • The active vitamin D metabolite 1α,25dihydroxyvitamin D3 (1,25(OH)2D3, Calcitriol) is a major regulator of gene expression • • • • •
Common types of cancer that vit D can suppress:
• 1.Colon Cancer
• 2.Prostate Cancer
• 3.breast cancer
5. Cardiovascular disease.
• Vitamin D receptors have a broad tissue distribution that includes vascular smooth muscle, endothelium, and cardiomyocytes. • Vitamin D deficiency also alters hormone levels and immune function, which can increase the risk of diabetes, a major contributor to cardiovascular disease,
Cvs diseases that may be caused by low vit D levels:
• Atherosclerosis • Hypertension and Myocardial Hypertrophy and infarction • Congestive Heart Failure