Vitamin D deficiency as adverse drug reaction A c

Authors: A C B van OrtenLuiten A Janse R A M DhonuksheRutten R F Witkamp

Publish Date: 2016/02/12

Volume: 72, Issue: 5, Pages: 605-614

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Abstract

Adverse drug reactions as well as vitamin D deficiency are issues of public health concern in older people However relatively little is known about the impact of drug use on vitamin D status Our primary aim is to explore associations between drug use and vitamin D status in older people Furthermore prevalences of drug use and vitamin D deficiency are estimatedIn a population of 873 communitydwelling Dutch geriatric outpatients we explored the crosssectional relationships of polypharmacy ≥5 medications concomitantly used severe polypharmacy ≥10 medications and use of twentyone specific drug groups with serum 25hydroxyvitamin D 25OHD by analysis of covarianceOverall prevalence of polypharmacy was 65  of severe polypharmacy 22  Depending on the cutoff value prevalence of vitamin D deficiency was 49  50 nmol/l or 77  75 nmol/l Of the patients using a vitamin D supplement 17  50 nmol/l or 49  75 nmol/l were still deficient In nonusers of supplemental vitamin D after adjustment for age and gender negative associations were found for severe polypharmacy metformin sulphonamides and urea derivatives SUDs vitamin K antagonists cardiac glycosides loop diuretics potassiumsparing diuretics ACE inhibitors and serotonin reuptake inhibitors for nonselective monoamine reuptake inhibitors NSMRIs the association was positive The most extreme impacts of drug use on adjusted mean 25OHD were −19 nmol/l for SUDs and +18 nmol/l for NSMRIsAdverse drug reactions ADRs substantially contribute to global disease burden Median prevalence of ADRrelated hospital admissions in European countries is estimated 35  prevalence of ADRs amongst inpatients 101  1 These figures increase significantly with increase in age 2The high prevalence of vitamin D deficiency in older people is also an issue of global public health concern 3 Apart from a negative impact on calcium metabolism and bone health vitamin D deficiency might also lead to nonskeletal diseases and an increased inflammatory status 4 5 An important determinant of deficiency of this micronutrient is a reduced synthesis of precursors in the skin by increase in age less exposure to sunlight or pigmented skin Furthermore insufficient dietary intake impaired absorption liver or kidney dysfunction obesity and inflammation may be of influence 6 7 8 9 10 However about the role of medication little is known Observational and experimental research on this subject is scarce 11 Also during drug development and in postmarketing studies drug effects on nutritional status are not specifically addressed 12 This is remarkable as drug use as well as an impaired nutritional status are related to frailty 13 14 15 and predict disability hospitalisations and death 16Challenged by the lack of knowledge of this type of adverse drug reaction we formulated the following study objectives to investigate crosssectional relationships of polypharmacy number of drugs used and use of 21 individual drug groups with serum 25hydroxyvitamin D 25OHD secondary aims were to determine prevalences of drug use and vitamin D deficiency For statistical analyses we used data from a population of communitydwelling geriatric outpatients of a Dutch nonacademic regional hospital

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