Riesgo del uso de dosis altas de vitamina D en ancianos. Una revisión a propósito de la pandemia por COVID-19

En los últimos años la vitamina D ha sido considerada una panacea y cura de varias enfermedades, aunque el número de estudios de intervención bien realizados es escaso e incluso contradictorio. En el momento actual de la pandemia por COVID-19, se han levantado algunas voces para recomendar las dosis altas de vitamina D para el control y el tratamiento de las infecciones. El objetivo de esta revisión es proporcionar información sobre los riesgos potenciales y los eventos adversos de las dosis altas de vitamina D. A la luz de la evidencia actual, es esencial mantener los niveles de vitamina D dentro de los rangos normales. Generalmente se acepta que los valores entre 30 y 40 ng/mL son suficientes para la mayoría de la población adulta mayor, en quienes la afección por COVID-19 es más severa.

1. Holick MF. The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord. 2017;18(2):153-65. doi: 10.1007/s11154-017-9424-1
2. Chiodini I, Bolland MJ. Calcium supplementation in osteoporosis: useful or harmful? 2018;178(4):D13-D25. doi: 10.1530/EJE-18-0113
3. Grant WB, Lahore H, Mc Donnell SL, Baggerly C, French C, Aliano J, et al. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients. 2020;12(4):988. doi: 10.3390/nu12040988
4. Garland CF, Kim JJ, Mohr SB, Burgette S, Gorham E, Grant W, et al. Metaanalysis of All-Cause Mortality According to Serum 25-Hydroxyvitamin D. Am J Public Health. 2014;104(8):e43-50. doi: 10.2105/AJPH.2014.302034
5. Melamed ML, Michos ED, Post W, Astor B. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Int Med. 2008;168(15):1629-37. doi: 10.1001/archinte.168.15.1629
6. Jia X, Aucott LS, McNeill G. Nutritional status and subsequent all-cause mortality in men and women aged 75 years or over living in the community. Br J Nutr. 2007;98(3):593-9. doi: 10.1017/S0007114507725163
7. Sempos CT, Durazo-Arvizu RA, Dawson-Hughes B, Yetley E, Looker A, Schleicher R, et al. Is there a Reverse J-shaped Association between 25-Hydroxyvitamin D and All-Cause Mortality. Results from the US Nationally Representative NHANES. J Clin Endocrinol Metabol. 2013:98(7):3001-9. doi: 10.1210/jc.2013-1333
8. Dror Y, Giveon SM, Hoshen M, Feldhamer I, Balicer R, Feldman B, et al. Vitamin d levels for preventing acute coronary syndrome and mortality: evidence of a nonlinear association. J Clin Endocrinol Metabol. 2013;98(5):2160-7. doi: 10.1210/jc.2013-1185
9. Durup D, Jorgensen HL, Christensen J, Schwarz P, Heegaard A, Lind B. A reverse J-shaped association of all-cause mortality with serum 25-hydroxyvitamin D in general practice: the CopD study. J Clin Endocrinol Metabol. 2012;97(8):2644-52. doi: 10.1210/jc.2012-1176.
10. Amrein K, Quraishi SA, Litonjua AA, Gibbons F, Pieber T, Camargo C, et al. Evidence for a U-shaped relationship between prehospital vitamin D status and mortality: a cohort study. J Clin Endocrinol Metab. 2014;99(4):1461- 9. doi: 10.1210/jc.2013-3481
11. Mellenthin L, Wallaschofski H, Grotevendt A, Völzke H, Nauck M, Hannemann A. Association between serum vitamin D concentrations and inflammatory markers in the general adult population. Metabolism. 2014;63(8):1056-62. doi: 10.1016/j.metabol.2014.05.002
12. Tonelli M, Sacks F, Pfeffer M, Gao Z, Curhan G, et al. Relation between serum phosphate level and cardiovascular event rate in people with coronary disease. Circulation. 2005;112(17):2627-33. doi: 10.1161/CIRCULATIONAHA.105.553198
13. Litonjua A. Childhood asthma may be a consequence of vitamin D deficiency. Curr Opin Allergy Clin Immunol. 2009;9(3):202-7. doi: 10.1097/ ACI.0b013e32832b36cd
14. Adams JS, Hewison M. Unexpected actions of vitamin D: new perspectives on the regulation of innate and adaptive immunity. Nat Clin Pract Endocrinol Metab. 2008;4(2):80-90. doi: 10.1038/ncpendmet0716
15. Chishimba L, Thickett D, Stockley R, Wood A. The vitamin D axis in the lung: a key role for vitamin D-binding protein. Thorax. 2010;65(5):456- 62. doi: 10.1136/thx.2009.128793
16. Hansen S, Maslova E, Strom M, Linneberg A, Halldorsson T, Granström, et al. The long-term programming effect of maternal 25hydroxyvitamin D in pregnancy on allergic airway disease and lung function offspring after 20 to 25 years of follow-up. J Allergy Clin Immunol. 2015;136(1):169-76. doi: 10.1016/j.jaci.2014.12.1924
17. van Oeffelen A, Bekkers M, Smit H, Kerkhof M, Koppelman G, HavemanNies A, et al. Serum micronutrient concentrations and childhood asthma: the PIAMA birth cohort study. Pediatr Allergy Immunol. 2011;22(8):784- 93. doi: 10.1111/j.1399-3038.2011.01190.x
18. Rothers J, Wright al, Stern DA, Halonen M, Camargo C. Cord blood 25-hydroxyvitamin D levels are associated with aeroallergen sensitization in children from Tucson, Arizona. J Allergy Clin Immunol. 2011;128(5):1093- 9. doi: 10.1016/j.jaci.2011.07.015
19. Gale C, Robinson SM, Harvey NC, Jiang J, Martyn C, Godfrey K, et al. Maternal vitamin D status during pregnancy and child outcomes. Eur J Clin Nutr. 2008;62(1):68-77. doi: 10.1038/sj.ejcn.1602680
20. Janssen HC, Samson MM, Verhaar HJ. Vitamin D deficiency, muscle function, and falls in elderly people. Am J Clin Nutr. 2002;75(4):611-5. doi: 10.1093/ajcn/75.4.611
21. Bischoff-Ferrari HA, Borchers M, Gudat F, Dürmüller U, Stähelin H, Dick W. Vitamin D receptor expression in human muscle tissue decreases with age. J Bone Miner Res. 2004;19(2):265-9. doi: 10.1359/jbmr.2004.19.2.265
22. Dawson H. Vitamin D and muscle function. J Steroid Biochem Mol Biol. 2017;173:313-6. doi: 10.1016/j.jsbmb.2017.03.018
23. Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck A, Staehelin H, Orav E, et al. Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Internal Med. 2009;169(6):551-61. doi: 10.1001/archinternmed.2008.600
24. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA. 2005;293(18):2257- 64. doi: 10.1001/jama.293.18.2257
25. Bischoff-Ferrari HA. Vitamin D and fracture prevention. Rheum Dis Clin North Am. 2012;38(1):107-13. doi: 10.1016/j.rdc.2012.03.010
26. Boonen S, Bischoff-Ferrari HA, Cooper C, Lips P, Ljunggren O, Meunier P, et al. Addressing the musculoskeletal components of fracture risk with calcium and vitamin D: a review of the evidence. Calcif Tissue Int. 2006;78(5):257-70. doi: 10.1007/s00223-005-0009-8
27. Anders KM, Stuart AL, Williamson EJ, Simpson J, Kotowicz M, Young D, et al. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA. 2010;303(18):1815-22. doi: 10.1001/jama.2010.594
28. Bischoff-Ferrari HA, Dawson-Hughes B, Orav EJ, Staehelin HB, Meyer O, Theiler R, et al. Monthly High-Dose Vitamin D Treatment for the Prevention of Functional Decline: A Randomized Clinical Trial. JAMA Intern Med. 2016;176(2):175-83. doi: 10.1001/jamainternmed.2015.7148
29. Vásquez D, Cano C, Gómez A, González M, Guzmán R, Martínez J, et al. Vitamina D. Consenso colombiano de expertos. Medicina. 2017;39(2):140- 57.
30. Yomayusa-González N, Low-Padilla E, Oliveros-Velásquez JD, MendivelsoDuarte F, Gómez-Gómez O, Castilla-Gutiérrez A, et al. Recomendaciones para el uso racional de la prueba 25-hidroxi vitamina D Policy Brief. Rev Colomb Nefrol. 2019;6(2):179-92.

accidentes por caídas
coronavirus
enfermedades cardiovasculares
fracturas óseas
Vitamina D