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Endocrinol Nutr 2005;52:215-23 - DOI: 10.1016/S1575-0922(05)71018-4
Curso de endocrinología para posgraduados
Déficit de vitamina D en el adulto: clínica, diagnóstico y tratamiento
Vitamin D deficiency in adults: clinical features, diagnosis and treatment
M. Marazuela??,
Servicio de Endocrinología y Nutrición. Hospital de la Princesa. Universidad Autónoma. Madrid. España
Recibido 31 enero 2005, Aceptado 07 febrero 2005
Resumen

Para mantener un esqueleto sano y mineralizado es de importancia crítica tener una fuente adecuada de vitamina D, que puede conseguirse mediante la exposición solar o la dieta. Estudios recientes han observado un aumento de la prevalencia del déficit de vitamina D que se ha extendido a distintos grupos de edad y diferentes regiones, y ha alcanzado proporciones epidémicas. Se han identificado distintos factores de riesgo para su desarrollo, entre los que destaca la exposición solar inadecuada. Se ha demostrado, recientemente, que la ingesta de calcio es importante en el desarrollo del déficit de vitamina D, ya que puede aumentar el metabolismo de la vitamina D y agravar el cuadro.

La vitamina D tiene un papel bien conocido en el mantenimiento de la homeostasis del calcio y la salud ósea. Su déficit provoca hiperparatiroidismo secundario, recambio óseo acelerado, pérdida de hueso y/o alteraciones de la mineralización que conducen a un cuadro de osteoporosis o, bien si se trata de un déficit de larga duración y gravedad, a un cuadro de osteomalacia. Asimismo, estudios recientes han demostrado la importancia de la vitamina D en la función neuromuscular, y su déficit se ha relacionado con alteraciones funcionales y riesgo de caídas en ancianos. También se ha relacionado con la vitamina D la inhibición de la proliferación celular y la inmunomodulación y su deficit crónico se ha asociado con determinados tumores.

Es complejo establecer criterios estrictos de déficit de vitamina D, ya que no existe un claro consenso sobre los valores normales del parámetro que se utiliza para valoración de los valores de vitamina D: la 25-hidroxivitamina D. Así, se propugna no utilizar el límite por debajo del que aparece osteomalacia clínica como punto de referencia, sino definir como el valor normal por debajo del que se empiezan a producir alteraciones en el metabolismo óseo. La prevención del déficit es posible mediante la exposición a luz ultravioleta, la fortificación de los alimentos y la utilización de suplementos. Los suplementos de vitamina D producen un descenso de concentraciones de la parathormona, disminuyen el remodelamiento óseo, aumentan la densidad mineral ósea y son capaces de disminuir el riesgo de fracturas.

Resumen

An adequate supply of vitamin D, either from exposure to sunlight or from the diet, is essential to develop and maintain a healthy mineralized skeleton. Several recent studies have reported that the prevalence of vitamin D deficiency is increasing and has spread across distinct age groups and global regions to reach epidemic proportions. Several risk factors for this deficiency, mainly inadequate sunlight exposure, have been identified. An important recent observation is that low dietary calcium intake may increase turnover of vitamin D metabolites, thereby aggravating vitamin D deficiency.

Vitamin D plays a well-known role in calcium homeostasis and maintenance of bone health. Vitamin D deficiency causes secondary hyperparathyroidism, high bone turnover, bone loss and mineralization defects, which can lead to osteoporosis and, if the deficiency is severe and prolonged, cause osteomalacia. In addition, recent research has characterized the importance of vitamin D in neuromuscular function and how vitamin D deficiency may relate to functional alterations and the risk of falls in the elderly. Studies of the role of vitamin D in the inhibition of cell proliferation and immunomodulation have associated chronic vitamin D deficiency with various malignancies.

Definition of strict diagnostic criteria for vitamin D deficiency is hampered by the lack of a clear consensus on normal levels of the parameter used to evaluate vitamin D levels: 25-hidroxyvitamin D. Instead of taking the extreme limit of clinical osteomalacia as a reference point, it has been proposed that the normal value below which alterations in bone metabolism begin to appear should be used. Prevention is feasible through exposure to UV light, food fortification and supplements. Vitamin D supplementation decreases serum parathyroid hormone concentrations and bone turnover, increases bone mineral density and reduces hip fractures.

Palabras clave
Déficit vitamina D, Osteomalacia, Hiperparatiroidismo secundario
Key words
Vitamin D deficiency, Osteomalacia, Secondary hyperparathyroidism
El Texto completo solo está disponible en PDF
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Correspondencia: Dra. M. Marazuela. Hospital de la Princesa. Diego de León, 62. 28006 Madrid. España. (M. Marazuela mmarazuela.hlpr@salud.madrid.org)
Copyright © 2005. Sociedad Española de Endocrinología y Nutrición