A system for improving vitamin D nutrition in residential care.

OBJECTIVE: To assess the feasibility of administering an inexpensive preparation of vitamin D(3) 100 000 IU orally 3 monthly to aged-care residents. DESIGN: Prospective, controlled open-label implementation trial. SETTING: Residential aged care, November 2003 to May 2004 (primary study). PARTICIPANTS: 137 ambulant residents: 107 treated (mean age, 85 years; 79 were women), 30 untreated controls (mean age, 87 years; 22 were women). INTERVENTIONS: Lactose microencapsulated vitamin D(3) 100 000 IU orally at baseline, then 3 monthly (three or more doses); untreated subjects were observed contemporaneously. MAIN OUTCOME MEASURES: Serum levels of 25-hydroxyvitamin D [25(OH)D] at 6 months compared with baseline; acceptability of the program to residents and staff. RESULTS: At baseline, 95% of residents assessed (n = 137) had serum 25(OH)D levels below the desirable range of 60-160 nmol/L. At 6 months, all treated residents (n = 98) achieved desired levels, with the mean (+/- SD) 25(OH)D level increasing from 36.4 +/- 12.6 nmol/L (range, 12-75 nmol/L) at baseline to 124.0 +/- 27.9 nmol/L (range, 68-244 nmol/L). In no resident did 25(OH)D approach toxic levels. The mean serum 25(OH)D level remained low in the control group (n = 27): 42.8 +/- 18.3 nmol/L (range, 18-98 nmol/L). The difference between the mean 25(OH)D levels of treatment and control groups at 6 months was 81.2 nmol/L (95% CI, 69.7-92.0 nmol/L). The cost of the supplement was $4 per resident per annum. Substudies showed mean trough serum 25(OH)D levels in the desired range at 3 months (n = 31), but below the desired range at 6 months (n = 50). Subjects given 3-monthly doses for up to 2 years maintained serum 25(OH)D levels within the desired range, with no trend toward undesirable accumulation (n = 11). CONCLUSIONS: Vitamin D(3) 100 000 IU given orally 3 monthly is a practical, safe, effective and inexpensive way to meet the vitamin D(3) requirements of aged-care residents.

Number, incidence, and projections of distal forearm fractures admitted to hospital in Australia.

BACKGROUND: This study documents the number, incidence, and relative risk (RR) of distal forearm fractures requiring admission to hospital in Australia in 1997 and estimates of the projected numbers for 2021. METHODS: Distal forearm fracture numbers from 1993 to 1998 were obtained. The incidence and RR were calculated by gender and 5-year age groups for 1997. Projected numbers for 2021 were estimated using population projection data. RESULTS: In 1997, fracture numbers were 12357 for male patients and 19319 for female patients. The incidence was 152 per 100000 for male patients and 157 per 100000 for female patients. The highest incidence and RR was in the 10- to 14-year age group for male patients and in the 85 years and over age group for female patients. If fracture incidence remains constant (on the basis of predicted population changes in Australia), by 2021, it is estimated that fracture numbers for people 50 years of age and over will increase by 81%, compared with 11% for people under 50. In the older age group, the number for women will be 4.7 times higher than for men. CONCLUSION: This study quantifies the potential disproportionate increase in distal forearm fractures requiring admission in Australia, particularly for female patients, because of an aging population.