RISK OF HYPERCALCEMIA IN ELDERLY PATIENTS WITH HYPERVITAMINOSIS D AND INTOXICATION.

Area of Science:

• Geriatric Medicine
• Endocrinology
• Nutritional Science

Background:

• Very high levels of 25-hydroxy-vitamin D (25(OH)D) are increasingly observed.
• The association between extremely high 25(OH)D and hypercalcemia risk in the elderly is not well-defined.

Purpose of the Study:

• To investigate the incidence of hypercalcemia in a geriatric population receiving very high doses of 25(OH)D.
• To identify risk factors associated with hypercalcemia in this demographic.

Main Methods:

• Retrospective, cross-sectional, two-center study.
• Inclusion criteria: elderly patients with 25(OH)D levels >88 ng/mL between January 2014 and December 2019.
• Subgroup analyses based on calcium, vitamin D, intact parathormone (iPTH), phosphorus, and alkaline phosphatase (ALP) levels.

Main Results:

• Screened 81,101 elderly patients; 458 (0.6%) had 25(OH)D >88 ng/mL. Of these, 217 with complete data were analyzed.
• Median 25(OH)D level was 103.7 ng/mL (range: 88.2-275.9 ng/mL).
• 86.6% of patients with very high 25(OH)D levels were normocalcemic. Hypercalcemic patients showed significantly higher PTH suppression rates (p=0.005) but no differences in 25(OH)D, iPTH, phosphorus, ALP, or age compared to normocalcemic patients.

Conclusions:

• Very high 25(OH)D levels in the elderly are predominantly associated with normocalcemia.
• Life-threatening hypercalcemia can occur, emphasizing the need for individualized treatment and monitoring.
• Adherence to clinical guidelines is crucial for managing vitamin D therapy in older adults.