?Repost PO4 Binder Pictoral Handout

[Guest guest]

Hi, I thought I kept a copy of the 1 page pictoral teaching tool called:

WHICH BINDER DO YOU TAKE?

It showed pictures of phoslo,tums;Ca++ acetate

Fosrenol;renagel and renvela... Looking for it now for a bulleting Board

and can NOT find.

Please repost if you saved it THANKS mary

________________________________

From: rd-usa [mailto:rd-usa ] On Behalf

Of Digna Cassens

Sent: Wednesday, June 08, 2011 10:38 AM

To: rd-usa

Subject: RE: Re: Endocrine Society Issues Practice Guideline on

Vitamin D

Catia,

I have a home health client with advanced osteoporosis - has lost 8

inches

in height in the last few years and has suffered atleast 3 compression

fractures of spine. She has difficulty eating enough calories and

continues

to lose weight - a total of 15 lbs since first fx 2 years ago. She is

prescribed amonth her multiple meds Vitamin D 3500 IU She will not take

it

bc per client her extensive research and sources indicate that Vit D in

large doses is toxic. She has argued this with her MD, with me, the

pharmacist. She is educated (mental health field) and has access to

current

literature. I have not been able to convince her that her deterioration

will

continue unless she takes the supplements prescribed and she will

continue

to lose bone. This in turn increases her pain, gastric distress and risk

of

fractures.

I need additional sources that contradict her conviction and that are

not as

" controversial " or " iffy " as what she is reading. Her torso has folded

forward and I have grave concern for her at this time. She is scared to

death and I don't blame her.

From: rd-usa <mailto:rd-usa%40yahoogroups.com>

[mailto:rd-usa <mailto:rd-usa%40yahoogroups.com> ] On

Behalf Of

catianutr

Sent: Wednesday, June 08, 2011 2:51 AM

To: rd-usa <mailto:rd-usa%40yahoogroups.com>

Subject: Re: Endocrine Society Issues Practice Guideline on

Vitamin

D

The efficacy can be the same if the patient doesn't have renal

impairment.

It is needed a higher dose of vitamin D2 though to have the same effect

as

vitamin D3 since it has transformed in the kidney. Since renal function

declines with age imo elderly patients should receive vitamin D3.

Catia Borges

>

> > Medscape Medical News from:

> >

> > ENDO 2011: The Endocrine Society 93rd Annual Meeting

> >

> > This coverage is not sanctioned by, nor a part of, The Endocrine

Society.

> >

> > From Medscape Medical News

> >

> > Endocrine Society Issues Practice Guideline on Vitamin D

> >

> >

> >

> > Authors and Disclosures

> >

> > June 7, 2011 (Boston, Massachusetts) - The Endocrine Society today

> > unveiled a Clinical Practice Guideline on the evaluation, treatment,

and

> > prevention of vitamin D deficiency, with an emphasis on the care of

> > patients who are at risk for vitamin D deficiency.

> >

> > F. Holick, MD, PhD, from Boston University Medical Center,

> > Massachusetts, who chaired the 8-member task force that developed

the

> > guideline, summarized the recommendations at a press briefing here

at

> > ENDO 2011: The Endocrine Society 93rd Annual Meeting.

> >

> > The guideline also was published online June 6 in the Journal of

> > Clinical Endocrinology and Metabolism.

> >

> > " Based on all the evidence, at a minimum, we recommend vitamin D

levels

> > of 30 ng/mL, and because of the vagaries of some of the assays, to

> > guarantee sufficiency, we recommend between 40 and 60 ng/mL for both

> > children and adults, " Dr. Holick said.

> >

> > The society's clinical practice guideline was developed by " experts

in

> > the field who carefully reviewed the current literature and features

the

> > latest and most comprehensive recommendations available on the

> > prevention and treatment of vitamin D deficiency, " he said.

> >

> > The guideline recommends that clinicians screen for vitamin D

deficiency

> > in people at risk for deficiency, including obese individuals,

blacks,

> > pregnant and lactating women, and patients with malabsorption

syndromes.

> >

> > " We do not recommend population screening for vitamin D deficiency

in

> > individuals who are not at risk, " Dr. Holick said, but added that

> > " vitamin D deficiency is very common in all age groups - essentially

> > everyone is at risk. "

> >

> > Screening should be performed using a " reliable assay " for

> > 25-hydroxy-vitamin D (25[OH]D), not 1,25-dihydroxy-vitamin D

> > (1,25[OH]2D), " which tells you nothing about vitamin D status, " Dr.

> > Holick said. Vitamin D deficiency is defined as 25[OH]D levels below

20

> > ng/mL.

> >

> > " Considering that vitamin D deficiency is very common in all age

groups

> > and that few foods contain vitamin D, the Task Force recommended

> > supplementation at suggested daily intake and tolerable upper limit

> > levels, depending on age and clinical circumstances, " the guideline

states.

> >

> > For bone health, infants and children up to 1 year of age require at

> > least 400 IU/day vitamin D, and children 1 year and older need at

least

> > 600 IU/day, the guideline states. However, at least 1000 IU/day of

> > vitamin D may be needed to raise the blood level of 25(OH)D

consistently

> > above 30 ng/mL, it notes.

> >

> > Adults aged 19 to 70 years require at least 600 IU/day of vitamin D

to

> > maximize bone health and muscle function. However, getting 25(OH)D

> > levels consistently above 30 ng/mL may require at least 1500 to 2000

> > IU/day of vitamin D.

> >

> > Adults 70 years and older require at least 800 IU/day of vitamin D

for

> > bone health and fall prevention; at least 1500 to 2000 IU/day of

> > supplemental vitamin D may be needed to keep 25(OH)D levels above 30

ng/mL.

> >

> > Pregnant and lactating women need a minimum of 600 IU/day of vitamin

D;

> > 1500 IU/day may be needed to maintain blood levels of 25(OH)D higher

> > than 30 ng/mL.

> >

> > " Obese children and adults and children and adults on anticonvulsant

> > medications, glucocorticoids, antifungals such as ketoconazole, and

> > medications for AIDS need at least 2 to 3 times more vitamin D for

their

> > age group to satisfy their body's vitamin D requirement, " Dr. Holick

> > reported.

> >

> > Tolerable upper limits of vitamin D, which " should not be exceeded

> > without medical supervision, " include the following:

> >

> > 1000 IU/day for infants aged up to 6 months,

> > 1500 IU/day for infants aged 6 months to 1 year old,

> > 2500 IU/day for children aged 1 to 3 years,

> > 3000 IU/day for children aged 4 to 8 years, and

> > 4000 IU/day for everyone older than 8 years.

> >

> > However, the guideline states that for individuals who are vitamin D

> > deficient, higher levels of vitamin D (2000 IU/day for children up

to

> > age 1 year; 4000 IU/day for children aged 1 - 18 years, and up to

10,000

> > IU/day for adults aged 19 years and older) " may be necessary to

correct,

> > treat, and prevent vitamin D deficiency, " Dr. Holick said.

> >

> > " Both vitamin D2 and vitamin D3 is equally fine in treating and

> > preventing vitamin D deficiency, " he added.

> >

> > For all age groups, it is unknown whether these age-specific levels

of

> > vitamin D are " enough to provide all of the potential nonskeletal

health

> > benefits associated with vitamin D, " Dr. Holick noted.

> >

> > He also said that at present, " there is not sufficient evidence to

> > recommend prescribing vitamin D to attain the noncalcemic benefit

for

> > cardiovascular protection. " However, association studies have

suggested

> > that increasing vitamin D levels may help protect against some

cancers,

> > including colorectal cancer, as well as infectious disease,

diabetes,

> > and high blood pressure.

> >

> > The upper limits and the dietary intake levels in the Endocrine

Society

> > guideline for the most part mirror those of the 2010 Institute of

> > Medicine consensus report, " Dietary Reference Intakes for Calcium

and

> > Vitamin D, " although the Endocrine Society gives more explicit

> > recommendations for care.

> >

> > Dr. Holick commented that the Institute of Medicine report used a

> > " population model, not a medical model, and was not intended to

direct

> > physicians on care of patients. It was up to professional

associations

> > to establish guidelines of care, which is why [the Endocrine

Society]

> > became involved. "

> >

> > Stencel, media relations officer of the National Academy

of

> > Sciences, said the committee that issued the 2010 report is no

longer an

> > entity and would not have a comment on the Endocrine Society

guideline.

> >

> > " At some point down the road, there is the potential that [institute

of

> > Medicine] could convene a new committee to reexamine all the new

> > information and look at changing the [dietary reference intakes],

but at

> > this point we wouldn't do any immediate re-look at this, " she said.

> >

> > Development of the clinical practice guideline was supported solely

by

> > the Endocrine Society. Dr. Holick has disclosed financial or

> > business/organizational interests with Merck, Novartis,

Nichols-Quest

> > Diagnostics, Bayer, Aventis, Warner Chilcott, Amgen, the UV

Foundation,

> > DMI, and the Mushroom Council. A complete list of disclosures for

the

> > task force are listed with the original article.

> >

> > ENDO 2011: The Endocrine Society 93rd Annual Meeting. Presented June

6,

> > 2011.

> >

> > J Clin Endocrinol Metabol. Published online June 6, 2011. Abstract

> >

> > http://www.medscape.com/viewarticle/744128?sssdmh=dm1.693427

<http://www.medscape.com/viewarticle/744128?sssdmh=dm1.693427 & src=nldne>

& src=nldne

> >

> >

> > ------------------------------------

> >

> >