Sulo A. Rajala

Annual Injection of Vitamin D and Fractures of Aged Bones

SummaryIn order to investigate the effect of a supplementation of vitamin D in the prophylaxis of fractures of the bones of aged people, an annual intramuscular injection of ergocalciferol (150,000–300,000 IU) was given to two series of aged subjects: first to 199 (45 male) of 479 subjects (110 male) aged more than 85 years who were living in their own home, and second to 142 (29 male) of 320 (58 male) subjects aged 75–84 and living in a home for aged people. This prospective series was divided into treatment groups according to month of birth. These injections were given annually from September to December in the years 1985–1989, two to five times to each participant. The fracture rates, laboratory values, vitamin D levels, possible side effects, and mortality were followed until October 1990. A total of 56 fractures occurred in the 341 vitamin D recipients (16.4%) and 100 in 458 controls (21.8%) (P=0.034). The fracture rate was about the same in both outpatient and municipal home series. Fractures of the upper limb were fewer in the vitamin D recipients, 10/341=2.9% (P=0.025), than in the controls, 28/458=6.1%, during the follow-up. A similar result was obtained in fractures of ribs, 3/341=0.9% and 12/458=2.6%, respectively. Fractures of the lower limbs occurred almost as frequently, 31/341=9.1%, among the vitamin D recipients as among the controls, 49/458=10.7%. The fracture rate was higher in females (22.2%) than in males (9.5%). The fractures were fewer in the vitamin D recipients only in females. No significant differences were found in total mortality, or due to any group of diseases, between the two treatment groups. No deleterious effects of the vitamin D injections were seen. The authors recommend the supplementation of vitamin D in aged people, at least in northernmost latitudes (e.g., as an annual intramuscular injection).

Blood pressure in the very old

Seven hundred and twenty-four people (541 female, 183 male), aged 84-88 years and living at home in the city of Tampere, Finland, accepted our invitation to be examined in the outpatient department of the local geriatric hospital. These subjects were re-examined annually, and their fate was followed for 3 years. The blood pressure level was a prognostic sign for mortality during the first year after its measurement. The lowest mortality rate was found among those subjects with systolic blood pressure between 140 and 169 mmHg and diastolic blood pressure between 70 and 99 mmHg. Blood pressures outside of these ranges were associated with increased mortality rates, particularly cardiac and coronary mortality. The mortality rate was especially high among those whose systolic blood pressure had decreased to low levels in the year before, but was lower in those whose systolic blood pressure had decreased from high to middle levels (140-169 mmHg) than in those with consistently high systolic blood pressure. Eventual institutionalization was more common in those with low systolic blood pressure.

Mortality in Relation to Urinary Characteristics in the Very Aged

The value of urinary characteristics observed in a health survey of people aged 85 years or more was studied in a 5-year follow-up. Of the 561 aged people participating in the initial survey, 167 (30%) were alive after 5 years. Hematuria, pyuria, and albuminuria were associated with high mortality; urinary acidity was associated with low mortality. Positive bacterial staining, glucosuria, and specific gravity of urine were not related to the survival rate. Contrary to earlier observations, bacteriuria found in the urinary bacterial culture did not have any prognostic significance in respect of survival during the follow-up period. Judging from the results, the medical treatment of asymptomatic bacteriuria, with the aim of reducing the mortality of the very aged, appears to be unwarranted.

Serum vitamin D level after an annual intramuscular injection of ergocalciferol

SummaryAn annual intramuscular injection of ergocalciferol (150 000 IU) normalized low serum (25(OH)D concentrations in elderly people for 1 year. The treatment had a slight effect on serum 24,25(OH)2D levels but no effect on 1,25(OH)2D levels.

Electrocardiogram, clinical findings and chest X-ray in persons aged 85 years or older

Persons aged 85 years or more (n = 674) living in Tampere, Finland, were surveyed in 1977 and 1978. Five hundred fifty-nine persons (83%) were examined. Electrocardiographic findings, classified according to the Minnesota code, were compared with reported cardiac symptoms, clinical congestive heart failure, clinical coronary heart disease and relative cardiac volume on chest radiograph. Electrocardiographic items had a poor association with cardiac symptoms. ST-segment depression, T-wave inversion, ventricular premature complexes and atrial fibrillation were related statistically highly significantly to clinical congestive heart failure, as were ST-segment depression and T-wave inversion to clinical coronary heart disease. High left R waves, ventricular premature complexes and atrial fibrillation showed a significant association with cardiac enlargement (over 500 ml/m2) and pulmonary congestion in chest radiographs.