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
Autor para correspondencia
mmarazuela.hlpr@salud.madrid.org
Correspondencia: Dra. M. Marazuela. Hospital de la Princesa. Diego de León, 62. 28006 Madrid. España.
Correspondencia: Dra. M. Marazuela. Hospital de la Princesa. Diego de León, 62. 28006 Madrid. España.
Servicio de Endocrinología y Nutrición. Hospital de la Princesa. Universidad Autónoma. Madrid. España
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Fernández-Vázquez, E. Melián, N. González, F. Sánchez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Fernández-Vázquez" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Melián" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "González" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Sánchez" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1575092205710172?idApp=UINPBA00004N" "url" => "/15750922/0000005200000005/v1_201305082025/S1575092205710172/v1_201305082025/es/main.assets" ] "es" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Curso de endocrinología para posgraduados</span>" "titulo" => "Déficit de vitamina D en el adulto: clínica, diagnóstico y tratamiento" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "215" "paginaFinal" => "223" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Marazuela" "autores" => array:1 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Marazuela" "email" => array:1 [ 0 => "mmarazuela.hlpr@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Endocrinología y Nutrición. Hospital de la Princesa. Universidad Autónoma. Madrid. España" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: Dra. M. Marazuela. Hospital de la Princesa. Diego de León, 62. 28006 Madrid. España." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Vitamin D deficiency in adults: clinical features, diagnosis and treatment" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-01-31" "fechaAceptado" => "2005-02-07" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec134369" "palabras" => array:3 [ 0 => "Déficit vitamina D" 1 => "Osteomalacia" 2 => "Hiperparatiroidismo secundario" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec134370" "palabras" => array:3 [ 0 => "Vitamin D deficiency" 1 => "Osteomalacia" 2 => "Secondary hyperparathyroidism" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">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.</p><p class="elsevierStyleSimplePara elsevierViewall">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.</p><p class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">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.</p><p class="elsevierStyleSimplePara elsevierViewall">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.</p><p class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.M. Parfitt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1997" "editorial" => "Academic Press" "editorialLocalizacion" => "San Diego" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." 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| 2023 Diciembre | 151 | 75 | 226 |
| 2023 Noviembre | 231 | 99 | 330 |
| 2023 Octubre | 242 | 81 | 323 |
| 2023 Septiembre | 120 | 64 | 184 |
| 2023 Agosto | 120 | 57 | 177 |
| 2023 Julio | 162 | 69 | 231 |
| 2023 Junio | 155 | 64 | 219 |
| 2023 Mayo | 279 | 143 | 422 |
| 2023 Abril | 271 | 176 | 447 |
| 2023 Marzo | 257 | 119 | 376 |
| 2023 Febrero | 125 | 82 | 207 |
| 2023 Enero | 147 | 79 | 226 |
| 2022 Diciembre | 148 | 106 | 254 |
| 2022 Noviembre | 226 | 108 | 334 |
| 2022 Octubre | 204 | 72 | 276 |
| 2022 Septiembre | 201 | 148 | 349 |
| 2022 Agosto | 177 | 94 | 271 |
| 2022 Julio | 184 | 90 | 274 |
| 2022 Junio | 289 | 99 | 388 |
| 2022 Mayo | 251 | 113 | 364 |
| 2022 Abril | 277 | 125 | 402 |
| 2022 Marzo | 236 | 115 | 351 |
| 2022 Febrero | 206 | 79 | 285 |
| 2022 Enero | 204 | 115 | 319 |
| 2021 Diciembre | 137 | 127 | 264 |
| 2021 Noviembre | 168 | 120 | 288 |
| 2021 Octubre | 147 | 113 | 260 |
| 2021 Septiembre | 148 | 94 | 242 |
| 2021 Agosto | 166 | 78 | 244 |
| 2021 Julio | 169 | 46 | 215 |
| 2021 Junio | 210 | 80 | 290 |
| 2021 Mayo | 263 | 101 | 364 |
| 2021 Abril | 442 | 269 | 711 |
| 2021 Marzo | 281 | 1854 | 2135 |
| 2021 Febrero | 257 | 1536 | 1793 |
| 2021 Enero | 165 | 1045 | 1210 |
| 2020 Diciembre | 219 | 967 | 1186 |
| 2020 Noviembre | 185 | 861 | 1046 |
| 2020 Octubre | 174 | 646 | 820 |
| 2020 Septiembre | 152 | 772 | 924 |
| 2020 Agosto | 166 | 668 | 834 |
| 2020 Julio | 196 | 823 | 1019 |
| 2020 Junio | 257 | 755 | 1012 |
| 2020 Mayo | 263 | 712 | 975 |
| 2020 Abril | 282 | 533 | 815 |
| 2020 Marzo | 177 | 638 | 815 |
| 2020 Febrero | 276 | 896 | 1172 |
| 2020 Enero | 227 | 748 | 975 |
| 2019 Diciembre | 184 | 524 | 708 |
| 2019 Noviembre | 201 | 648 | 849 |
| 2019 Octubre | 199 | 1013 | 1212 |
| 2019 Septiembre | 146 | 1198 | 1344 |
| 2019 Agosto | 83 | 933 | 1016 |
| 2019 Julio | 167 | 1356 | 1523 |
| 2019 Junio | 174 | 1402 | 1576 |
| 2019 Mayo | 213 | 1674 | 1887 |
| 2019 Abril | 189 | 1795 | 1984 |
| 2019 Marzo | 205 | 1729 | 1934 |
| 2019 Febrero | 173 | 1280 | 1453 |
| 2019 Enero | 165 | 1081 | 1246 |
| 2018 Diciembre | 179 | 698 | 877 |
| 2018 Noviembre | 148 | 1024 | 1172 |
| 2018 Octubre | 168 | 286 | 454 |
| 2018 Septiembre | 170 | 1161 | 1331 |
| 2018 Agosto | 30 | 3386 | 3416 |
| 2018 Julio | 26 | 1997 | 2023 |
| 2018 Junio | 41 | 2266 | 2307 |
| 2018 Mayo | 46 | 2469 | 2515 |
| 2018 Abril | 68 | 2023 | 2091 |
| 2018 Marzo | 64 | 1973 | 2037 |
| 2018 Febrero | 38 | 1601 | 1639 |
| 2018 Enero | 56 | 1462 | 1518 |
| 2017 Diciembre | 37 | 1181 | 1218 |
| 2017 Noviembre | 72 | 1733 | 1805 |
| 2017 Octubre | 61 | 1513 | 1574 |
| 2017 Septiembre | 52 | 1166 | 1218 |
| 2017 Agosto | 57 | 1233 | 1290 |
| 2017 Julio | 126 | 1257 | 1383 |
| 2017 Junio | 252 | 1677 | 1929 |
| 2017 Mayo | 416 | 1740 | 2156 |
| 2017 Abril | 830 | 1458 | 2288 |
| 2017 Marzo | 1020 | 1775 | 2795 |
| 2017 Febrero | 1384 | 1490 | 2874 |
| 2017 Enero | 1495 | 1025 | 2520 |
| 2016 Diciembre | 1853 | 833 | 2686 |
| 2016 Noviembre | 2370 | 1321 | 3691 |
| 2016 Octubre | 2155 | 1163 | 3318 |
| 2016 Septiembre | 1125 | 1273 | 2398 |
| 2016 Agosto | 93 | 962 | 1055 |
| 2016 Julio | 2256 | 251 | 2507 |
| 2016 Junio | 4457 | 483 | 4940 |
| 2016 Mayo | 4654 | 463 | 5117 |
| 2016 Abril | 5120 | 422 | 5542 |
| 2016 Marzo | 4399 | 322 | 4721 |
| 2016 Febrero | 4255 | 254 | 4509 |
| 2016 Enero | 3885 | 186 | 4071 |
| 2015 Diciembre | 4379 | 179 | 4558 |
| 2015 Noviembre | 7234 | 247 | 7481 |
| 2015 Octubre | 7947 | 245 | 8192 |
| 2015 Septiembre | 6746 | 192 | 6938 |
| 2015 Agosto | 6203 | 123 | 6326 |
| 2015 Julio | 7221 | 116 | 7337 |
| 2015 Junio | 6749 | 124 | 6873 |
| 2015 Mayo | 7532 | 131 | 7663 |
| 2015 Abril | 7100 | 128 | 7228 |
| 2015 Marzo | 8486 | 46 | 8532 |
| 2015 Febrero | 6595 | 24 | 6619 |
| 2015 Enero | 4199 | 21 | 4220 |
| 2014 Diciembre | 5773 | 26 | 5799 |
| 2014 Noviembre | 6947 | 24 | 6971 |
| 2014 Octubre | 6635 | 23 | 6658 |
| 2014 Septiembre | 5779 | 29 | 5808 |
| 2014 Agosto | 5108 | 29 | 5137 |
| 2014 Julio | 6871 | 34 | 6905 |
| 2014 Junio | 6151 | 36 | 6187 |
| 2014 Mayo | 5767 | 39 | 5806 |
| 2014 Abril | 4821 | 21 | 4842 |
| 2014 Marzo | 5207 | 29 | 5236 |
| 2014 Febrero | 3824 | 25 | 3849 |
| 2014 Enero | 3040 | 24 | 3064 |
| 2013 Diciembre | 1952 | 20 | 1972 |
| 2013 Noviembre | 2043 | 17 | 2060 |
| 2013 Octubre | 3026 | 22 | 3048 |
| 2013 Septiembre | 1467 | 32 | 1499 |
| 2013 Agosto | 1124 | 31 | 1155 |
| 2013 Julio | 718 | 21 | 739 |
| 2005 Abril | 10595 | 0 | 10595 |
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