Effect van vitamine D suppletie op de 25-OH vitamine D spiegels bij patienten met ernstige vitamine D deficientie, Presentatie van dr. E.J. ter Borg op 18 april 2012 voor de Stichting IWO.
Este documento es una factura emitida por Industrias Latinas, SA a la empresa Marinera de Asturias. La factura detalla la venta de 900 unidades de Articulo K a 3000€ cada una y 600 unidades de Articulo L a 1200€ cada una, por un importe bruto total de 2.700.000€. Aplicando un descuento del 7% deja un importe neto de 3.180.600€ más gastos de transporte, embalaje y seguro por un total de 3.140.600€ con un IVA del 18% de 565.308€, lo que da un
This document discusses Jean Baudrillard's theories on simulation and the lack of meaning in a hyper-real world. It presents several quotes from Baudrillard on topics like the proliferation of information without meaning, the nonexistence of truth, and the evacuation of qualities like depth and authenticity in postmodern culture. The document provides context for Baudrillard's sometimes provocative views and examines what his work means for design and visual rhetoric.
1. Jean Baudrillard was a sociologist and philosopher who was interested in how media and technology influenced human communication, meaning-making, and experience in modern society.
2. Though often considered a postmodernist, Baudrillard saw himself more as studying a media-saturated world. He was concerned with how "symbolic exchange" or meaningful collective experiences were being replaced by superficial interactions with signs and simulations.
3. Baudrillard argued that contemporary society has replaced authentic experiences with artificial simulations through mass media like television, to the point that reality itself has been replaced by artificial "hyperreality" divorced from genuine human experiences.
Jean Baudrillard was a French sociologist and philosopher known for his theories on simulacra and hyperreality. He argued that reality is indistinguishable from simulations of reality in contemporary society due to advancements in media and technology. In a hyperreal system, signs and symbols circulate without reference to an original and it is impossible to distinguish the real from artificial simulations. Baudrillard used examples like Disneyland and photography to show how the proliferation of images and signs has blurred the lines between what is real and what is a copy, to the point that the simulation becomes more "real" than material reality. He believed contemporary society has entered a state of hyperreality where reality is indistinguishable
This document provides biographical information about French philosopher Jean Baudrillard and summaries of some of his major works. It discusses his educational and professional background, bibliographies of his writings and works about him, and short precis of 5 key works covering topics like simulations, utopias, and terrorism.
Este documento es una factura emitida por Industrias Latinas, SA a la empresa Marinera de Asturias. La factura detalla la venta de 900 unidades de Articulo K a 3000€ cada una y 600 unidades de Articulo L a 1200€ cada una, por un importe bruto total de 2.700.000€. Aplicando un descuento del 7% deja un importe neto de 3.180.600€ más gastos de transporte, embalaje y seguro por un total de 3.140.600€ con un IVA del 18% de 565.308€, lo que da un
This document discusses Jean Baudrillard's theories on simulation and the lack of meaning in a hyper-real world. It presents several quotes from Baudrillard on topics like the proliferation of information without meaning, the nonexistence of truth, and the evacuation of qualities like depth and authenticity in postmodern culture. The document provides context for Baudrillard's sometimes provocative views and examines what his work means for design and visual rhetoric.
1. Jean Baudrillard was a sociologist and philosopher who was interested in how media and technology influenced human communication, meaning-making, and experience in modern society.
2. Though often considered a postmodernist, Baudrillard saw himself more as studying a media-saturated world. He was concerned with how "symbolic exchange" or meaningful collective experiences were being replaced by superficial interactions with signs and simulations.
3. Baudrillard argued that contemporary society has replaced authentic experiences with artificial simulations through mass media like television, to the point that reality itself has been replaced by artificial "hyperreality" divorced from genuine human experiences.
Jean Baudrillard was a French sociologist and philosopher known for his theories on simulacra and hyperreality. He argued that reality is indistinguishable from simulations of reality in contemporary society due to advancements in media and technology. In a hyperreal system, signs and symbols circulate without reference to an original and it is impossible to distinguish the real from artificial simulations. Baudrillard used examples like Disneyland and photography to show how the proliferation of images and signs has blurred the lines between what is real and what is a copy, to the point that the simulation becomes more "real" than material reality. He believed contemporary society has entered a state of hyperreality where reality is indistinguishable
This document provides biographical information about French philosopher Jean Baudrillard and summaries of some of his major works. It discusses his educational and professional background, bibliographies of his writings and works about him, and short precis of 5 key works covering topics like simulations, utopias, and terrorism.
Jean Baudrillard was a French sociologist and philosopher known for his work on postmodernism and post-structuralism. Some of his key works examined the concepts of simulacra and simulations, and argued that contemporary reality is defined by hyperreality rather than material reality. Baudrillard also analyzed the emerging consumer society and how technology and mass consumption had come to define social and cultural spaces through his works on systems of objects and symbolic exchange.
Google provides image search results that represent topics, but may not accurately depict the topic's full meaning or definition. Jean Baudrillard argues that in modern society, symbols and signs have replaced reality and human experience is a simulation. When using Google image search to understand unfamiliar words, the top results are popular representations rather than the most accurate depictions, making Google a superficial source of information that interrupts the visualization process. Experiments searching terms like "Huckaback" and "Eft Newt" found Google images simplified topics by focusing on popularity over completeness or reality.
The document provides an overview of postmodernist concepts related to media and reality as discussed by theorists Jean Baudrillard and Marshall McLuhan. It summarizes Baudrillard's view that media creates a "hyperreality" that replaces genuine social experience with artificial simulations and signs, while McLuhan believed media unified society into a "global village." Reality television is discussed as a prime example of how media constructs an artificial hyperreal version of reality that further distances people from lived experiences.
The document discusses Jean Baudrillard's concepts of simulacra and hyperreality. It argues that in postmodernity, simulations and copies of reality have replaced the real to such an extent that it is difficult to distinguish reality from its representations. Media and technology have created a hyperreality that seems more real than actual lived experience. People can lose the ability to separate reality from fantasy and begin to engage with and find fulfillment in simulated realities rather than any objective reality.
Postmodernism (Foucault and Baudrillard)John Bradford
This document provides an overview of postmodernism and some of its key thinkers. It discusses:
- Postmodernism emerged as a critique of modernity and challenged ideas like universal truths, objective knowledge, and historical progress.
- Key postmodern thinkers included Derrida, Foucault, Lyotard, and Baudrillard. They analyzed how power shapes knowledge and questioned foundations of knowledge.
- Foucault argued that knowledge is a form of power and that what counts as truth is determined by prevailing power structures in society rather than objective facts. He analyzed how power operates in subtle ways through social institutions and practices.
This document discusses Jean Baudrillard's concepts of hyperreality and simulacra and how they relate to media representations of reality. Baudrillard argued that the media can create idealized simulations of reality that become indistinguishable from reality itself. This leads to a "hyperreality" where audiences' perceptions of the real world are distorted by artificial media representations. The document analyzes how this applies to topics like gender and beauty standards in advertising, war reporting that constructs narratives, and how viewers may mistake simulations for reality. It also references Dove's "Real Beauty" campaign and the controversies around its approach to portraying women.
Jean Baudrillard's theory of hyperreality describes a state where simulations have replaced reality such that the distinction between real and simulated has collapsed. Hyperreality is exemplified by celebrity culture, where celebrities live in a cocooned world detached from normal interactions, and some fans become so engaged with the hyperreal celebrity world that they lose touch with reality. Video games also demonstrate hyperreality, as rare cases occur where players commit violent acts because they cannot distinguish between the simulated game world and reality.
This document discusses simulation examples and simulation of queuing systems. It provides three key steps to carry out a simulation: 1) determine input characteristics, 2) construct a simulation table to track the system state over time, and 3) initialize and run the simulation. It then gives an example of simulating a single-channel queue, including generating random interarrival and service times from distributions and constructing a simulation table. Key performance measures like average wait time and server idle time are calculated from the table.
Jean Baudrillard argues that there is more information in the world today but less meaning. He presents three hypotheses to explain this: 1) that information produces meaning but eventually devours itself, 2) Shannon's hypothesis that information and meaning are not related, and 3) that information is directly destructive of meaning. Baudrillard believes information exhausts itself by staging communication as simulation rather than true communication, and dissolves meaning and the social sphere. He argues we live in a "hyperreal" state where media images shape our expectations and realities without basis in fact, blurring the lines between real and represented experiences.
Simulacra and Simulations - Jean BaudrillardSamantha Trieu
This document provides an overview of Jean Baudrillard's theories of simulation and hyperreality as presented in his book Simulacra and Simulation. It summarizes that Baudrillard believed reality has been replaced by simulation through sign systems and media that construct symbolic representations of the world without reference to an original. Contemporary society consumes these empty signs and loses the ability to distinguish reality from simulation. The document also briefly outlines Baudrillard's four stages of the process of simulation replacing reality and some influences and critiques of his work.
Aansluitend zal door Dr. Natalia Kuchuk ingegaan worden op de preventie van fracturen tijdens GC-gebruik. Zijn er nieuwe inzichten in de pathophysiologie? Hoeveel calcium en vitamine D is nodig? Van welke medicamenten is fractuurreductie aangetoond tijdens GC-gebruik? Hoe lang anti-osteoporose medicatie voorschrijven bij langdurig prednisongebruik?
IWO Meeting 1 November 2023 - Stopping with Denosumab and Romosozumab, basic mechanisms and clinical aspects door Prof. dr. S. Ferrari, Geneva, Switzerland. (Engelstalige lezing)
1) DXA scanning is a reliable and low-radiation method to measure bone mineral density (BMD) at the lumbar spine, hip, and wrist to diagnose osteoporosis.
2) DXA can also detect vertebral fractures (VFA) and measure whole body composition, abdominal fat, and aortic calcification.
3) Interpretation of DXA results requires attention to potential variability between devices, accurate placement of regions of interest, and use of appropriate reference data since BMD can be under or overestimated in certain patients.
Jean Baudrillard was a French sociologist and philosopher known for his work on postmodernism and post-structuralism. Some of his key works examined the concepts of simulacra and simulations, and argued that contemporary reality is defined by hyperreality rather than material reality. Baudrillard also analyzed the emerging consumer society and how technology and mass consumption had come to define social and cultural spaces through his works on systems of objects and symbolic exchange.
Google provides image search results that represent topics, but may not accurately depict the topic's full meaning or definition. Jean Baudrillard argues that in modern society, symbols and signs have replaced reality and human experience is a simulation. When using Google image search to understand unfamiliar words, the top results are popular representations rather than the most accurate depictions, making Google a superficial source of information that interrupts the visualization process. Experiments searching terms like "Huckaback" and "Eft Newt" found Google images simplified topics by focusing on popularity over completeness or reality.
The document provides an overview of postmodernist concepts related to media and reality as discussed by theorists Jean Baudrillard and Marshall McLuhan. It summarizes Baudrillard's view that media creates a "hyperreality" that replaces genuine social experience with artificial simulations and signs, while McLuhan believed media unified society into a "global village." Reality television is discussed as a prime example of how media constructs an artificial hyperreal version of reality that further distances people from lived experiences.
The document discusses Jean Baudrillard's concepts of simulacra and hyperreality. It argues that in postmodernity, simulations and copies of reality have replaced the real to such an extent that it is difficult to distinguish reality from its representations. Media and technology have created a hyperreality that seems more real than actual lived experience. People can lose the ability to separate reality from fantasy and begin to engage with and find fulfillment in simulated realities rather than any objective reality.
Postmodernism (Foucault and Baudrillard)John Bradford
This document provides an overview of postmodernism and some of its key thinkers. It discusses:
- Postmodernism emerged as a critique of modernity and challenged ideas like universal truths, objective knowledge, and historical progress.
- Key postmodern thinkers included Derrida, Foucault, Lyotard, and Baudrillard. They analyzed how power shapes knowledge and questioned foundations of knowledge.
- Foucault argued that knowledge is a form of power and that what counts as truth is determined by prevailing power structures in society rather than objective facts. He analyzed how power operates in subtle ways through social institutions and practices.
This document discusses Jean Baudrillard's concepts of hyperreality and simulacra and how they relate to media representations of reality. Baudrillard argued that the media can create idealized simulations of reality that become indistinguishable from reality itself. This leads to a "hyperreality" where audiences' perceptions of the real world are distorted by artificial media representations. The document analyzes how this applies to topics like gender and beauty standards in advertising, war reporting that constructs narratives, and how viewers may mistake simulations for reality. It also references Dove's "Real Beauty" campaign and the controversies around its approach to portraying women.
Jean Baudrillard's theory of hyperreality describes a state where simulations have replaced reality such that the distinction between real and simulated has collapsed. Hyperreality is exemplified by celebrity culture, where celebrities live in a cocooned world detached from normal interactions, and some fans become so engaged with the hyperreal celebrity world that they lose touch with reality. Video games also demonstrate hyperreality, as rare cases occur where players commit violent acts because they cannot distinguish between the simulated game world and reality.
This document discusses simulation examples and simulation of queuing systems. It provides three key steps to carry out a simulation: 1) determine input characteristics, 2) construct a simulation table to track the system state over time, and 3) initialize and run the simulation. It then gives an example of simulating a single-channel queue, including generating random interarrival and service times from distributions and constructing a simulation table. Key performance measures like average wait time and server idle time are calculated from the table.
Jean Baudrillard argues that there is more information in the world today but less meaning. He presents three hypotheses to explain this: 1) that information produces meaning but eventually devours itself, 2) Shannon's hypothesis that information and meaning are not related, and 3) that information is directly destructive of meaning. Baudrillard believes information exhausts itself by staging communication as simulation rather than true communication, and dissolves meaning and the social sphere. He argues we live in a "hyperreal" state where media images shape our expectations and realities without basis in fact, blurring the lines between real and represented experiences.
Simulacra and Simulations - Jean BaudrillardSamantha Trieu
This document provides an overview of Jean Baudrillard's theories of simulation and hyperreality as presented in his book Simulacra and Simulation. It summarizes that Baudrillard believed reality has been replaced by simulation through sign systems and media that construct symbolic representations of the world without reference to an original. Contemporary society consumes these empty signs and loses the ability to distinguish reality from simulation. The document also briefly outlines Baudrillard's four stages of the process of simulation replacing reality and some influences and critiques of his work.
Aansluitend zal door Dr. Natalia Kuchuk ingegaan worden op de preventie van fracturen tijdens GC-gebruik. Zijn er nieuwe inzichten in de pathophysiologie? Hoeveel calcium en vitamine D is nodig? Van welke medicamenten is fractuurreductie aangetoond tijdens GC-gebruik? Hoe lang anti-osteoporose medicatie voorschrijven bij langdurig prednisongebruik?
IWO Meeting 1 November 2023 - Stopping with Denosumab and Romosozumab, basic mechanisms and clinical aspects door Prof. dr. S. Ferrari, Geneva, Switzerland. (Engelstalige lezing)
1) DXA scanning is a reliable and low-radiation method to measure bone mineral density (BMD) at the lumbar spine, hip, and wrist to diagnose osteoporosis.
2) DXA can also detect vertebral fractures (VFA) and measure whole body composition, abdominal fat, and aortic calcification.
3) Interpretation of DXA results requires attention to potential variability between devices, accurate placement of regions of interest, and use of appropriate reference data since BMD can be under or overestimated in certain patients.
This document summarizes osteonecrosis of the jaw (ONJ) associated with antiresorptive agents. It defines ONJ and stages its severity. It discusses the pathogenesis of ONJ and risk factors like underlying disease, treatment duration, and dental procedures. Cancer patients on intravenous bisphosphonates have the highest ONJ risk of 1-8% due to higher drug doses and worse oral/general health. Management involves conservative measures like mouthwashes for early stages and surgery with antibiotics for later stages. Discontinuing antiresorptives may help healing but risks fractures. Teriparatide may help healing in some cases but its use in cancer is uncertain. More research is needed on preventing and treating established ON
This systematic review analyzed 895 cases of tumor-induced osteomalacia (TIO) from case reports. TIO is caused by tumors that produce excess fibroblast growth factor 23 (FGF23), which causes hypophosphatemia and osteomalacia. The review found that TIO mostly affects adults aged 40-60 years old, with long diagnostic delays of several years on average. The tumors were located variably but most commonly in the lower limbs or head and neck region. Higher FGF23 levels correlated with larger tumor size. Patients experienced significant bone fragility and fracture rates as high as 60% due to long-term hypophosphatemia. Early tumor detection and removal are important to improve outcomes for
This document discusses real-world evidence on denosumab for osteoporosis treatment and fracture prevention. It summarizes several studies, including one that found denosumab reduced fracture risk by 38% compared to placebo in over 25,000 postmenopausal women. Another study showed good long-term persistence with denosumab therapy in over 800 patients. Additional studies observed that zoledronic acid can prevent bone loss following denosumab discontinuation, and bisphosphonate treatment after denosumab provides protection against new vertebral fractures.
IWO Meeting 16 November 2022 - ASBMR young talent: Silvia Storoni (Amsterdam): Prevalence and Hospital Admissions in Patients With Osteogenesis Imperfecta in The Netherlands: A Nationwide Registry Study
The document appears to be a presentation on highlights from the ASBMR 2021 conference in San Diego. It discusses several topics that were covered at the conference, including fracture risk assessment, the effects of various osteoporosis treatments on bone mineral density, safety issues like osteonecrosis of the jaw and atypical femoral fractures, the role of vitamin D, and applications of artificial intelligence. The entire document is copyrighted by Prof. Dr. Joop van den Bergh.
This document discusses guidelines for medication to prevent fractures in patients using glucocorticoids. It notes that glucocorticoids significantly increase the risk of vertebral and non-vertebral fractures. While effective anti-osteoporosis drugs are available, many glucocorticoid-treated patients remain untreated. The document reviews new guidelines that simplify treatment criteria to improve implementation and outlines recommendations for when to start bone-sparing medications based on patient factors and glucocorticoid dose and duration. The goal is to optimize fracture prevention in glucocorticoid-treated patients.
This document discusses what actions should be taken when a vertebral fracture is discovered incidentally. It notes that vertebral fractures are very common fractures, especially in older individuals, and are often asymptomatic. Having a vertebral fracture significantly increases one's risk for future fractures both in the short and long term. If a vertebral fracture is found incidentally, such as on a CT scan, further investigation is warranted including assessing bone mineral density and checking for underlying bone diseases. Treatment options should also be considered, especially if the individual has low bone density in addition to the vertebral fracture, as this combination confers the highest risk. New automated detection algorithms aim to help identify vertebral fractures on scans to ensure appropriate follow up for individuals.
This document summarizes a cost-effectiveness model of Fracture Liaison Services (FLS) care in the Netherlands. The model found that FLS care would be highly cost-effective, with a cost of €9,076 per quality-adjusted life year gained. Total 5-year costs with FLS would be only 1.7% higher than current costs but would prevent fractures and improve health outcomes. The model can help decision-makers prioritize secondary fracture prevention and allow local payers and FLS to predict costs and benefits of implementation.
More from Stichting Interdisciplinaire Werkgroep Osteoporose (20)
Effect van vitamine D suppletie op de 25-OH vitamine D spiegels bij patienten met ernstige vitamine D deficientie
1. Effect van vitamine D suppletie op de 25-
OH vitamine D spiegels bij patienten met
ernstige vitamine D deficientie
Retrospectief onderzoek bij patienten > 50 jaar met
een laag-energetische fractuur en een vitamine D
spiegel < 30 nmol/l
IWO 18-04-2012
“Is vitamine suppletie van 800 IU dd voldoende”
Zie ook artikel osteoporosejournaal 2012
Copyright
Dr. E.J. ter Borg
3. Achtergrond
• Vitamine D deficientie (def: < 50 nmol/l) komt vaak voor
na laag-energetische fracturen (64 % < 50 nmol/l) Van den
Bergh et al, Ned Tijdschr Geneesk 2010
• Vaak worden adequate vitamine spiegel na suppletie niet
bereikt
• Ernstige vitamine D deficientie spierzwakte, botpijnen,
fracturen Rosen et al, NEJM 2011; 364: 248-254
• Gezondheidsraad: bij osteoporose a: dagelijks 800 IU
vitamine D en b: 25-OH vitamine D > 50 nmol/l
• 25-OH > 50 adequate PTH suppressie
• Vitamine D suppletie van groot belang mbt val en
fractuurpreventie Bisschof-Ferrari, Best Pract Res Clin Rheumatolo 2009; 23:
789-95
Copyright
Dr. E.J. ter Borg
4. Vitamine D (25-OH) spiegels
Lips, P. Endocr Rev 2001;22:477-501
Copyright
Dr. E.J. ter Borg
5. Lips, 2004, Journal of Steroid & Molecular
Biology
25(OH)D
(nmol/l)
PTH Bone
Vitamin D
replete
>50 No increase normal
Mild
deficiency
25-50 <15%
increase
Normal or
high turnover
Moderate
deficiency
12.5-25 15-30%
increase
High turnover
Severe
defiency
<12.5 nmol/L >30%
increase
Osteo-
malacia
Copyright
Dr. E.J. ter Borg
6. Copyright restrictions may apply.
Bischoff-Ferrari, H. A. et al. JAMA 2005;293:2257-2264.
Hip and Nonvertebral Fracture Efficacies by Achieved 25-Hydroxyvitamin D Levels in 400 IU/d
and 700-800 IU/d Vitamin D-Treated Groups
Copyright
Dr. E.J. ter Borg
7. Setting
• Fractuur osteoporose kliniek Antonius ziekenhuis
Nieuwegein, retrospectief geprotocolleerd
onderzoek
• EJ ter Borg, reumatoloog
• EHH Wilting, klinisch farmacoloog
• W van den Hoeven-Kastele, fractuur-osteoporose
verpleegkundige
• JC Kelder, arts-epidemioloog
Copyright
Dr. E.J. ter Borg
8. Vragen met betrekking tot vitamine suppletie bij ernstige
vitamine D deficientie
• Geen consensus over controle (en zo ja, wanneer)
van 25-OH spiegel na suppletie
• Geen consensus over optimale dosis vitamine D
prospectief onderzoek ontbrak tot voor kort
• Heany: advies bij basale 25 OH van 20-40 2200 IU
vitamine D dd om 25-OH > 80 nmol/l te bereiken
J Steroid Biochem 2005; 97: 13-19
• Onduidelijkheid veiligheid hoge dosis vitamine D
Copyright
Dr. E.J. ter Borg
10. Vraagstellingen onderzoek
• Hoe groot is de stijging van de 25-OH
spiegel na suppletie met 800-880 IU
vitamine D
• Na hoeveel tijd wordt een plateaufase
bereikt
• Welke factoren zijn van invloed op de
mate van stijging van de 25-OH spiegel:
basale 25-OH, gewicht, BMI, geslacht,
BMI, leeftijd, nierfunctie
Copyright
Dr. E.J. ter Borg
11. Exclusiecriteria
studie populatie
• Gebruik vitamine D < 3 maand
• GFR < 40 cc/min
• Bekende darmresorptiestoornis
• PHP
• Twijfel therapietrouw
• Ontbreken tweede 25-0D spiegel na suppletie
Copyright
Dr. E.J. ter Borg
12. Uitvoering
• Fractuur-osteoporosekliniek
• 25-OH vitamine < 30 nmol/l 800-880 IU
vitamine en verwijzing reumatoloog
• Bij reumatoloog controle 25-OH vitamine
D spiegel en evaluatie oorzaak vitamine
D deficientie
Copyright
Dr. E.J. ter Borg
13. Opbouw studiepopulatie
• Patiënten met een vitamine D spiegel < 30 en 111
voldoende aan de inclusiecriteria
• Patienten gezien door reumatoloog en 75
• een tweede vitamine D bepaling
• Exclusie na bezoek aan reumatoloog ivm 6
• twijfel vitamine D intake 1
• Intolerantie vitamine D 1
• M Crohn 1
• Primaire hyperpara 1
• GFR < 40 cc/min 1
• Onvoldoende data 1
• Uiteindelijke studiepopulatie 67
Copyright
Dr. E.J. ter Borg
14. PATIENTEN KARAKTERISTIEKEN
(gemiddelde waarden met tussen haakjes de s.d.)
• Geslacht (man/vrouw [%]) 26/41 [39%/41%]
• Leeftijd (jaar) 68.0 (10.6)
• Gewicht (kg) 74.5 (20.7)
• Kaukasisch/niet Kaukasisch 62/5 [93%/7%]
• BMI* (kg/m2) 25.4 (4.1)
• 25-OH vitamine D spiegel (nmol/l) 21.1 (6.1)
• Serumcalcium (2.10-2.50 mmmol/l) 2.37 (0.13)
• Serumkreatinine (62-106 umol/l) 8.2 (14.4)
• Alkalische phosphatase (0-120 U/l) 99.1 (34.4)
* n = 30
Copyright
Dr. E.J. ter Borg
15. RISICOFACTOREN* VOOR VITAMINE D DEFICIENTIE
• Onvoldoende zoncontact 19
• Verpleeghuis 1
• Gekleurde huid# 5
• Overig 13
• Anti-epileptica 1
* vaak meerdere risicofactoren per persoon aanwezig
# 1 patient met een hoofddoek
Copyright
Dr. E.J. ter Borg
16. 5 10 15 20 25 30 35 40
20
40
60
80
100
Vit D meting 1
Vit
D
stijging
correlation coefficient = -0.325 p= 0.0106
Copyright
Dr. E.J. ter Borg
20. Conclusies
• Na gemiddeld 9 weken suppletie met viamine D
800-880 IU 25-OH > 50 nmol/l bij slechts 42 %
• Sterkste stijging bij de laagste basale 25-OH, zoals
bekend Rosen et al NEJM 2011; 364: 248-54
• Relatie mate stijging 25-OH en tijdsinterval tussen de
bepalingen
• Na 3 maand lijkt er nog geen plateaufase te zijn
bereikt
• Geen relatie tussen de geteste variabelen en mate
van stijging van 25-OH, mn niet met BMI (iit literatuur)
en GFR
Copyright
Dr. E.J. ter Borg
21. Bekende LITERATUUR mbt vitamine D suppletie en
effect op 25 OH spiegel
• Chel et al: verpleeghuispatienten (gem. 84
jaar) na 4 maand 600 IU vitamine D: stijging
25 OH van 23 70 nmol/l Osteoporosis Int 2008; 19: 663-
671
• Lips et al: ouderen (> 80 jaar) na 3-6 maand
800 IU: stijging 25-OH 23.7 80 nmol/l,
plateaufase pas na 6-9 maand J Clin Endocrinol
Metab 1988: 67: 644-50
• Vieth et al: Gezonde vrijwilligers na 1000 IU
vitamine D ged. 3 maand: 25-OH van 41 69
nmol/l Am J Clin Nutr 2001; 72: 288-94
• Geen literatuur over effect/dosis vitamine D
suppletie op 25-OH spiegels bij osteoporose
patienten met ernstige vitamine D deficientie
Copyright
Dr. E.J. ter Borg
22. Recente publicatie
Ann Int Med 2012; 156: 425-437 (1)
:first randomized controled dose–response study
• Zeer gezonde blanke post-menopauzale vrijwilligers
• Randomized controled study: placebo 400 IU
4800 vitamine D dd , FU na 6 en 12 maanden
• Gemiddeld 67 jaar, BMI 30.2, baseline 25-OH: 39
nmol/l, n = 167
Copyright
Dr. E.J. ter Borg
23. Ann Int Med 2012; 156: 425-437 (2)
• Na 800 IU vitamine D dd (winter en voorjaar) bij
97.5 %: 25-OH > 50 nmol/l na 6 maand
• Relatie vitamine D dosis en 25-OH niet lineair naar
quadratisch (rate limiting mechanism)
• Geen significant verschil voor alle doses tussen de 6
en 12 maand 25-OH waarden
• Plateaufase 25-OH bij 4800 IU dd na 12 maand
• Relatie BMI met a: basale 25-OH en b: stijging 25-OH
na suppletie (door groter verdelingsvolume)
• Hypercalciemie ( > 2.7) bij 5 (3%)
• Hypercalciurie (> 10 mmol/dag) bij 19 (11%)
Copyright
Dr. E.J. ter Borg
27. ADVIEZEN
• Controle 25 OH spiegel is zinvol maar dan pas na
minimaal 6 maand
• Wellicht zijn hogere doseringen vitamine D
nodig/zinvol bijv 50.000 IU/maand ook eerder
adequate 25-0H spiegels
• Hogere dosis vitamine D bij hoge BMI?
• Vraag over hoogte dosis vitamine D bij
onderzochte populatie niet exact te geven RCT
nodig
• Wsch. is 800 IU vitamine D dd wel genoeg
Copyright
Dr. E.J. ter Borg
31. 50 60 70 80
5
10
15
20
25
30
35
40
leeftijd
Vit
D
meting
1
correlation coefficient = -0.17
Copyright
Dr. E.J. ter Borg
32. 0 10 20 30 40
0
20
40
60
80
100
120
Vit D meting 1
Vit
D
meting
2
correlation coefficient = -0.026
Copyright
Dr. E.J. ter Borg
33. 25-OH stijging per geslacht
mean sd
man 48.79 23.34
vrouw 49.86 21.09
t-test p-waarde:
0.852937
man vrouw
20
40
60
80
100
geslacht
vit
D
stijging
Copyright
Dr. E.J. ter Borg
34. 50 60 70 80
20
40
60
80
100
leeftijd
Vit
D
stijging
correlation coefficient = 0.052
Copyright
Dr. E.J. ter Borg