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Dosagem do hidroclorotiazida. The two have published more than 50 articles in the Journal of American Geriatrics Society, Annals Internal Medicine, The Endocrine Society's Journal of Clinical Endocrinology or Diabetes, Metabolism and Nutrition, the New England Journal of Medicine. Dosage Children and adolescents are encouraged to receive vitamin D supplementation. Adults will not need to supplement as there has been no evidence in adults, but view of the limited availability sunlight, Food and Drug Administration (FDA) has published safety and efficacy data on oral 400 ng/mL of D3, but not for oral 400 ng/mL to 600 (1,2). Because of the small dose and potential toxicity that results from a very large oral dose of this vitamin (3,4), a daily dose of 400–600 ng D3 taken with each meal may help prevent D deficiency and improve bone health. Daily doses of 400–800 ng D3 may be used safely in healthy adults during certain seasons. The most effective dosages have not been calculated adequately for healthy elderly subjects; however, oral doses of 400–800 ng should be considered adequate if the doses are greater than those used routinely or otherwise considered a sufficient dose in similar context, including the elderly. A daily oral dose of 600 ng to 800 D3 in most adults does not appear to cause liver toxicity, and the risk of significant kidney toxicity does not appear to exist at doses greater than 200–800 mg (2). Treatment In most cases, D deficiency is the result of not receiving adequate sun exposure. However, because vitamin D can also be an inhibitor of calcification, vitamin D supplementation may be needed to maintain adequate bone health (5). Supplementation with vitamin D should be considered in patients who fail to respond adequately calcium treatment (6). options include tablets and/or a long list of vitamin D-friendly foods that are rich in vitamin D (7). However, older adults and in those with rickets, therapy might be more appropriate. In this patient population, vitamin D intake should be monitored by clinical decision (8). Adverse Effects D deficiency is associated with an increased risk of hip fracture and other calcifications (1,2,7). In the United States from 1975 to 1990, a rate of hip fracture increased from 12 to 14% and has remained unchanged since (2,7). In a study conducted Japan between 1985 and 1993, a rate of hip fracture in the D-deficient population increased 2.2-fold among postmenopausal women and 2.6-fold premenopausal during a time when vitamin D deficiency was decreasing globally (9). The exact mechanisms by which higher plasma concentrations of vitamin D cause increased calcification are unknown. Zovirax mail order One potential mechanism is that calcium less able to bind and prevent mineralization in calcified tissues. However, because the calcium-binding capacity of vitamin D is very low, the increased risk of calcification would be reduced in the presence of vitamin D. A more likely reason for the increased risk of both fractures and hip mineralization in the D-deficient population is higher plasma concentration of vitamin D, especially since the effect of this vitamin does not appear to depend on blood levels but the ability of tissues to use the vitamin (7). A possible explanation is that because calcification increases with time, a person who does not need to take supplement vitamin D could still develop calcification if exposed to the high sun exposure or sunblock products that have limited sun protection. Prevention To prevent the calcification of affected tissues, adequate sun exposure in the winter and use of a sun block product during the summer is important winter months. A number of factors increase the risk calcification, such as lack of sun exposure during childhood or malnutrition. The treatment of fractures and fracture risk generally requires no treatment. The majority of fractures (approximately 80%-85%) require surgery and a relatively large proportion may require bone density or orthopedic therapy to treat symptoms and stabilize. The goal in treatment of osteoporosis is to prevent bone loss by increasing strength until bone loss is prevented. The current recommendation to take vitamin D for as long needed to prevent bone loss. However, because of the limited availability sunshine during summer months, vitamin D supplementation with a daily dose of 400–600 ng (400–800 pg) is not recommended (7). Summary Older adults with D deficiency may require daily vitamin D supplementation for prevention of loss bone density and fracture. Vitamin D intake of approximately 600–800 ng/d (400–800 pg) per day may decrease the rate of bone loss, reduce risk hip fracture and calcification, protect against fractures.

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