Answer to Question 1
d
Answer to Question 2
Persons 65 years old and older are at increased risk of osteomalacia due to diets low in calcium and vitamin D, a lack of sun exposure, decreased efficiency in synthesizing vitamin D, and increased incidence of intestinal malabsorption problems. The treatment of osteomalacia should address the underlying causes. Effective treatment of vitamin D deficiency may require a multivitamin providing as much as 20 g of vitamin D. Calcium intake should be adequate and may require a supplement providing as much as 1,5002,000 mg of elemental calcium per day. Patients with severe, longstanding vitamin D deficiency may initially require pharmacologic doses of up to 1,250 g per week for 312 weeks, followed by maintenance therapy of 20 g per day. Patients taking drugs that accelerate hepatic breakdown of vitamin D, and those with intestinal malabsorption problems, will require vitamin D in doses much greater than the RDA. Patients with liver or kidney diseases that prevent the activation of vitamin D into its biologically active form will require a form of vitamin D that is already biologically active, such as calcitriol.
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