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The theme of this issue is calcium and vitamin D. While several articles address the effects of calcium and vitamin D on bone health, this issue also explores the ramifications of vitamin D and the effects that go beyond bone health. First, in an Invited Commentary, Dr Koo highlights the articles in this issue and addresses the need for adequate dietary intake of calcium and vitamin D. He differentiates recommended dietary allowance from estimated average requirement and average intake. Dietary sources of these nutrients found naturally or fortified in foods are discussed. Next, Drs Lata and Elliott skillfully use a patient case to illustrate the diagnosis, prevention, and treatment of osteoporosis. They define the assessment phase in which medical and social history is reviewed along with diet and supplement use, physical activity, and family history. The authors also discuss the imaging options for screening and diagnosis of osteoporosis as well as laboratory tests for evaluating osteoporosis. The next 2 articles evaluate treatment options for osteoporosis. First, Dr Mayes looks at the pharmaceutical treatment—including antiresorptive and anabolic agents. Then, Straub clarifies the forms and recommended doses of supplemental calcium to prevent and treat osteoporosis. As I mentioned at the outset, the roles of vitamin D go beyond bone health; these alternate roles are the focus of 2 articles. Vitamin D receptors have been found in many body tissues and cells emphasizing vitamin D's roles outside of bone health. According to Shinchuk and Holick,1 Vitamin D is involved with "cell growth, immune function, blood pressure control, insulin production" and "improves musculoskeletal function." Drs Mullin and Dobs elaborate on vitamin D and how it is involved in preventing cancer and autoimmune diseases. Both of these articles are "must reads" for anyone needing an update on the non-calcemic roles of vitamin D.
The next article looks at calcium levels in critically ill patients. We
know that ionized calcium levels are correlated with total calcium levels, but
true hypocalcemia can be unrecognized in critically ill patients if only serum
total calcium levels are evaluated. Dr Dickerson and colleagues from the
University of Tennessee Health Science Center examine the relationship between
total and ionized calcium in critically ill patients and report that 85% of
patients with a total serum calcium level of <7 mg/dL had a low ionized
calcium level ( Switching from the intensive care unit to a home setting, 2 articles look at home nutrition support. The first of these papers is by Ferrone and Geraci. They specifically look at the relationship between long-term parenteral nutrition and metabolic bone disease. Discussed in this article are clinical presentations and diagnoses, etiology and pathophysiology, and management of parenteral nutrition-associated bone disease. This is accompanied by a paper on general management strategies for monitoring home parenteral nutrition by Dr Siepler. The issue ends with a pediatric focus. First, Dr Saavedra provides a comprehensive review of probiotics in infants. He reviews the basic concepts of probiotics, the establishment of microflora in the human intestine, and documented clinical efforts of probiotics in infants. Finally, there is a book review on a pediatric nutrition text.
This issue of NCP provides a comprehensive look at calcium and
vitamin D. I hope that you, as I, have learned new facts that you can apply in
your clinical practice.
1 Shinchuk L, Holick M. Vitamin D and rehabilitation: improving
functional outcomes. Nutr Clin Pract.2007; 22:297
–304.
Nutrition in Clinical Practice, Vol. 22, No. 3,
iv (2007)
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1.12 mg/dL). 
