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vitamin D supplementation are useful in preventing osteomalacia Vitamin D supplementation reduces the incidence of vertebral fractures by 37% and may slightly reduce the incidence of nonvertebral fractures Oral vitamin D is given in doses of 400 1000 IU daily Higher doses of vitamin D may be required during winter months and for patients having prolonged hospitalization or nursing home care, for patients with serum levels of 25-hydroxyvitamin D below 30 ng/mL, and those with intestinal malabsorption Calcium supplementation alone has only a minor effect on the prevention of osteoporosis and such supplementation has not been established to reduce fracture risk significantly Therefore, calcium supplementation is an optional preventive measure, indicated principally for those with diets low in calcium More important is the assurance of adequate vitamin D through sun exposure or oral vitamin D supplementation, and calcium supplementation should include vitamin D Calcium supplementation may be given as calcium citrate (04 07 g elemental calcium per day) or calcium carbonate (1 15 g elemental calcium per day) 2 Bisphosphonates Bisphosphonates work similarly, inhibiting osteoclast-induced bone resorption They increase bone density significantly and reduce the incidence of both vertebral and nonvertebral fractures Bisphosphonates have also been effective in preventing corticosteroid-induced osteoporosis To ensure intestinal absorption, oral bisphosphonates must be taken in the morning with at least 8 oz of plain water at least 30 minutes before consumption of anything else The patient must remain upright after taking bisphosphonates to reduce the risk of esophagitis These medications are excreted in the urine However, no dosage adjustments are required for patients with creatinine clearances above 35 mL/min There has been little experience giving bisphosphonates to patients with severe renal insufficiency; if given, the dose would need to be greatly reduced and serum phosphate levels monitored Bisphosphonates may be given orally once monthly or weekly; which is more convenient than daily therapy and equally effective Available oral preparations include alendronate, 70 mg orally once weekly (tablet or solution), and risedronate, 35 mg orally once weekly Both these medications reduce the risk of both vertebral and nonvertebral fractures Studies sponsored by the manufacturer of alendronate found that alendronate was significantly more potent than risedronate and equally well tolerated Another bisphosphonate, ibandronate sodium, is taken once monthly in a dose of 150 mg orally Once-monthly ibandronate is convenient and reduces the risk of vertebral fractures but not nonvertebral fractures; its effectiveness has not been directly compared with other bisphosphonates Oral bisphosphonates can cause esophagitis, especially in patients with hiatal hernia and gastroesophageal reflux For patients who cannot tolerate oral bisphosphonates or for whom oral bisphosphonates are contraindicated, intravenous bisphosphonates are available Zoledronic acid is a third-generation bisphosphonate and a potent osteoclast inhibitor It can be given every 6 12 months in doses of 2 4 mg intravenously over 15 30 minutes Pamidronate is an older parenteral bisphosphonate that can be given in doses of.

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In this case, the condition in the first if statement tests whether temp is less than 32, not less than or equal to 32. Because temp is hardwired to exactly 32, the first expression is false, and control passes to the else if statement. The second statement is true, so the third case, the else statement, never executes. Please note, however, that this code is identical (as far as the compiler is concerned) to the following:

For prevention and treatment of osteoporosis, the diet should be adequate in protein, total calories, calcium, and vitamin D Pharmacologic corticosteroid doses should be reduced or discontinued if possible Thiazides may be useful if hypercalciuria is present High-impact physical activity (eg, jogging) significantly increases bone density in men and women Stair-

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Feb 22, 2017 · Technology: .NET, Platform: ASP.NET Web Forms, Type: Question, Subject: ASP.NET - PDF Viewer control.

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found in 41% of these women; 35% in the United States and 125% in Italy Vitamin D deficiency is particularly common in the institutionalized elderly, with the incidence exceeding 60% in some groups not receiving vitamin D supplementation Deficiency of vitamin D may arise from insufficient sun exposure, malnutrition, or malabsorption (due to pancreatic insufficiency, cholestatic liver disease, sprue, inflammatory bowel disease, jejunoileal bypass, Billroth type II gastrectomy, etc) Cholestyramine binds bile acids necessary for vitamin D absorption Patients with severe nephrotic syndrome lose large amounts of vitamin D-binding protein in the urine, and osteomalacia may also develop Anticonvulsants (eg, phenytoin, carbamazepine, valproate, phenobarbital) inhibit the hepatic production of 25(OH)D and sometimes cause osteomalacia Phenytoin can also directly inhibit bone mineralization Serum levels of 1,25(OH)2D are usually normal Vitamin D dependent rickets type I is caused by a rare autosomal recessive defect in renal synthesis of 1,25(OH)2D It presents in childhood with rickets and alopecia; osteomalacia develops in adults with this condition unless treated with oral calcitriol in doses of 05 1 mcg daily Vitamin D dependent rickets type II (better known as hereditary 1,25[OH]2D-resistant rickets) is caused by a genetic defect in the 1,25(OH)2D receptor Adults respond variably to oral calcitriol in very large doses (2 6 mcg daily)

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Decreased bone density from defective mineralization Laboratory abnormalities may include increases in alkaline phosphatase, decreased 25-hydroxyvitamin D, or hypocalcemia, hypocalciuria, hypophosphatemia, secondary hyperparathyroidism Classic radiologic features may be present

Defective mineralization of the growing skeleton in childhood causes permanent bone deformities (rickets) Defective skeletal mineralization in adults is known as osteomalacia It is caused by any condition that results in inadequate calcium or phosphate mineralization of bone osteoid

static void Main( ) { int temp = 32; if ( temp < 32 ) { Console.WriteLine( "Warning! Ice on road!" ); } else { if ( temp == 32 ) { Console.WriteLine("Temp exactly freezing, beware of water."); } else { Console.WriteLine("No ice; drive with confidence."); } } }

Etiology (Table 26 12)

Vitamin D deficiency decreases the intestinal absorption of calcium and is the most common cause of osteomalacia Significant vitamin D deficiency (serum 25[OH]D < 50 nmol/L or < 20 ng/mL) was found in 243% of postmenopausal women from 25 countries in the MORE study The incidence varied: < 1% in Southeast Asia, 293% in the United States, and 36% in Italy Severe vitamin D deficiency (serum 25[OH]D < 25 nmol/L or < 10 ng/mL) was

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Vitamin disorders Decreased availability of vitamin D Insufficient sunlight exposure Nutritional deficiency of vitamin D Malabsorption Nephrotic syndrome Vitamin D dependent rickets type I Liver disease Chronic renal failure Kidney transplantation Phenytoin, carbamazepine, or barbiturate therapy Dietary calcium deficiency Phosphate deficiency Decreased intestinal absorption Nutritional deficiency of phosphorus Malabsorption Phosphate-binding antacid therapy Increased renal loss X-linked hypophosphatemic rickets Tumoral hypophosphatemic osteomalacia Association with other disorders, including paraproteinemias, glycogen storage diseases, neurofibromatosis, Wilson s disease, and Fanconi s syndrome Disorders of bone matrix Hypophosphatasia Fibrogenesis imperfecta Axial osteomalacia Inhibitors of mineralization Aluminum Bisphosphonates

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