Men's Osteoporosis Support GroupA solar vitamin D-Estimator spreadsheet; two vitamin D and hip fracture studies Note on website with a D-Estimator spreadsheet: This website has multiple methods to estimate your vitamin D status and suggested dosages of sunlight and/or vitamin D3 supplements. And, on the right side of the page, you'll see the D-Estimator, a downloadable XLS spreadsheet. This is the most comprehensive method I've seen to estimate your vitamin D production from sunlight. It accounts for multiple variables: latitude, skin type, BMI, age, percent of body surface exposed, weekly minutes of exposure, etc. I can't assure the accuracy of the information, so use it accordingly. If in doubt, discuss this with your care provider. And, I would recommend getting your serum vitamin D level tested after following suggested methods to verify that you can attain adequate serum vitamin D. Note that some of the people in the Khadgawat R and others study below were in the sun and/or were taking supplemental vitamin D and calcium, with no effect on serum vitamin D. This likely due to inadequate time in the sun and/or too low a vitamin D dosage. There are home vitamin D test methods available or go through your care provider and your health insurance plan to be tested. Osteoporos Int. 2011 Mar 11. [Epub ahead of print]. Hypovitaminosis D as a risk factor of hip fracture severity. Larrosa M and others. PMID: 21394494. This cross-sectional study involved 325 patients with osteoporotic hip fractures who were aged 65 years or older admitted to a hospital during a one-year period. They had more severe fractures, Garden grades III-IV and Kyle III-IV. Among several factors examined was serum vitamin D levels. They found, “In patients with severe femoral neck or intertrochanteric fractures (Garden III-IV and Kyle III-IV), vitamin D deficiency was more frequent (74%) and severe (25OHD3 20 ± 15 ng/ml) than in patients with less severe fractures (57%, 25OHD3 26 ± 21 ng/ml).” Additionally they note that 43% of patients had previous fractures, while only 15% had been diagnosed with osteoporosis, and only 10% were receiving treatment. Those patients who had been prescribed vitamin D supplements had higher serum vitamin D levels. Editor's comments. This study points to multiple problem areas for people with osteoporosis. Namely that they are often not properly diagnosed and treated, even in the event of an obvious osteoporotic fracture. When 43% of the patients in this study had previous fractures that means they should have been presumed to have osteoporosis at that time. They should have received diagnostic and treatment care as would be appropriate. That didn't happen, and the end result was severe and complicated hip fractures. These fractures were very often associated with low serum vitamin D levels. Presumably had these individuals been prescribed vitamin D supplements or told to spend time in the sun daily, many might have avoided these severe fractures and the subsequent pain and suffering. This is a common theme in the literature I review: patients have fractures but don't receive osteoporosis diagnosis or treatment. It is time that the orthopedic and endocrinology specialties devise workable methods to get proper diagnosis and treatment for low-trauma fracture patients with likely osteoporosis. Older individuals, and their friends and family, need also to be aware that osteoporosis is the presumed cause of low-trauma fractures. So they must demand diagnosis and, if warranted, treatment for their osteoporosis. Also note that 10% of those who fractured were receiving osteoporosis treatment. For some reason that had not protected them from additional fracture. I can only conjecture as to the cause. Perhaps they had only been on therapy a short time, they weren't compliant regarding taking their medications, etc. J Assoc Physicians India. 2010 Sep;58:539-42. High prevalence of vitamin D deficiency in Asian-Indian patients with fragility hip fracture: a pilot study. Khadgawat R and others. PMID: 21391372. This study involved individuals with non-traumatic hip fracture who were older than 50 years of age. They were compared to age and sex matched controls who had bone mineral density (BMD) tests. There were 9 men and 34 women with a mean age of 62.2 years. Adequate sun exposure was reported in 34.8% of the cases. Important findings were: 1) Almost 77% of fractures occurred at home, and 51.5% of those were due to falls/slips in the bathroom. 2) Mean serum vitamin D was 9.9 ng/ml. 3) All patients but one had vitamin D deficiency. 4) There was no apparent effect on BMD from adequate sun exposure and/or calcium/vitamin D supplements. 5) BMD was significantly lower in fracture patients than controls. Twenty-six patients/families were contacted a year after the fractures with the following results: 1) Eleven (42.3%) died within one year of surgery. 2) Eight died within the first six months of surgery. 3) Two died within 72 hours of hospital discharge. 4) Of the 15 patients alive after one year, only two could walk without any support. The authors concluded, “Our study shows very high prevalence (96.7%) of vitamin D deficiency in Asian-Indian patients with fragility hip fracture. The BMD of these patients is significantly low in comparison to age and sex matched healthy controls. More fractures occurred at home than outside, with a majority of fall (sic) being in the bathroom.” Editor's comments. This is a very interesting study with a group of findings that are explained in more detail than usually happens. One extremely important finding is that 51.5% of falls/slips occurred in the bathroom. This means the bathroom is a dangerous place for older individuals. They should take every precaution to make it safer: include handles on the walls, cover slippery surfaces with mats that are sticky, assure that small rugs and carpets are slip-proof, etc. Of additional importance is that serum vitamin D levels are important, and often not adequately maintained by older individuals. This is easily remedied by either adequate time spent in the sun with enough surface area of the skin exposed and during the middle of the day when UVB radiation is at maximum levels. But older individuals often only produce 25% or so of vitamin D compared to younger persons. So they will need to spend more time in the sun. In addition to sun exposure, or in lieu of it, adequate vitamin D3 supplements can be taken. There is a wide range of recommendations on the correct amount. But from my readings 400-600 IU is woefully inadequate, even though that number if often mentioned and is the what is in many multivitamins. Certainly 1,000 IU/day would be needed, and up to 5,000 IU/day have shown to cause no harm. Note that in the vitamin D3 study by Heaney and others linked above, individuals were given 50,000 IU/week. This high of dosage gave a mean serum vitamin D level of 45 ng/ml, which is considered sufficient, but not overly high.
|