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What's All the Hype About Vitamin D Deficiency?
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Posted on: 10/29/2009
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If you have watched any health-related news on TV or read the health section of your newspaper, you know that getting enough calcium for strong bones isn't enough. Now studies show that low levels of Vitamin D (deficiency) is just as important. Without sufficient vitamin D, the liver and kidneys can't help the body absorb calcium needed for bone and muscle function. How do you know you're getting enough vitamin D? That's the focus of this article in which five patient cases are highlighted.
Unless you develop bone pain, muscle weakness, a fracture, or start to fall, you may not know you suffer from vitamin D deficiency. A blood test will help confirm the diagnosis. Less then 30 ng/mL of vitamin D in the blood is the medical definition of vitamin D deficiency. And according to the National Health and Nutrition Examination Survey, three-fourths of American adults age 20 years old or older falls into this category. That's a shocking figure.
Who's at risk? Known risk factors include not getting enough of the right kind of sunshine, having dark colored skin, living with chronic kidney disease, and taking anticonvulsant medications for any reason. Low body weight, especially as a result of an eating disorder can increase the risk of poor vitamin D absorption, decreased intestinal calcium absorption, and low bone mass density. That was the case in the first patient reviewed. She experienced a spontaneous snap in her groin that turned out to be a hip fracture. Her medical history included long-term anorexia and a seizure disorder treated with phenytoin, an anticonvulsant drug.
Most people don't develop decreased bone mass over night. There are often signs and symptoms that there's a problem. Muscle pain, muscle weakness, a change in posture or gait (walking) pattern are often telltale signs if you know what to look for. The take home message from this article is for for everyone. All adults (even healthy adults) and health care professionals caring for patients should be on the lookout for such symptoms. Spinal deformities such as scoliosis (spinal curvature), kyphosis (increased forward spinal curve causing a hunchback appearance), leg bowing, or other bone deformities are additional signs of a problem.
Preventing vitamin D deficiency in the face of skin cancer has become quite a challenge. With the rising rates of skin cancer, the use of sunblock has limited the amount of sun exposure some people get. And for those with dark skin or who live in areas where the sun's rays don't reach a level sufficient to provide enough vitamin D, bone health is an issue. That's why current recommendations are for adults to supplement their diet with calcium and vitamin D (foods rich in vitamin D and calcium along with vitamin/calcium pills).
For individuals who have chronic health problems like cystic fibrosis or kidney disease, the challenge of getting enough vitamin D can be difficult. Research is underway trying to determine how much vitamin D and how often this product should be taken by people with these kinds of problems in order to ensure a safe blood level and absorption. These recommendations may vary depending on where the person lives and how much sunshine he or she gets at that geographical latitude.
For the patient in the second case reviewed (a 41-year-old man with cystic fibrosis), the lack of pancreatic enzymes needed to absorb vitamin D resulted in low levels of bone density. He was advised to increase his sun exposure and take at least 50,000 IU/day of vitamin D for two weeks. Retesting showed an improvement but not enough to be out of the danger zone. His vitamin D2 was bumped up to 100,000 IU/d for 30 days and then back down to a maintenance level of 50,000 IU/d once a week. He eventually responded well to this approach.
Some people who suffer low vitamin D levels have unusual health circumstances. In the third case examined during this study, a 41-year-old woman with chronic pancreatitis ended up with muscle weakness and falls as the first sign that something was wrong. With this condition, there is poor fat absorption. Vitamin K is a fat-soluble vitamin, which means it is absorbed by fat cells and used when needed. Without proper fat metabolism, vitamin D levels decline.
In this case, the patient was advised to go to a tanning booth twice a week to get the needed UV B rays. She was under the supervision of a dermatologist who prescribed the UV B therapy. The use of tanning booths is not normally recommended because of the increased risk of deep, long-term skin damage and skin cancer. Studies are needed to determine the safety and effectiveness of this treatment approach for vitamin D deficiency.
Case number four was an older adult (92 years old) with kidney disease. Just turning over in bed caused two very painful vertebral bone compression fractures, which tells you how weak his bones were. Hyperparathyroidism, a result of having chronic kidney disease is also a risk factor for vitamin D deficiency. The longer the patient has had chronic kidney disease and the more progressed the disease is, the greater the risk is for vitamin D depletion and bone loss.
The final case study presented was a middle-aged male (45 years-old) with osteoporosis and a serious seizure disorder that required chronic use of an anticonvulsant. Medications of this type seem to be able to inactivate vitamin D in the body. Taking supplemental doses helps but the exact dosage needed varies and must be determined on a case-by-case basis. Anyone taking vitamin D depleting medications should be tested every year for vitamin D blood levels and bone density. For anyone with vitamin D deficiency, active measures must be taken to correct the problem through diet, supplementation, and supervised sun exposure (or UV-B therapy).
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References:
Andrea N. Jones, and Karen E. Hansen, MD. Recognizing the Musculoskeletal Manifestations of Vitamin D Deficiency. In The Journal of Musculoskeletal Medicine. October 2009. Vol. 26. No. 10. Pp. 389-396.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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