Vitamin D Deficiency And Osteoporosis

September 19, 2011 Jean Morgan Osteoporosis, 13

Vitamin D Deficiency And Osteoporosis

In simple terms, osteoporosis means “weak bones.” With weak bones, you’re at increased risk of breaking a bone even after a trivial trauma that otherwise wouldn’t cause a fracture.

While no one is immune, the following conditions increase your risk for Osteopenia/Osteoporosis:

Vitamin D deficiency
Elderly men and women
Post-menopausal women
Men with low testosterone
Patients on steroids
Patients with an over-active thyroid gland
Patients who receive too much thyroid hormone in a pill form
Patients with Diabetes
Patients with Rheumatoid arthritis

In medical literature, it’s well established that vitamin D deficiency is a major cause for osteoporosis. A number of studies have clearly shown that people with osteoporosis are often low in vitamin D. In one such study (1), researchers looked at the bone mineral density, calcium intake and vitamin D level of 4958 women and 5003 men living in the U.S.; They found that there was a direct correlation between vitamin D level and bone mineral density: the lower the vitamin D level, the lower the bone mineral density and the higher the vitamin D level, the higher the bone mineral density.

In the same study, researchers also found that calcium intake of more than about 600 mg per day did not cause any increase in bone mineral density in the majority of patients. This obviously contradicts the standard advice to take at least 1500 mg per day of calcium to keep your bones healthy. It’s clear that vitamin D plays the predominant role in determining bone strength. Calcium intake of about 600 mg per day is adequate if you have a good level of vitamin D.

In another study (2), researchers obtained vitamin D levels in 1292 menopausal women with osteopenia or osteoporosis living in France. They found that 90% of these women were low in vitamin D.

The main reason of concern regarding low bone mineral density is that if you have osteopenia or osteoporosis, it increases your risk for fracturing a bone. When you have osteoporosis, even a trivial trauma can cause a fracture.

Is there a direct correlation between the level of vitamin D and risk for fracture? The answer is Yes. In an interesting study (3), researchers investigated the hypothesis that low vitamin D places you at risk for a fracture of the bone, regardless of whether the trauma is trivial or heavy. The research was carried out at a hospital in New York. The researchers found that 59% of all patients (men and women) with a bone fracture after any degree of trauma were low in vitamin D. Even more impressive was the finding that up to 80% of women who sustained a fracture after a trivial or heavy trauma were low in vitamin D. 

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When you’re low in vitamin D, as most people are, your bones start to weaken. Therefore, the first step in the treatment of osteopenia and osteoporosis is to achieve a good level of vitamin D in your body. As discussed in Chapter 23, Treatment of Vitamin D Deficiency, for most people that means taking a large dose of Vitamin D supplement.

Unfortunately most physicians don’t check vitamin D level in patients with osteopenia/osteoporosis and rush to prescription drugs. With this approach, vitamin D deficiency remains undiagnosed and untreated and can have serious health consequences.

Perhaps now you understand one of the most important factors causing osteopenia/osteoporosis is vitamin D deficiency. Unfortunately, it’s often ignored.  Meanwhile, pharmaceutical companies push their anti-osteoporosis drugs. Unfortunately, vitamin D doesn’t have the backing and marketing muscle of a pharmaceutical company, because it’s cheap and easily available over the counter. Physicians are taught to diagnose osteopenia  or osteoporosis and prescribe a drug, without even checking vitamin D level.  Sad, but it is a fact.

Over the years, I’ve seen many patients take expensive anti-osteoporosis drugs faithfully, but their osteoporosis gets worse. When checked, I find these patients to be quite low in vitamin D. Simply treating them with the right dose of vitamin D makes all the difference in the world.

Most people, including many doctors, don’t quite understand what osteoporosis really is. Let me explain to you what really goes on in the bones when someone develops osteoporosis.

Bones, like every other organ in the body, are constantly going through a “death and birth cycle of tissues.” Old bone is eaten away by specialized cells in the bone called osteoclasts. This process is called bone resorption. Then, another type of cells in the bones called osteoblasts lay down new bone in the space created by the resorption of the old bone. This process is called bone formation. These are slow processes and take place over a period of several months.

When I see a patient with osteopenia or osteoporosis, first of all I check her/his vitamin D level, which often turns out to be low. I put these patients on a good dose of vitamin D which is usually in a range of 2000-6000 units of vitamin D3 per day. Details for determining the proper dose of vitamin D are discussed in Chapter 23, Treatment of Vitamin D Deficiency. 

In my patients, I monitor mineral bone density every one to two years.  If a patient has a good vitamin D level, yet continues to have low bone density as estimated by the T-score on a bone DXA test, then I add an anti-osteoporosis drug. However, before I add any anti-osteoporosis drug, I discuss efficacy and potential side-effects of each of these medications and let my patient decide which potential side-effects they are willing to gamble on. In this way, my patients make an educated, well-informed decision when they choose to take an anti-osteoporosis drug.

1. Bischoff-Ferrari HA, Kiel DP, et al. Dietary calcium intake and serum 25-hydroxyvitamin

    D status in relation to BMD among U.S. adults. J Bone Miner Res. 2009; 24(5):935-942.

2. De Cock C, Bruyere O, et al. Vitamin D inadequacy in French osteoporotic and

    osteopenic women. Joint Bone Spine. 2008;75(5):567-572.

3. Steele B, Serota A, et al. Vitamin D deficiency: A common occurrence in both high and

    low-energy fractures. HSS J. 2008;4(2):143-148.

4. Bruyere O, Reginster JY. Vitamin D status and response to antiosteoporotic therapy.

   Womens Health (Lond Engl). 2008;4(5):445-447.

 

About the Author:

Sarfraz Zaidi, MD specializes in Endocrinology, Diabetes and 
Metabolism. He is a leading Endocrinologist and Diabetologist in the 
U.S. Dr. Zaidi is an Assistant Clinical Professor of Medicine at UCLA. 
In addition, he is the Medical Director at the Jamila Diabetes and 
Endocrine Medical center, in Thousand Oaks, California, where he 
enjoys a busy clinical practice. Patients come to see him not only 
from various parts of California but also from other states and even 
from other countries.

Dr. Zaidi loves to teach. He has published numerous articles in many 
prestigious medical journals. He frequently lectures other physicians 
as well as the general public.

Dr. Zaidi’s mission is to disseminate the correct, uninfluenced and 
up to date medical information. He is the author of the popular diabetes 
book, “Take Charge of Your Diabetes” which came out in 2007 and has 
touched the lives of thousands of people in the U.S. and around the 
world. His latest ground breaking book,” Power of Vitamin D” just got 
released and is bound to help millions of people around the world.

Dr. Zaidi also has an educational website, www.doctorzaidi.com

 

 

 

 

 

Check out these sites for more menopause information

vitamin d level
vitamin d level
Menopause | What to expect during menopause | womenshealth.gov
European Menopause and Andropause Society - Wikipedia the free ...
Menopause and menopause treatments fact sheet | womenshealth ...

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