The topic of Vitamin D and Calcium supplementation seems to pop up quite frequently on the evening news. Recent reports on the benefits of Vitamin D have been closely followed by concerns over side effects of too much Vitamin D. Experts vary in the recommendation of supplementation from 500 units daily to 50,000 units weekly, depending on whether you are Vitamin D deficient or insufficient. As far as Calcium goes, experts also have varying opinions that seem to change yearly. Some say you should take Calcium daily, others caution that we may be taking too much Calcium. So, what’s the big deal about Vitamin D and Calcium supplementation anyway?
In order to fully understand Vitamin D and Calcium supplementation, it’s important to understand why we supplement to begin with. In a nutshell, as we get older the likelihood of bony fractures or falls leading to bony fractures increase because our bone density decreases. Loss in bone density is called osteopenia and in more severe cases osteoporosis.
Osteoporosis is the most common bone disease in the U.S. and a major risk factor for fractures. In the U.S. there are more than 1.5 million osteoporotic fractures each year, attributing to an annual cost of $15 Billion in health care and disability expenses. Overall, osteoporosis affects women more than men, but it does affect men to a significant degree.
Fractures at a young age may at face value not seem so bad, but a fracture such as a hip fracture at an older age is much more significant and is associated with many other medical problems. Winter 2011 dealt Atlanta a pretty significant snow storm (I would call it ice storm). I can’t tell you how many people I came in contact with who slipped and fell or knew someone who slipped and fell. I know it sounds odd, but one of my initial thoughts when I hear of a fall is, “I hope they have dense bones.” I frequently see elderly patients who are hospitalized due to a fall that resulted in a hip fracture. They undergo surgery and post operatively develop worsening of their existing medical conditions such as tachycardia, or heart failure, or may develop new problems such as pneumonia or blood clots. Regardless, my point is that fractures at an older age can lead to many medical complications. The best strategy is prevention of osteopenia and osteoporosis and, consequently, avoidance of fractures. That’s the big deal about Vitamin D and Calcium Supplementation.
To be clear, it’s not just supplementation or the lack of supplementation that predisposes us to decreased bone density. A variety of genetic factors can predispose a person to low bone mass, such as gender, race, body build and family history. Acquired factors also predispose us to low bone density including a diet low in Calcium or Vitamin D, early menopause, a sedentary lifestyle, and cigarette smoking.
Let’s initially discuss prevention and screening of decreased bone density. Everyone clearly agrees that prevention is key. The health habits of individuals in early and middle life play a role in their risk of osteoporosis as they age. Adequate dietary intake of Calcium and Vitamin D, active physical exercise and avoidance of excess alcohol, tobacco and drugs known to cause osteopenia are all useful measures for the prevention of osteoporosis. As far as screening goes, we usually screen people with multiple fractures, women in the perimenopausal time of their life, as well as people with medical conditions that may predispose them to osteoporosis, such as hyperparathyroidism or other endocrine problems. The most commonly used test for screening is the DEXA bone scan. DEXA bone scans are available at most hospitals in Atlanta, including Piedmont and Northside Hospital. DEXA bone scans assist physicinas in making the diagnosis of osteoporosis at guide us in determinining treatment stratagies. Ask your doctor if she or he recommends this test for you.
As with most medical topics there is some degree of disagreement among the experts. How and who to supplement is what is usually debated. In November of 2010, the Institute of Medicine released their new recommendations for supplementation. This report was good juicy material for journalists. It became news because it was somewhat of a change of opinion from the existing recommendations. In this report the IOM reviewed the existing data on Vitamin D and Calcium supplementation. The report recommended specific individual daily requirements for optimum bone health that were slightly changed from the existing recommendations. The IOM underscored the importance of not over supplementing Vitamin D and Calcium in patients without deficiency. A couple of additional important points that were made were based on the medical communities views that Vitamin D and Calcium may play key roles in the immune system as well as in supporting a person’s overall cardiovascular health. The IOM report concluded that current evidence does not support other benefits for Vitamin D or Calcium intake such as immune system or cardiovascular benefits. The other key point they highlighted was the concern over measurement of Vitamin D. In the medical community we have for some time expressed concern over how reliable the lab results are when measuring a person’s Vitamin D level in the blood. The IOM report raised concern in the reliability of laboratories performing serum Vitamin D levels as these may have high variability and may possibly be over estimating the number of Vitamin D deficient persons. If you click on this link you will be directed to a pdf file that contains a summary of the IOM report, as well as my recommendations for supplementation.
As far as treatment goes, when people develop osteoporosis and associated fractures, separate from continued supplementation with Calcium and Vitamin D, there are treatments that help to prevent further excessive bone loss, promote bone formation, prevent fractures, reduce pain, and restore physical function. These medications, although somewhat controversial on their own, are available as a treatment strategy. These include: Estrogen Replacement, Selective Estrogen Receptor Modulators (SERMS), Bisponsphonates, and Calcitonin. If you have osteopenia or osteoporosis, I encourage you to speak with your primary care provider and/or endocrinologist to discuss these treatment options.