Vitamin D Deficiency And Osteoporosis
Author: Dr. Sarfraz Zaidi, M.D.Vitamin D Deficiency and Osteoporosis
What is 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.
Who Gets Osteoporosis?
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
The Relationship Between Vitamin D Deficiency and Osteoporosis
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 90of 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 59of 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 80of women who sustained a fracture after a trivial or heavy trauma were low in vitamin D.
Treatment of Osteopenia/Osteoporosis
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.
What osteoporosis really is and how anti-osteoporosis drugs work.
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.
My approach to the Treatment of Osteopenia/Osteoporosis
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.
References:
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
Article Source: http://www.articlesbase.com/supplements-and-vitamins-articles/vitamin-d-deficiency-and-osteoporosis-1948615.html
About the AuthorSarfraz Zaidi, MD, FACP, FACE is an Assistant Clinical Professor of Medicine at UCLA. Dr. Zaidi is a leading expert on Vitamin D, Diabetes and Thyroid. He frequently lectures other physicians as well as the public. He has published numerous articles in medical journals. Dr. Zaidi is also director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California, where he treats patients on a daily basis. Dr. Zaidi is also the author of the popular Diabetes book, Take Charge of Your Diabetes, and the newly released book, Power of Vitamin D, both of which are available at www.DoctorZaidi.com.
