The role of vitamin D in osteoporosis – Jan 2015

doi:10.1016/j.maturitas.2014.12.018 online 13 January 2015
Max Brincata, , Jeannine Gambina, Mark Brincata, Jean Calleja-Agiusa, b, ,

Highlights

• Circulating vitamin D predominately arises from synthesis in the skin after exposure to sunlight (ultraviolet B photons with wavelengths between 290 and 315 nm) and should therefore be considered as a hormone.
• Vitamin D deficiency is world-wide epidemic and presents when serum 25 hydroxyvitamin D levels fall below 50 nmol/L.
• Vitamin D deficiency is a factor in the multifactorial causes of non-vertebral & hip fractures, falls and loss of muscles power.
• It is recommended that a deficiency in vitamin D should be aggressively treated with higher pharmacological doses with the aim of achieving serum levels above or equal to 75 nmol/L.
• Further RCTs are needed to evaluate a possible isolated or combined role for vitamin D in reduced bone mass density, non-vertebral fractures, falls and muscle strength.
• Future research should focus on the effects and implications of treating vitamin D deficiency with high pharmacological doses (>1000 IU).
• The aim is to achieve a general consensus on recommended doses of vitamin D supplementation.

Abstract
It is known that circulating vitamin D predominantly originates from cutaneous synthesis and therefore should be considered as a hormone rather than a vitamin. Vitamin D deficiency (<50 nmol/L) is a worldwide epidemic with multiple implications on human health, due to its role in various physiological systems. Various studies have shown that with higher serum 25 hydroxyvitamin D levels, there is a decrease in the incidence of non-vertebral and hip fractures. There is limited research data on the management of vitamin D deficiency using therapeutic doses. The majority of studies focus on lower physiological doses rather than high pharmacological doses. In order to reach serum levels of 75 nmol/L from a deficiency state, higher doses than 800–1000 IU/day are required. Future focus should be on the implications of a rise in systemic 25(OH)D3 levels from a deficiency state to 75 nmol/L on bone density and fracture risk, and the use of high doses in cases of vitamin D deficiency. Vitamin D treatment and supplementation need to be re-evaluated in the light of new evidence suggesting that high pharmacological doses need to be used in order to obtain the desired effect in the prevention of osteoporosis and recurrence of osteoporotic fractures.

1. Introduction
2. Vitamin D synthesis
3. Dosage
4. Vitamin D deficiency
5. Vitamin D anti-fracture efficacy and risk of falls
6. Dose recommendations
7. Conclusion
8. Practice points
9. Research agenda

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See also VitaminDWiki

• 20X increase in vitamin D sold and 36 percent decrease in osteoporosis business in Australia – Nov 2013
• Overview Osteoporosis and vitamin D contains the following summary
• FACT: Bones need Calcium (this has been known for a very long time)
• FACT: Vitamin D improves Calcium bioavailability (3X ?)
• FACT: Should not take > 750 mg of Calcium if taking lots of vitamin D (Calcium becomes too bio-available)
• FACT: Adding vitamin D via Sun, UV, or supplements increased vitamin D in the blood
• FACT: Vitamin D supplements are very low cost
• FACT: Many trials, studies. reviews, and meta-analysis agree: adding vitamin D reduces osteoporosis
• FACT: Toxic level of vitamin D is about 4X higher than the amount needed to reduce osteoporosis
• FACT: Co-factors help build bones.
• FACT: Vitamin D Receptor can restrict Vitamin D from getting to many tissues, such as bones
• It appears that to TREAT Osteoporosis:
•        Calcium OR vitamin D is ok
•        Calcium + vitamin D is good
•        Calcium + vitamin D + other co-factors is great
•        Low-cost Vitamin D Receptor activators sometimes may be helpful
• CONCLUSION: To PREVENT many diseases, including Osteoporosis, as well as TREAT Osteoporosis
• Category Osteoporosis has 219 items
• Category Bone Health has 311 items

Note: Osteoporosis causes bones to become fragile and prone to fracture
  Osteoarthritis is a disease where damage occurs to the joints at the end of the bones

Pages in BOTH the categories Osteoporosis and Meta-analysis