Friday, May 14, 2010

Vitamin D Deficiency in Adults

By Marilyn Nelson, MD



Most of us are aware of the association of Vitamin D with bone health.  Supplements of Calcium and Vitamin D help maintain normal bone density.  Unfortunately, this is often not addressed until there is already significant loss of bone density, and increased risk of fractures.  Vitamin D deficiency is also associated with muscle weakness, muscle aches and increased risk of falls.  It may cause low back pain, or bone pain.  These symptoms are often vague, nonspecific, and may be misdiagnosed as fibromyalgia, CFS (chronic fatigue syndrome), arthritis, or side effects from other medications such as statins (cholesterol lowering medications).  Vitamin D deficiency may also play a role in increased risk of Heart Disease, Colon Cancer and Depression, but more research is needed.

Vitamin D deficiency is becoming more common. There are estimates that 50% of adults age 65 and older in North America, and 66% of persons internationally have failed to maintain healthy bone density and tooth attachment due to inadequate Vitamin D levels.

Risk factors for Vitamin D deficiency
1. Increasing age
2. Decreased sun exposure -
            Increased use of sunscreen (does decrease risk of skin cancer)
            Shift work - 2nd and 3rd shift workers tend to sleep during the day
            Religious or other beliefs that require covering all skin when outside
            Living more than 40 degrees latitude from the equator
                        north of NYC, or south of Wellington New Zealand
3. Being overweight - more Vit D is bound by body fat, and less available for use
            as needed by the body
4. Dark skin - produces less Vit D than light skin
5. Fat malabsorption syndromes - cystic fibrosis, many forms of liver disease,
            Gastric bypass surgery, inflammatory bowel disease
6. Some Medications - many anticonvulsants (seizure medications),
glucocorticoids, or rifampin (medication to treat Tuberculosis)


General recommendations are for 200 IU Vit D3 for adults under 51yo, 400 IU for those 51 to 70yo, and 600 IU for adults over 70.  However, the best indicator of vitamin D status is a blood test, 25-hydroxyvitamin D.  This should be checked in anyone with unexplained symptoms, or increased risk factors, such as those listed above.  Recommendations can then be based on your Vitamin D level.  It is possible to get too much Vit D, and this may cause nausea, vomiting, headache, kidney stones, pancreatitis, or vascular calcifications.  People with uncorrected hyperparathyroidism, metastatic bone disease, sarcoidosis, or Williams Syndrome should not take Vitamin D supplements.

More information about Vitamin D from WebMD, a trusted source of health and medical information:

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