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Vitamin D Intake by Older People Should be Increased
for Bone Health
Osteoporosis experts reach consensus on role of
vitamin D for those over 50
Nov. 17, 2005 - The American Medical Women's
Association (AMWA) today issued physician recommendations to generate
greater understanding of the role of vitamin D in bone health in women
and men over 50, calling for an increase in currently recommended
vitamin D intake and encouraging individualized treatment in senior
citizen and late boomer patients.
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According to an analysis published in 2004 and
based on the Third National Health and Nutrition Examination Survey (NHANES
III), over 70 percent of women ages 51-70 and nearly 90 percent of women
over 70 are not getting the recommended adequate intake of vitamin D.
For this reason, AMWA recently convened a panel of experts to discuss
the importance of vitamin D for overall bone health, the challenges of
ensuring adequate vitamin D intake and how to best communicate this
information to primary care physicians, specialists and patients.
Vitamin D, an essential component in bone health,
helps ensure that the body absorbs and retains calcium, which is
critical for building strong, healthy bones. Vitamin D deficiency has
often been linked to osteoporosis, a condition that affects more than 10
million Americans and threatens 34 million others.
"We agreed that there is a need for increased
awareness of the role of vitamin D in osteoporosis treatment," said
Felicia Cosman, MD, clinical director of the National Osteoporosis
Foundation and associate professor of clinical medicine at Columbia
University School of Medicine, and chair of the expert panel.
"These
recommendations will serve to call attention to the high prevalence of
vitamin D deficiency and help ensure that patients, particularly women
and men over 50, receive optimal care for bone health."
The panel outlined the following action points
regarding vitamin D and its role in bone health for physicians treating
women and men over 50, including:
● Optimum treatment for bone health should be
individualized and may include a combination of exercise, healthy diet,
vitamin D and calcium supplements, and potentially, prescription
medications.
● Women and men over 50 receiving treatment for
osteoporosis need to receive adequate vitamin D. Supplements are
recommended as one of the best sources of vitamin D.
● Current daily vitamin D intake requirements for
women and men over 50 should be increased to 800-1,000 International
Units (IU).
An Increase in Current Vitamin D Intake
Current recommendations from the Institute of
Medicine (IOM) for vitamin D intake are 400 IU for women and men ages
51-70 and 600 IU for women and men over 70.
The roundtable panelists
expressed concern that current recommendations do not provide for
optimal bone health and recommended that intake levels be increased to
800-1,000 IU per day for patients over age 50.
In addition to the
government data that found 70-90 percent of postmenopausal women are not
taking the recommended adequate intake of vitamin D, an additional study
found that over half of postmenopausal women already being treated for
osteoporosis have inadequate levels of vitamin D, underscoring the need
for more aggressive treatment guidelines and greater overall awareness
of the role of vitamin D in bone health.
"The recommendations we provided are designed as a
guide for primary care physicians and specialists and are sufficient for
most patients. However, some patients may need to obtain serum levels of
vitamin D, as determined by their physician, to ascertain vitamin D
adequacy. Vitamin D deficiency should ultimately be treated on a
patient-by-patient basis," said Kimberly Templeton, MD, AMWA
representative and associate professor of orthopedic surgery at the
Kansas University Medical Center and fellow of the American Academy of
Orthopaedic Surgeons (AAOS).
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D-Bunking the Role
of Vitamin D in Bone Health |
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A How-To-Guide For Physicians And Patients To Treating Vitamin D
Deficiency
According to the
U.S. Surgeon Generals Report on Bone Health & Osteoporosis (2004),
vitamin D is an essential component in bone health and helps ensure that
the body absorbs calcium, which is critical for building strong, healthy
bones. Vitamin D deficiency has often been linked directly to
osteoporosis a condition that affects more than 10 million Americans
and threatens 34 million.
The American
Medical Womens Association (AMWA) convened a panel of top osteo-porosis
and bone health experts to address vitamin D deficiency and raise
awareness of the role of vitamin D in protecting bone health and overall
physical well-being.*
This Tip Sheet
contains the panel's recommendations to ensure that patients,
particularly women and men over 50, receive optimal care for their bone
health. The companion
Patient Brochure provides recommendations from the panel regarding
vitamin D and its role in bone health for women and men over 50.
Address Vitamin D
Needs for Optimal Bone Health
Understand the role
of vitamin D. Although most people are familiar with calciums role in
bone health, it is important to know that vitamin D is responsible for
helping your body absorb and effectively utilize calcium. Unfortunately,
research shows that over 70 percent of women ages 51-70 and nearly 90
percent of women over 70 are not getting an adequate intake of vitamin D
from food and supplements. Low levels of vitamin D are associated with
reduced calcium absorption, bone loss and increased risk of fracture.
Discuss vitamin D
supplementation. Supplements are recommended for women and men over 50
who, due to lifestyle, concern for skin cancer and wrinkling, and the
wide use of sunscreen, may not be enough sunlight exposure, and
therefore, may be at increased risk of vitamin D deficiency. It is also
difficult to obtain vitamin D through food sources because few foods
contain an adequate level of vitamin D.
Select a supplement
or tratment containing vitamin D3. Vitamin D3 is also called
cholecalciferol, and can help you reach an optimum blood level of
vitamin D. An alternate form of vitamin D, ergocalciferol (D2), can also
be effective when taken in higher doses and may be preferred by
vegetarians because it is a plant-based mineral.
Determine if an
increased dose of vitamin D is needed. In addition to vitamin D
deficiency, factors such as a personal history of fracture after age 50,
a family history of osteoporosis, inadequate calcium intake and inactive
lifestyle, among others, all contribute to an increased risk for
osteoporosis. If you are female, Caucasian or Asian, or of a small
frame, you are also at an increased risk for osteoporosis.
Discuss Treatment
Options
Determine the best,
individualized treatment option for optimal bone health. This should
include a combination of weight-bearing exercises, a healthy diet rich
in calcium and vitamin D, additional vitamin D and calcium
supplementation, and if needed, prescription medications.
Women and Men over
50 receiving treatment for osteoporosis need to receive adequate vitamin
D. Determine with your doctor whether use of a treatment containing
vitamin D may be advisable.
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"I encourage people to speak to their
physicians about whether vitamin D supplementation may be appropriate.
In addition, patients can access an online brochure on the AMWA web site
to learn more about the role of vitamin D in overall bone health."
Obtaining Adequate Levels of Vitamin D
Vitamin D is produced in the body after exposure to
UVB rays. Indeed, individuals can obtain over 90 percent of vitamin D
through sun exposure, but the panel agreed that this is becoming
increasingly difficult as a result of the wide use of sunscreen and
protective clothing, due to concerns about skin cancer and other skin
diseases, aging and geographic limitations.
Vitamin D is also found
naturally in a limited number of foods, such as fatty fish, and in
certain fortified foods such as milk, orange juice and ready-to-eat
cereal.
However, many of these foods are not part of most people's diets
or must be consumed in large volumes to meet the requirement. Therefore,
supplements were recommended as one of the best sources of vitamin D for
many older Americans.
In using supplements, the panel advised that
physicians should help their patients choose the supplement that is
right for them by explaining the medical terms associated with the
different forms of vitamin D.
Although bone health was the primary focus of the
recommendations, the panelists also reviewed other research studies
published in the recent months that reflect on vitamin D's ability to
potentially protect against lymphoma and cancers of the prostate,
breast, colon, ovary and other cancers, and noted that a variety of
research is currently underway to examine the effects of vitamin D on
other health conditions.
The Fundamentals of Vitamin D in Bone Health
Vitamin D plays an important role in building and
maintaining healthy bones by promoting calcium absorption. Suboptimal
levels of vitamin D are associated with reduced calcium absorption, bone
loss and an increased risk for osteoporosis -- a condition characterized
by low bone mass, bone fragility and susceptibility to fractures,
especially of the hip and spine.
In fact, the first-ever Bone Health and
Osteoporosis: A Report of the Surgeon General (2004) listed vitamin D,
along with calcium and physical activity, as the three key elements to
maintaining optimal bone health.
Based on relevant clinical practice
experience and involvement in various research that highlights the role
of vitamin D in bone health, the panel concluded that it is of paramount
importance that vitamin D be considered in patients being treated for
osteoporosis and other bone diseases.
To find out more about the recommendations and
vitamin D's role in bone health, talk to your physicians or visit
http://www.amwa-doc.org/ to view/download an online patient
brochure.
About AMWA
The American Medical Women's Association (AMWA) --
Founded in 1915 as the oldest and largest only national medical
association dedicated to women physicians, residents and medical
students, AMWA today represents a community of professionals working to
promote health, encourage the professional and personal development of
those in medicine, healthcare and health-related fields and provide a
range of educational, charitable and awards programs that make a
difference.
AMWA believes that medical decisions should be the
decision of a woman and her health care provider based on her individual
needs. AMWA does not endorse specific products or services.
Funding for this initiative has been provided by
Merck & Co., Inc.
Source: The American Medical Women's Association
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