Tough break: Osteoporosis, calcium, and vitamin D deficiency

Column by Dr. Tim Moser

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By Dr. Tim Moser, Denver House Calls in Denver
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It is very early in the morning and your elderly mother sits up in her bed. She has slept poorly this night, and decides her insomnia has been caused by her full bladder. Slight dizziness accompanies her as she stands from the sitting position on the side of her bed. Feeling her surroundings are familiar in her home, she does not turn on the light as the gropes her way in the dark towards her bathroom.

As she placed her weight on her right leg, there is the sudden onset of excruciating pain in her hip. She crumples to the carpeted floor, unable to bear weight on her leg. Stunned, it takes a moment to make sense of what has just happened. Her hip has fractured, and she is in immediate need of medical attention.

Your mother calls to your father, who is still asleep in bed. Gradually, he awakens, and is alarmed to find his wife on the floor, unable to stand. He immediately calls 911, and the paramedics arrive within minutes. Your mother is taken to the hospital by ambulance, and is taken to surgery for hip surgery later the same day.

Osteoporosis is a common condition affecting primarily post-menopausal women. Men and middle age adults of both sexes may also be affected, depending on the associated medical problems which may be present. This is a dreaded diagnosis for a patient, since it usually means prescription medications will be prescribed to help correct the problem.

All about osteoporosis

Osteoporosis literally means porous bones in Greek. It is usually the result of a complex interplay between what you have inherited from your parents, diet, and activity level. Also, smoking tobacco definitely increases the risk for thin bones.

Thin bones have a tendency to break more easily. This can result in a deformed spine from vertebral fractures (leading to the characteristic bent over appearance of many elderly folks), a fractured wrist from a simple fall, or a hip fracture, which is by far the most serious fracture, since it can be life threatening for the elderly.

Those at the highest risk for osteoporosis include women over the age of 65, smokers, thin individuals, having a family member that has been diagnosed with osteoporosis, and being of Caucasian or Asian descent.

The Vitamin D connection

Osteoporosis is the result of many possible factors over several decades. Those at risk can lower their chances of a fracture several ways. Here is where Vitamin D plays a role. The body cannot properly absorb the calcium needed for strong bones without adequate Vitamin D. Vitamin D is unique among all vitamins, since your body is able to manufacture it's own supply, as long as exposure to strong sunlight (ultraviolet radiation) is present. It has been estimated that being in the sun for 20 minutes every day during the spring or summer months would be enough to prevent Vitamin D deficiency. Of course, patients are warned to avoid strong sunlight without adequate skin protection to avoid the harmful and damaging effects from ultraviolet radiation, namely skin cancer. Patients that are in the most need for Vitamin D (the elderly) are often never exposed to sunlight at all. The result is an almost epidemic of Vitamin D deficiency in the United States.

The recommended daily allowance (RDA) of Vitamin D has been increased recently. It used to be a mere 400IU ( International Units) was deemed adequate, but this was woefully inadequate. Most experts agree the dose should be a whopping 1000IU of Vitamin D every day. Fear not, overdose of Vitamin D is very rare, and should not occur unless very high doses (15,000IU per day or higher) are ingested.

The calcium connection

Adequate calcium in the diet is also needed for bone health. Doctors recommend 1200 mg of calcium per day. Many times supplements are needed to reach this goal, and often these calcium supplements are also fortified with Vitamin D. Calcium citrate is absorbed the best of all the calcium types, since it does not require the action of stomach acid to pass across the intestine wall.

Women in their 30's (especially those that have a family history of osteoporosis, or other risk factors) should work on building strong bones before menopause is reached. Regular weight bearing exercise helps increase the bone density in all age groups, and has the added benefit of heart health, weight loss, and improved mood.

Need more information? The following Web sites may help.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001400/

http://www.mayoclinic.com/health/osteoporosis/DS00128

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