Vitamin D and Bone Health

Vitamin D plays an important role in protecting your bones. Your body requires vitamin D to absorb calcium. Children need vitamin D to build strong bones, and adults need it to keep bones strong and healthy. When people do not get enough vitamin D, they can lose bone. Studies show that people with low levels of vitamin D have lower bone density or bone mass. They are also more likely to break bones when they are older.

Severe vitamin D deficiency is rare in the United States. It can cause a disease known as osteomalacia where the bones become soft. In children, this is known as rickets. This is a different condition from osteoporosis.

NOF Recommendations for Vitamin D

The National Osteoporosis Foundation (NOF) recommends that adults under 50 get 400-800 International Units (IU) of vitamin D daily, and that adults 50 and over get 800-1,000 IU of vitamin D daily. Some people may need more. There are two types of vitamin D supplements. They are vitamin D3 and vitamin D2. Previous research suggested that vitamin D3 was a better choice than vitamin D2. However, more recent studies show that vitamin D3 and vitamin D2 are equally good for bone health. Vitamin D3 is also called cholecalciferol. Vitamin D2 is also called ergocalciferol.

Very high amounts of vitamin D can be harmful and may result in kidney stones and other kidney problems. Some kidney problems can cause bone loss. Experts disagree on the safe upper limit for vitamin D. In the past, experts said that people should not get more than 2,000 IU of vitamin D a day. Because of recent studies, some experts now say that a much higher amount is safe. It is difficult to get too much vitamin D unless a person is taking a prescription dose of the vitamin. In that case, healthcare providers can easily monitor a person’s vitamin D level with a blood test.

Sources of Vitamin D

There are three ways to get Vitamin D:

• Sunlight
• Food
• Supplements and medications

Sunlight

Your skin makes vitamin D from the ultra-violet light (UVB rays) in sunlight. Your body is able to store the vitamin and use it later. The amount of vitamin D your skin makes depends on time of day, season, latitude, skin pigmentation and other factors. Depending on where you live, vitamin D production may decrease or be completely absent during the winter. It is difficult to measure the amount of vitamin D that your skin makes.

People with fairer skin make more vitamin D than people with darker skin. People who live in higher latitudes such as New York, instead of lower latitudes such as Florida, may get less vitamin D from sunlight. Window glass and air pollution also decrease the amount of vitamin D that your skin can make.

People who are housebound and do not get outside in the sun are unable to make vitamin D. As adults age, the ability to make vitamin D decreases.

Because of concerns about skin cancer, many people stay out of the sun, cover up with clothing and use either sunscreen or sunblock to protect their skin. Probably the most important factor which limits the ability of the skin to make vitamin D is the use of sunscreen and sunblock. Even an SPF (sun protection factor) of 8 reduces the production of vitamin D by 95 percent. These products help protect the skin from the harmful effects of the sun. Because of the cancer risk from staying in the sun, many people need to get vitamin D from other sources.

Food

Vitamin D is naturally available in only a few foods. It is very difficult to get all the vitamin D you need from food. Foods that have vitamin D include fatty fish (examples are mackerel, salmon and tuna), egg yolks and liver. Vitamin D is also added to milk and to some brands of orange juice, soymilk and cereals. At this time vitamin D is not added to other milk products like cheese, yogurt and butter.

Supplements and Medications

Many people do not get enough vitamin D. Therefore, they may need to take a supplement. Before adding a supplement with vitamin D, check whether your calcium supplement, multivitamin or medication contains vitamin D. Excluding sunlight, the total vitamin D you get includes the following: food + supplements (including multivitamin) + medications.

People Who May Not Get Enough Vitamin D

People most likely at risk for not getting enough vitamin D include:

• people who spend little time in the sun
• people with very dark skin
• elderly people
• people living in nursing homes or other institutions
• people with certain medical conditions such as serious diseases of the nervous or
• digestive systems
• obese or very overweight people.

Lab Test to Check Your Vitamin D Level

Some people ask how they can know if they are getting enough vitamin D. The best way to find out is with a simple blood test that checks your vitamin D level. Discuss with your healthcare provider whether you should have this test done. It measures 25-hydroxyvitamin D, which is also written as 25(OH)D. This test should not be confused with a test for 1,25-dihydroxyvitamin D.

To protect your bone health, you need one of the following test results according to most experts:

• 75 nmol/L or higher
• 30 ng/mL or higher  [the optimal range is 20 ng/mL or higher]

If you have osteoporosis and your blood test shows that you do not have enough vitamin D, your healthcare provider may prescribe extra vitamin D (usually vitamin D2) until your blood level increases. Most healthcare providers do this for a short time to quickly boost the vitamin D level. Afterwards, you should continue on a vitamin D dose that maintains the blood level you need to protect your bones.

For your health and convenience, Pure Prescriptions now offers the vitamin D lab test (25-hydroxyvitamin D).

FYI, May is also National Physical Fitness and Sports Month sponsored by the President’s Council and the Department of Health and Human Services.

Exercise is strongly recommended for prevention of osteoporosis.  Here are the specific recommendations by the National Osteoporosis Foundation:

Bone is living tissue that responds to exercise by becoming stronger.

You know that your muscles get bigger and stronger when you use them. Bones are similar; they get stronger and denser when you make them work. And “work” for bones means handling impact, the weight of your body, or more resistance. Currently, we know the most about two types of exercises that are important for building and maintaining bone density. These are:

WEIGHT-BEARING, IMPACT EXERCISES.
These exercises include activities that make you move against gravity while staying upright.

Weight-bearing, High-Impact Exercises are best for building bones in people who do not have low bone mass, osteoporosis or are frail.

Some of these exercises include:

• Dancing
• High-impact aerobics
• Hiking
• Jogging/running
• Jumping Rope
• Stair climbing
• Tennis

 
Weight-bearing, Low-Impact Exercises can also help to build bones and are safer for people who cannot do high-impact exercises.

Some of these exercises include:

• Elliptical training machines
• Low impact aerobics
• Stair-step machines
• Walking (treadmill/outside)

RESISTANCE AND STRENGTHENING EXERCISES
These exercises include activities where you move your body, a weight or some other resistance against gravity.

• Functional movements, such as standing and rising up on your toes
• Lifting weights
• Using elastic exercise bands
• Using weight machines
• Lifting your own body weigh

 
NON-IMPACT ACTIVITIES (BALANCE, FUNCTIONAL AND POSTURE EXERCISES)
These exercises can help you to improve balance, posture, and how well you move in every day activities. These exercises can also help to increase muscle strength and decrease the risk of falls and broken bones.

Some of these exercises include:

• Balance exercises. Exercises that strengthen your legs and challenge your balance, such as Tai Chi, can decrease your risk of falls.
• Posture exercises. Exercises that improve your posture and reduce rounded or “sloping” shoulders can help you decrease the risk of fractures, especially in the spine.
• Functional exercises. Exercises that improve how well you move can help you in everyday activities and decrease your risk of falls and fractures. For example, if you have trouble getting up from a chair or climbing stairs, you should do these activities as exercises (try standing up and sitting down several times until you are tired).

Yoga and Pilates can also improve strength, balance and flexibility; however people with low bone density or osteoporosis should avoid certain positions to prevent fractures. These include forward-bending exercises. A physical therapist should be able to help you learn which exercises are safe and appropriate for you.

NON-WEIGHT-BEARING, NON-IMPACT ACTIVITIES
These exercises can be part of a well-rounded exercise program, but do not help to build bones. If you like these activities, try to add in others that work your bones

Some of these exercises include:

• Bicycling/indoor cycling
• Deep-water walking
• Stretching and flexibility exercises
• Swimming
• Water aerobics

NOF’s publication, Boning Up on Osteoporosis offers step-by-step instructions and illustrations for posture exercises, hip and back strengthening exercises, balance exercises and functional exercises.

If you can’t do high-impact weight-bearing activities, try lower-impact ones. For example, try walking or stair-climbing instead of jogging. If you haven’t exercised regularly for a while, check with your healthcare provider before beginning a new exercise program—particularly if you have health problems such as heart disease, diabetes or high blood pressure.

Once you have your healthcare provider’s approval, start slowly. If you have already had spine fractures from osteoporosis, be very careful to avoid activities that require reaching down, bending forward, rapid twisting motions, heavy lifting and those that increase your chance of a fall.

HOW MUCH EXERCISE SHOULD I DO?
Weight-bearing, impact exercises should be done for 30 total minutes on most days of the week.

• Aim for 30 minutes at one time or break it up during the day. For example, 3 sessions for 10 minutes each will provide the same bone benefit as one 30-minute session.
• If you can’t fit 10 minutes in, spread your impact exercises throughout your day by taking the stairs or by parking farther from the store or work.

Resistance/strengthening exercises should be done two to three days per week.

• Try to do one exercise for each major muscle group for a total of 8-12 different exercises. Some of the major muscle groups include:
  • Upper back
  • Middle back
  • Lower back
  • Shoulders
  • Upper arms
  • Forearms (wrists)
  • Chest
  • Abdominals
  • Hips
  • Thighs
  • Calves (lower legs)
• Do one or two sets of 8 to 10 repetitions for each exercise. For example, if you lift a weight 10 times in a row and then stop, you have completed one set of 10 repetitions. You should rest for about 30 seconds to one minute between each set.
• If you can’t do 8 repetitions in a row, the weight is too heavy or resistance is too much.
• If you can do more than 10 repetitions in a row, you should probably increase the weight or resistance.
• If you have osteoporosis or are frail, you may want to do 10 to 15 repetitions of a lighter weight.

If you’re at high risk of having a fracture, you should work with a physical therapist to develop a safe exercise program.

If you don’t have much time for strengthening/resistance training, do small amounts at a time. You can do just one body part each day. For example do arms one day, legs the next and trunk the next. You can also spread these exercises out during your normal day.

Balance, posture and functional exercises can be done every day. You may focus on one area more than the others. If you have fallen or lose your balance, spend time doing the balance exercises. If you are getting rounded shoulders, work more on the posture exercises. If you have trouble climbing stairs or getting up from the couch, do more functional exercises. You can also perform these exercises at one time or spread them throughout your day.

As you get started, your muscles may feel sore for a day or two after you exercise. If soreness lasts longer, you may be working too hard and need to ease up. Exercises should be done in a pain-free range of motion.

In summary:

• Evaluate vitamin D
• Review exercise recommendations
• Also consider evaluating your hormones which also play an integral role in bone strength (also offered at Pure Prescriptions)