Daily D Good Bone Defense
Despite widespread recommendations of taking vitamin D as a bone-strengthening measure, several recent studies have questioned whether it is useful for fracture prevention. A new study published in the Archives of Internal Medicine suggests that supplemental vitamin D remains an important defense against fractures and may reduce the risk of certain fractures by at least 20% in people over age 65.
Getting enough D
The authors of a meta-analysis evaluated 20 randomized controlled trials to determine the benefits of supplemental vitamin D (D3, or cholecalciferol; and D2, or ergocalciferol) in preventing breaks in bones not related to the spine (nonvertebral) and hip fractures in seniors. Nearly 90% of the participants in the trials were women. Results showed that:
• Taking 482 to 770 IU per day reduced the risk of nonvertebral fractures by at least 20% compared with people who took less.
• Taking the higher amount reduced hip fracture risk by 18%, compared with people who took less.
• Risk of fractures did not decrease in people who took less than 380 IU per day.
• Taking vitamin D and calcium together reduced risk of nonvertebral fractures by 20%, compared with the placebo group—however, trials comparing people who took vitamin D alone with people who took placebo pills also had about a 20% reduced risk, suggesting that vitamin D is at least as important as calcium for preventing fractures.
Fracture risk was reduced most in people who took higher amounts of vitamin D and took it in the form of cholecalciferol rather than ergocalciferol, and in people who had the highest blood levels of a measurement of vitamin D known as 25-hydroxyvitamin D.
The authors conclude that “a higher received dose of supplemental vitamin D (482 to 770 IU per day) should reduce nonvertebral fractures by at least 20% and hip fractures by at least 18%.” Based on their findings, they note that commonly recommended amounts of vitamin D for fracture prevention may not be enough to reduce risk and that higher amounts should be explored in future research to optimize risk reduction.
Boning up on bone health
Vitamin D supplements are one important option for both men and women for keeping bones healthy as people age, but there are other important steps that people can take to maintain bone strength, such as:
• Talk with your doctor. Don’t begin taking supplements or start a new exercise program without first discussing best options for reducing your risk for age-related fractures with a doctor who knows you and your overall health status.
• Get plenty of vitamin D. Vitamin D is plentiful in fish, cod liver oil, and fortified milk and other fortified food products and is available as a dietary supplement. Getting small amounts of sun regularly can also increase D levels in the body, but the benefits should be weighed against the increased risk of skin cancer.
• Talk with your doctor about calcium supplements. Calcium supplements have also been shown to reduce the risk of fractures in both men and women.
• Exercise daily. Weight-bearing exercises such as brisk walking are excellent for building and maintaining bone strength. National guidelines recommend that healthy adults exercise 30 to 60 minutes per day most days of the week.
• Don’t smoke or drink excessive alcohol. Both smoking and drinking may harm your bones. People shouldn’t smoke at all and should follow the recommended guidelines for drinking, which for healthy people is no more than one alcoholic drink per day for women and one to two alcoholic drinks per day for men. Some people shouldn’t drink alcohol at all due to certain health conditions or medications they take.
• Review medications with your doctor. Some drug treatments may harm bones, such as long-term steroid use, but changes to treatment should always be discussed with a doctor first. Review your medications with your physician to see if they are affecting your risk for fractures and discuss options to help protect your bones.
April 30, 2009
(Arch Intern Med 2009;169:551-61.)
Jane Hart, MD, board-certified in internal medicine, serves in a variety of professional roles including consultant, journalist, and educator. Dr. Hart, a Clinical Instructor at Case Medical School in Cleveland, Ohio, writes extensively about health and wellness and a variety of other topics for nationally recognized organizations, Web sites, and print publications. Sought out for her expertise in the areas of integrative and preventive medicine, she is frequently quoted by national and local media. Dr. Hart is a professional lecturer for healthcare professionals, consumers, and youth and is a regular corporate speaker.
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