Posts Tagged ‘25-hydroxy Vitamin D’
We have “known” for years that 25-hydroxy Vitamin D levels over 50ng/ml are “too high” (hypervitaminosis D) and often cause high Calcium levels (hypercalcemia). The Mayo Clinic designed a 10 year study to confirm that causal relationship. It was presented at ASBMR.
NOF and others have called for higher Vitamin D supplementation and higher blood levels. Mayo researchers expected to find many more cases of hypercalcemia related to many more cases of hypervitaminosis D. The numbers of Vitamin D levels above 50ng/ml have doubled during the 10 years. Levels above 80 and 100ng/ml have not increased. The numbers of high calcium levels have not increased. Those patients with the highest Vitamin D levels were not the patients with the highest Calcium levels.
This week a patient was delighted to know she had no bone worries – based on her t-score of -2.4 in her hips. Unfortunately she was very wrong! “Osteopenia” is just a single test result. Other factors placed her at High Risk for Fracture.
One test does not tell the whole story. For instance, my total cholesterol is “normal”. That means that I have no heart worries? Wrong! I have hypertension, type-2 diabetes, and a history of congestive heart failure. I am at risk for heart problems. My patient is at risk for bone problems, specifically Fragility Fractures.
Patients often ask “What’s that for?” when I order blood tests. They understand that DXA is for Bone Mineral Density (BMD). They understand Vertebral Fracture Assessment (VFA) when I show the lateral Spine image to them on the screen. Blood tests are a bit more challenging.
Osteoporosis is often caused or made worse by other diseases and conditions. We screen for the common diseases and conditions. Some of them are easily corrected. Easy or hard, they must be identified and corrected to maximize bone health and minimize fracture risk. For this we need blood tests.
Once again we are warned of the dangers of calcium supplements. Once again those studies cited prescribed supplements without regard to total calcium intake, including diet. What matters is total calcium intake, including diet.
I prescribe a lot of Calcium Citrate for my patients. I would prefer not to. Dietary Calcium is more easily digested than supplements, and appears to hold fewer dangers than Calcium Carbonate or other calcium supplements. Unfortunately, we have lost our taste for calcium rich foods. There are tasty choices.