Posts Tagged ‘Vitamin D3’
Treat to Target means aiming for NO NEW FRACTURES. As discussed last time, the original target was to maintain Bone Mineral Density (BMD) at the level first tested. 25 years ago that was amended to be a T-score of -2.4 or higher, since “osteoporosis the test result” was set at -2.5.
But what if you already have fractured? Clinical Osteoporosis the diagnosis is a T-score of -1.5 plus a “Fragility Fracture” acquired in any fall from standing height, even on ice. That is because for the first year after a fracture your risk is 5 times normal. Your risk decreases to 2 times normal after 5 years, but always is higher after a fragility fracture.
If your Fragility Fracture was a Hip Fracture, you have Clinical Osteoporosis regardless of DXA BMD and T-score. You are at high risk of future fracture, especially of the other hip. You should start treatment to prevent a new fracture. At the very least you need to optimize calcium, vitamin D3, protein, and multiple vitamins & minerals intake.
If you also need a pharmaceutical, it should be one which can raise your T-score above -2.5 if you have no fractures, and above -1.5 if you already have a fracture. That usually means considering an anabolic. Your goal is NO NEW FRACTURES.
FRAX next time.
Jay Ginther, MD
Spring! The Sun is back for more than 12 hours daily! The sun crossed the equator at 0529 CDT. Vitamin D? Not so fast. This is Iowa and we are still too far north.
Your skin can make Vitamin D when exposed to strong enough sunlight. Strong enough sunlight happens when the sun is high enough in the sky that its UV rays are not blocked by the atmosphere. This happens at mid-day all year round in the tropics.
Iowa needs to wait another couple of weeks for our first moments of Vitamin D from the sun. Mid-day is around 1:10 to 1:25 pm CDT, depending on location. Southern Iowa will get enough sunlight several days before northern Iowa. Late June we will have 4-5 hours of opportunity.
Unfortunately, Vitamin D, Sunburn and Skin Cancer are often a package deal. You can encourage them all, or block them all with Sun-block.
Your safest move is to protect yourself from sunburn and skin cancer, and take your vitamin D3 tablets or gel-caps. A 25-hydroxy Vitamin D blood test will show if you have achieved the ideal range of 40-80 ng/ml.
You need to take control, but this is one area where naturally can have a significant downside.
Jay Ginther, MD
Vitamin D is necessary in order to absorb Calcium from your diet. Your skin can make some Vitamin D from the Mid-day Sun, but only in the “summer”. The sun is high enough above the horizon at mid-day only 5 months of the year in Iowa. Over half of Iowans are low on Vitamin D as summer ends in September. 7 out of 8 Iowans are low by mid April when we can first get a few minutes a day of Vitamin D. That’s the Good News.
The Bad News is that Sun Block blocks Vitamin D production in skin. You need to risk Sunburn and Skin Cancer “naturally” if you want to make your Vitamin D “naturally”. Plus you need to expose enough skin (determined by your age and personal genetics) to make enough Vitamin D.
Foods naturally high in Vitamin D3 include “yummy” Seal Blubber and Cod Liver Oil. Most Fish Oil does not have much D3. Vitamin D2 from plants (like mushrooms) is much less long lasting than D3, so we are talking pounds of mushrooms daily.
Your easiest and safest move is to take extra Vitamin D3. The amount of D3 in your multiple vitamins and minerals, calcium supplements, and milk combined are very rarely enough. Most of us need 2,000 to 5000 units of additional D3 daily.
Test for 25-hydroxy Vitamin D Level to tell if you are taking enough to get between 40 and 80 ng/ml in your blood.
Help to Take Control Naturally by getting enough Vitamin D.
Jay Ginther, MD
Determining the correct 25-hydroxy Vitamin D level is still a work in progress. In the 8 years I have been attending meetings, we have made considerable progress. NOF 2007 was the first time any society proposed an intake above 400 IU daily and a 25-hydroxy Vit D level of more than 20 ng/ml.
At the 2015 U. Wisconsin “Bare Bones Symposium” the latest recommendations were discussed. I have summarized them here.
Take Vitamin D3. D3 is Cholecalciferol (what we make in sunshine). Vitamin D2 is Ergocalciferol (what plants make and use). D3 works much better in people than D2 becuse it is the right stuff. It lasts 5 times longer and the assay is more accurate.
Test for 25-hydroxy Vitamin D level and aim for between 40 and 80 ng/ml. At 40 ng/ml over 98% of people can absorb and utilize Calcium fully. You want to have some margin of safety since lab test results vary by at least 20%. If you are seriously deficient, we give 50,000 IU of D3 every M, W, F based on your level and size, to correct the level quickly.
If you do not want to test your level, and you are the “average person” of 154# or 70 kg, you should take 3800 IU daily. This should achieve the 40 ng/ml level – eventually. If you are very deficient, this could take a year or more. If you are larger than the old average, or you have digestive issues, you will need more.
Finally, some cancer researchers believe that 70 ng/ml is better for preventing and treating cancers. If they are right, you should go for the higher level. If they are wrong, you have done no harm by going for the higher level.
Take Control of your Bone Health. Take enough D3.
Jay Ginther, MD