Vitamin D - Not Covid related

[doctorb]

Here's an interesting, just-released large study on Vitamin D (NEJM).

https://www.nejm.org/doi/full/10.1056/NEJMoa2202106

It found that Vitamin D supplement had no effect upon fracture.  This is a large randomized double blind study of excellent quality.  This blurs the treatment of osteoporosis.  As the population continues to age, bone health will continue to be a real problem in search of a better preventive pathway.

[doc henderson]

good info Bob.  It is helpful if there is a deficiency, I assume.  have no time to read the study yet.  It is still good to build calcium stores in the young girls.  Make sure daughters and granddaughters get enough calcium when young. It is like a 401 K and you only can add a lot in your teens and younger years.

[SwampDonkey]

Not surprising. I've never heard of Vit D being promoted as a preventative to fractures. Not at least from experts I have followed who have studied it for decades. But there is evidence that excessive amounts of Vit D can deplete calcium. And appears to be amounts quite a bit higher than recommended levels.  I've only heard of things to do with immunity. That can also include arthritis and such which trigger an immune response. It has helped mother, she doesn't need Tylenol any more. Might be anecdotal, but why was there a change? It never cured it, made it more comfortable.

[doc henderson]

Vitamin D, calcium homeostasis and aging - PMC

[doctorb]

Excellent medical,review of Vitamin D and bone health.  

Swamp-  the standard preventive treatment for those at risk for osteoporosis, or those that already are approaching it, has been Vit D and calcium supplements.  This large study states that those supplements don't prevent those issues.  This study also agrees with doc h that Vit D should be used to treat Vit D deficiency. It's most controversial conclusion is that it questions both the dose of Vit D required daily and whether Vit D levels should be routinely tested in a widespread manner, as they are today.

[SwampDonkey]

Like I said, I'm not surprised they don't prevent it. One of the references in Doc H's study (I don't have access to the first set of references) is one I follow. Michael H Holick. The reference points to a co-authored paper "Evaluation, treatment, and prevention of vitamin D deficiency".

[doctorb]

I'm a bit surprised.  And I'm sure the 10's of millions of women who have been taking Vit D and calcium are surprised.  These patients are not being treated for Vit D deficiency.  That's entirely another matter.

[SwampDonkey]

I know it is. On the other hand, if they are not deficient (Vit D and Calcium), why prescribe it? My mother has never been prescribed them for arthritis. But it turns out Vit D helps manage arthritic pain. So instead of Tylenol, Vit D is making it easier to deal with without taking a drug. Treating pain, not the disease. That paper I mentioned was a reference in Doc H's paper on deficiency. I have not seen the references in the paper you linked to. ;)

[doctorb]

They were prescribed the combo because it's easy and cheap and over time was hoped to lessen the rate of bone loss associated with aging, especially in females.  I agree with you, however, that if there's no deficiency, why take it.

[doc henderson]

We are all concerned with osteoporosis.  Many elderly folks' deaths result from complications of hip fracture.  If they survive, it may be the reason their home is sold, and they transition to "elder" options.  Try getting a 13-year-old with a family history to change diet to prevent fracture when they are 80.  treatment/prevention is best started in your teens.  it affects women more than men.  bone develops and maintains strength with use and stress.  the explanation is that (just like muscle), the bone will repair injury with more structure and mass.  the calcium is the mud and clay that makes a straw house strong.  This is in part the issue regular docs have with supplements, is it is unusual to have academic scrutiny.  I always say no harm if you can afford the "food supplement".  So, part of the point is the cost for the Vit. D for hundreds of millions of women that have been doing this for 40 years based on the assumption that it was saving lives.  Old folks tend to be less active, more inside, and may have limited diet based on finances and or bad teeth.  My definition of old is now anyone older than Lynn @Magicman .   8) 8) 8)  

[Gary_C]

VITAMIN D | Why it's essentially useless

[doctorb]

While I can't agree with everything he says, I agree with his premise...that Vit D supplements are OK to take ("I don't care if you take them"), but probably have little effect on bone health.  His distinction between the problem being a vitamin D deficiency, where supplementation treats the actual problem, and having a disease process that also lowers vitamin D levels, where supplementation does not treat the actual problem, is applicable to many medical issues.  

Gary - thx for posting.

[Brucer]

It found that Vitamin D supplement had no effect upon fracture

Hang on a minute. Did I miss something? Everything I've read about Vit D preventing fractures mentions a combination of Vit D with Calcium supplements. Yet there was no mention of Calcium at all in this study.

??? ???

[SwampDonkey]

There's many unknowns, but for sure. Vit D deficiency is prevalent. Add to that obesity, which doubles or triples your daily recommended dose. Too much Vit D can actually deplete calcium from bone. That is why recommended dose given is below the upper threshold. In part it does not account for sun exposure. K2 has been found to be important in calcium regulation in blood vessels. Calcification in blood vessels increases risk of heart disease. It helps put calcium in bone, and how else is it going to get there if not from blood flow?

[Ianab]

A deficiency in some vitamins or mineral can certainly cause problems, and make other conditions worse. But an overdose of some actually essential trace mineral or vit can also cause issues. Luckily there is a pretty wide range between deficient and overdose. If you take the minimum recommended dose, and are already getting that, no big deal. 2x what you need isn't a problem.  But if you take 10X the daily dose, plus that you get naturally? If you do that with carrots you might turn slightly orange, but won't actually get sick. 

NZ used to have a problem with sheep grazing in the central Nth island., The volcanic soils contained little selenium, This is usually considered a nasty toxic metal, but if there is none, animals (sheep and humans) actually get sick. The fix was to add a trace of selenium into the fertiliser, maybe a teaspoon per ton. Problem solved.  A lack of all sorts of minerals will make you sick (but so will an overdose)  

[doctorb]

Calcium and Vit D treatment for fracture prevention needs to be clearly separated from treating a Calcium and/or Vit D deficiency.  Lots of people were placed on a preventive regimen that may not be helpful.  Medicine changes over time.


Published online 2020 Apr 7. doi: 10.3390/nu12041011

PMID: 32272593

Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It?
Ian R Reid1,2,* and  Mark J Bolland1,2

Conclusions:
"The balance of evidence indicates that widespread use of calcium supplements in individuals without a specific bone pathology is not helpful, and may cause harm. Likewise, vitamin D supplements should be reserved for those with clinical risk factors for vitamin D deficiency, principally low sunlight exposure or dark skin and not living in a sunny environment. These recommendations are consistent with those of the United States Preventive Services Task Force, which does not support the use of either calcium or vitamin D supplements in otherwise healthy community-dwelling adults [44]. The position of the International Osteoporosis Foundation is similar, namely that "supplementation with calcium alone for fracture reduction is not supported by the literature" but that "calcium supplementation, with concomitant vitamin D supplementation, is supported for patients at high risk of calcium and vitamin D insufficiency" [45]. The efficacy and safety of anti-resorptive osteoporosis medications does not require co-administration of supplements, other than for the treatment or prevention of vitamin D deficiency in those with clinical risk factors."

[gspren]

This topic isn't too old so I'll tack this on. About two weeks ago my VA doc which was a PA filling in for my recently transferred doc told me my vit D was low and told me to take 5,000 units per day and they will do a follow up blood test in July. This was either the first mine was ever low or the first it was tested. On the way home I stopped at the local Dollar Store and they only had 2,000 strength so I've been taking 2 pills one day and 3 pills the next, made sense to me. A few days ago I picked up a bottle of the 5,000 pills but I've still got plenty of the 2,000 ones. Should I keep doing what I'm doing, start taking 3 every day, or start on my 5,000 pills now? They are cheap enough that I don't mind throwing some out but I hate to be wasteful.

[doc henderson]

It does not matter that much.  take what you got. how you want.