Friday, February 18, 2011

Low vitamin D a concern, but easily corrected

St. Lukes Health Watch

By Dr. Daniel B. Judd

     Vitamin D plays an important role in maintaining our calcium level by promoting calcium absorption for our diet and is crucial in maintaining our serum and bone levels of calcium and phosphate. It’s also needed for bone growth and remodeling. Vitamin D deficiency can result in a lower bone mineral density and increase the risk of bone fractures. Severe vitamin D deficiency can lead to rickets in children and osteomalacia in adults. However, there is evidence that less extreme levels of vitamin D deficiency can also lead to health problems.

     In addition to its importance in bone health, vitamin D has other roles in the body, including modulation of cell growth, neuromuscular and immune function, and reduction of inflammation. Adequate vitamin D levels may decrease cancer and cardiovascular disease, and have beneficial effects on the immune system.

     A recent study published in the Journal of Bone and Joint Surgery by a group from the Hospital for Special Surgery in New York City found that almost half of patients undergoing orthopedic surgery have vitamin D deficiency, and because vitamin D is essential for bone healing and muscle function, it’s critical for a patient’s recovery.  The authors of the study suggested that correction to appropriate vitamin D levels prior to surgery might improve patient outcomes. According to one author, Dr. Joseph Lane, bone remodeling or bone tissue formation, a part of the healing process, occurs about two to four weeks after surgery and he felt that this is the critical stage when your body needs vitamin D.

     The investigators reviewed the medical charts of 723 patients who had vitamin D levels measured prior to undergoing orthopedic surgery. They found that 43 percent had insufficient vitamin D, defined as a level of less than 32 nanograms per milliliter. Problems were more prevalent in younger patients, men and people with dark skin—blacks and Hispanic. All different types of orthopedic surgical patients were examined, the highest level of deficiency was seen in trauma patients, of whom 66 percent had insufficient levels.

     Other studies, from a variety of medical disciplines, have found vitamin D deficiency to be fairly widespread in other patient populations as well. Because vitamin D has an implication in terms of muscle and fracture healing, this study concluded that orthopedic patients should have their vitamin D levels measured and, if needed, corrected to optimize healing after surgery.

     Certainly, more studies are needed to completely understand the role vitamin D has in healing and recovery, but evidence seems to support that we should pay more attention to ensuring adequate levels.

     In November, the American Institute of Medicine increased its recommended dietary intake of vitamin D to:

· 1–70 years of age: 600 IU/day (200 IU is 5 μg equivalent).

· 71+ years of age: 800 IU/day.

     One final note: Consuming too much vitamin D can be dangerous. Adults should not exceed 4,000 IU/day; safe daily levels for children are lower. As with all supplements and medications, it’s wise to talk with your health care provider regarding dosage and possible interactions with other medications.

Dr. Daniel B. Judd is an orthopedic surgeon for St. Luke’s Sun Valley Sports Medicine.

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