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Should Vitamin D be included in routine basic investigations ? Clinical Vignette

Vitamin D refers to a group of fat-soluble secosteroids responsible for increasing intestinal absorption of calcium, iron, magnesium, phosphate, and zinc. In humans, the most important compounds in this group are vitamin D₃ . Vitamin D (cholecalciferol) is important for normal development and maintenance of the skeleton.

The metabolites 25(OH)D and 1,25(OH)(2)D are not only important for treating rickets and osteomalacia but also for all types and clinical stages of osteoporosis. Patients with low calcium intake and a low vitamin D status are at risk to develop secondary hyperparathyroidism, increased bone resorbtion, osteopenia and fractures. This can be counteracted by a lifelong sufficient vitamin D supply plus dietary or supplementary calcium.

The effects of vitamin D on muscle, balance and cognitive functions may be an added value in fracture prevention. Today it is generally accepted that a supplementation with vitamin D and calcium should be added to every specific medical treatment of osteoporosis. In contrast to this general recommendation the potency of vitamin D alone with or without calcium to reduce the incidence of falls and/or fractures is still a debated controversy. Studies and meta-analyses during the last two decades on the effect of vitamin D and calcium supplements have not resolved the controversy on the risk of falls and fractures in healthy or osteopenic elderly populations.
Vitamin D helps to regulate the amount of calcium and phosphate in the body. These nutrients are needed to keep bones, teeth and muscles healthy. A lack of vitamin D can lead to bone deformities such as rickets in children, and bone pain and tenderness as a result of a condition called osteomalacia in adults.
Good sources of vitamin D
From about late March/April to the end of September, most of us should be able to get all the vitamin D we need from sunlight on our skin. The vitamin is made by our body under the skin in reaction to sunlight.
If you are out in the sun, take care to cover up or protect your skin with sunscreen before you turn red or get burnt. Between October and early March we don’t get any vitamin D from sunlight.
Vitamin D is also found in a small number of foods. Good food sources are:
• oily fish – such as salmon, sardines, herring and mackerel
• red meat
• liver
• egg yolks
• fortified foods such as most fat spreads and some breakfast cereals
Another source of vitamin D is dietary supplements. In the UK, cows’ milk is generally not a good source of vitamin D because it isn’t fortified, as it is in some other countries.

7 Signs You May Be Vitamin D Deficient.

The only way to know for sure if you’re vitamin D deficient is via blood testing. However, there are some signs and symptoms to be aware of as well. If any of the following apply to you, you should get your vitamin D levels tested sooner rather than later.

You Have Darker Skin
African Americans are at greater risk of vitamin D deficiency, because if you have dark skin, you may need as much as 10 times more sun exposure to produce the same amount of vitamin D as a person with pale skin!
As Dr. Holick explained, your skin pigment acts as a natural sunscreen, so the more pigment you have, the more time you’ll need to spend in the sun to make adequate amounts of vitamin D.

You Feel “Blue”
Serotonin, the brain hormone associated with mood elevation, rises with exposure to bright light and falls with decreased sun exposure. In 2006, scientists evaluated the effects of vitamin D on the mental health of 80 elderly patients and found those with the lowest levels of vitamin D were 11 times more prone to be depressed than those who received healthy doses.3

You’re 50 or Older
As mentioned, as you get older your skin doesn’t make as much vitamin D in response to sun exposure. At the same time, your kidneys become less efficient at converting vitamin D into the form used by your body and older adults tend to spend more time indoors (i.e. getting even less sun exposure and therefore vitamin D).

You’re Overweight or Obese (or Have a Higher Muscle Mass)
Vitamin D is a fat-soluble, hormone-like vitamin, which means body fat acts as a “sink” by collecting it. If you’re overweight or obese, you’re therefore likely going to need more vitamin D than a slimmer person — and the same holds true for people with higher body weights due to muscle mass.

Your Bones Ache
According to Dr. Holick, many who see their doctor for aches and pains, especially in combination with fatigue, end up being misdiagnosed as having fibromyalgia or chronic fatigue syndrome.

“Many of these symptoms are classic signs of vitamin D deficiency osteomalacia, which is different from the vitamin D deficiency that causes osteoporosis in adults,” he says. “What’s happening is that the vitamin D deficiency causes a defect in putting calcium into the collagen matrix into your skeleton. As a result, you have throbbing, aching bone pain.”

Head Sweating
According to Dr. Holick, one of the first, classic signs of vitamin D deficiency is a sweaty head. In fact, physicians used to ask new mothers about head sweating in their newborns for this very reason. Excessive sweating in newborns due to neuromuscular irritability is still described as a common, early symptom of vitamin D deficiency.4

You Have Gut Trouble
Remember, vitamin D is a fat-soluble vitamin, which means if you have a gastrointestinal condition that affects your ability to absorb fat, you may have lower absorption of fat-soluble vitamins like vitamin D as well. This includes gut conditions like Crohn’s, celiac and non-celiac gluten sensitivity, and inflammatory bowel disease.

Many authors have discussed the need for Vitamin D. However, other have describe it be a major factor in falls in the elderly. High-dose vitamin D supplementation does not improve lower-extremity function and increases the risk for falls among elderly adults, a new study finds.

The results were published online January 4 in JAMA Internal Medicine by Heike A Bischoff-Ferrari, MD, DrPH, chair of the department of geriatrics and aging research at the University Hospital of Zurich, Switzerland, and colleagues.In the randomized clinical trial of 200 men and women aged 70 or older who had experienced at least one low-trauma fall in the prior year, two high vitamin D doses monthly were compared with a standard dose of 24,000 IU of vitamin D3 per month (equivalent to the currently recommended 800 IU per day). Subjects taking the higher doses showed no improvements in lower-extremity function and were more likely to have a second fall (P = .048) in the subsequent year.
The effect of Vitamin D on falls and fractures. – NCBI
by JD Ringe – 2012 – Cited by 25 – Related articles Scand J Clin Lab Invest Suppl. 2012;243:73-8. doi: 10.3109/00365513.2012. 681965. The effect of Vitamin D on falls and fractures. Ringe JD(1).

The effect of vitamin D on falls: a systematic review and meta … – NATAP
by MH Murad – 2011 – Cited by 256 – Related articles 27 Jul 2011 – dence regarding the effect of vitamin D supplementation on falls. Materials and ….. Elderly women with risk factors for hip fracture D3 800 IU.

PulseMedic Clinical Questions?
Should Vitamin D be included in routine basic A&E investigations ?
Do you know your vitamin D ?

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