Dory is lady who in May, 2005, at the age of 50, received her first DEXA scan as a screening test for osteoporosis. After her initial test she was told by her physician there were areas of osteoporosis and osteopenia in the scan. No treatment was recommended at that time. Her physician’s plan was to repeat the DEXA scan in 2 years. The DEXA scan and the 2 subsequent scans were obtained at Massachusetts General Hospital in Boston.
Dory and her husband are acquaintances of mine. So they called me to get another opinion on the scan. I recommended to Dory that she obtain a 25-hydroxyvitamin D level. Her first level was in the low 20’s. I initially recommended she take 5000 units of vitamin D and repeat the level in 6 months.
2 years and 2 months later Dory got her second DEXA. It showed improvement in most of the bone densities tested. Her Massachusetts General physician was surprised that the bone strength had improved without taking any prescription anti-osteoporosis drugs. By then Dory was noticing that she felt so much better since taking the vitamin D, and noticed the increased strength and growth in her fingernails. I discussed with her the ideal level of vitamin D, told her about the high levels that lifeguards and fishermen and women have in the summers. She has adjusted her dose in the last few years and she has reached what many vitamin D experts consider an ideal level of 70 to 90 ng, and she has kept her level at that number.
Almost 3 years later, in September, 2010, she received her third DEXA scan. All areas tested were very much improved.
Dory’s Dexa Results -
Improvement in Bone Density- May, 2005 to September, 2010 (5 years, 4 month interval). (L refers to lumbar vertebrae).
Hip Femur L1 L2 L3 L4 Average Increase
7.5% 13.5% 33.6% 13.3% 22.2% 8.13% 17%
Dory’s documented results are quite remarkable. The public (and many doctors) feel it’s inevitable that bone density decrease with age.
Are these results unique? Studies haven’t studied serial bone density in subjects taking vitamin D alone in the absence of anti-osteoporosis prescription drugs. I have seen 2 additional patients in the past 5 years and both had improvements of 15% taking vitamin D alone in DEXAs taken two years apart.
History of Vitamin D and osteoporosis
Sunlight (which produces vitamin D in the skin) was discovered to prevent rickets in 1850, and cod liver oil (which contains vitamin D) was recognized as preventing rickets in 1877. Rickets is a severe malformation of the bones occurring in young children. Vitamin D itself wasn’t discovered until 1922. Rickets continued to be common well until the 20th century.
It wasn’t until about 1970 that Vitamin D’s role in calcium regulation was recognized. For several decades vitamin D was considered to be just one of many minor risk factors in osteoporosis. The medical profession repeated its error that had been made with cholesterol (in 1978 cholesterol of 250 mg. was considered normal). Similarly a 25-hydroxyvitamin D level was considered normal from 20 to 30 ng/ml. This led, erroneously, to minimizing of the importance of vitamin D as a cause of osteoporosis. Ordering 25-hydroxyvitamin D levels, stimulated by the release of research reports, didn’t become common until about 2005. It has only been since about 2005 that laboratories no longer report a normal level starting at 20 ng. Even today, many people even with osteoporotic fractures don’t get a level ordered. I know of many extreme cases; including a case in which a woman with a hip fracture at 75 stayed in a nursing home for a year without a level being obtained, suffering increasing weakness and falls, and then being discovered to have an level of 8 ng once she was out of the nursing home.
A most remarkable and very sad case of osteoporosis was a 70 year old woman who I saw in 2005, only a few months after I started ordering levels. She walked totally bent over at the waist with her upper body at a 90% angle to the floor. This type of thing has shown to be caused by microscopic fractures of the spine that occur over decades that start at a young age. I ordered a vitamin D level, her first ever. Out of the over 3500 levels I have ordered before and since, it is the only one in which the result was “no detectable vitamin D.” Unfortunately the vitamin D she now takes, although it has relieved some of her pain, can not completely straighten her broken spine.
Many studies until recently showed that osteoporosis was common with what was called normal levels of 25-hydroxyvitamin D 20 to 30 ng. Even to this day, studies are published and reported to the public in newspapers falsely claiming that vitamin D doesn’t prevent fractures because of they occur with levels in the 20’s. For example, it has been shown repeatedly in studies that 400 units a day of vitamin D raises the level only an average of 5 ng,, and doesn’t significantly reduced the fracture rate. The truth is that in the last decade virtually EVERY study done comparing fracture rate above and below 32 ng has shown a significant reduction above 32 ng.
A landmark study in elderly patients from age 70 to 90 showed that in less than six months the number of falls and fractured decreased very significantly with very significant doses of vitamin D that raised the level, often over 40 ng. (Vitamin D was compared to placebo). Hundreds of well designed studies have demonstrated an extreme benefit of significant doses of vitamin D in terms of preventing osteoporosis).
Studies have shown that the parathyroid glands can have a detrimental effect on bone density up to a level of vitamin D of 40 ng. (The parathyroid glands produce their hormone to dissolve microscopic areas of bone in order to maintain a normal calcium level. A further beneficial effect with higher levels has not been studied, simply because not enough people have these higher levels. Many vitamin D experts consider an ideal level as 70 to 90 ng. Levels of vitamin D with sun exposure alone will not go up greater than 150 ng. At that level, there is a feedback mechanism which breaks down the chemicals in the skin that synthesize vitamin D.
No side effects occur with vitamin D at levels below 150 ng. There is a very specific situation in the rare disease of saroidosis and a few other illnesses in which the disease causes of disorder of vitamin D metabolism, so there is sometimes a hypersensitivity to vitamin D in these few rare cases that can be easily managed by monitoring blood chemistries.
Many studies have shown that taking calcium supplements increase the rate of kidney stones. Because these supplements are given with Vitamin D, some studies have erroneously concluded that vitamin D also raises the incidence of kidney stones. The truth is that all studies using vitamin D alone have NEVER shown an increase in kidney stones. In fact, with low vitamin D levels leading to an increase in calcium released from the bone, it is likely that treating vitamin D insufficiency leads to a DECREASE, not an INCREASE, in the rate of kidney stones.
Conclusions from my Clinical Practice:
I have obtained over 3,500 25-hydroxyvitamin D levels on patients since 2005. About 700 of these patients had the diagnosis of osteoporosis or osteopenia on DEXA scan or examination. 697 out of 700 (99.57%) of these people had initial levels of less than 32 ng. Out the 3 with levels above 32 ng., one female had an oophorectomy in her 40’s, and all 3 had levels below 36 ng. Rheumatologists at a major medical center in NJ have had similar results testing everyone with osteopenia or osteoporosis.
Osteoporosis is a multi-billion dollar public health problem that is largely and inexpensively preventable. DEFINITIONS:
All references to vitamin D levels mean 25-hydroxyvitamin D.
All vitamin D measurements above are ng/ml. Some medical research uses the measurement nmol.L.
Conversion:
25-hydroxyvitamin D in ng/ml multiplied by 2.5 = mmol/L.
25-hydroxyvitamin D in mmol/L multiplied by 0.4 = ng/ml.
DEXA scan is an x-ray test for bone density. It has become popular only in the past 10 years.
Showing posts with label vitamin d. Show all posts
Showing posts with label vitamin d. Show all posts
Tuesday, April 5, 2011
Thursday, January 1, 2009
AN OFFICE VISIT - GETTING VITAMIN D RESULTS revised 11/27/09
This blog allows you to hear what every person should know about when their vitamin D levels come back. I am talking to a hypothetical patient, Mrs. Smith.
Dr. B: Mrs. Smith, your blood work is mostly fine, you cholesterol is excellent. But remember I told you I was going to check your vitamin D level. Yours is low. Let me tell you about vitamin D. The normal level is 32 to 100. That’s a wide range. Ideal is at least 50 to 80. Yours is 15; very low. But we can get the level up easily within 6 months.
Vitamin D comes from the sun acting on the skin. But we’re so far north that we don’t make any vitamin D all winter; we use sun screen to protect our skin; and we wear a lot of clothes. So because of this, 2/3 of people have low levels. I’ve tested 1800 people since 2005, and over 1200 are low. Vitamin D increases the calcium we absorb and puts it in our bones. Osteoporosis is very common as we get older, and it’s not just in 80 year old women; we see it in 50 year olds, both men and women, and the process begins decades earlier. We’ve all of heard of the elderly getting hip fractures, and sometimes they end up in a nursing home and are never the same. The studies show that this is largely preventable.
A lot of people think they just need to buy vitamin D OTC, most commonly 400 units. Other people think they need to drink more milk, but 4 glasses of milk contain only the same 400 units, which raises levels only 5 nanograms; not enough. In fact, I’ve seen many people who take OTC vitamin D or a lot of dairy for years, and their level is still very low. There is a lot of evidence that vitamin D stops abnormal cell multiplication and is a powerful factor in preventing many cancers, (especially breast, prostate, and colon), and prevents many autoimmune diseases. Vitamin D also cuts down death from heart disease.
So how can we treat it? Several ways. With a prescription vitamin D2 capsule, 50,000 units. Recently OTC Vitamin D3 50,000 units has become available on the internet. It should be stressed it's not a daily pill, often it’s prescribed 1 capsule a week for awhile, then rechecking the level. I've seen many people on this dose for years. An alternative method is to take 5000 units of OTC Vitamin D3 daily that you can buy in a health food store (I haven't seen this strength in any pharmacy). (For those who are interested, prescription Vitamin D is vegetarian, and OTC Vitamin D isn't). Any brand from a reliable manufactuer is fine; in particular Solgar makes a bottle of 120Vitamin D3 5000 unit capsules; I buy it for $20,00 and at one a day, it costs $5 a month. The prescription 50,000 unit capsules cost $30 for 20 capsules (about $6 a month), although sometimes people pay a higher copay per capsule with their insurance than if they had just obtained 20 capsules without insurance.Initially blood levels every 6 months, then yearly when stable, should be done to make sure an ideal level is reached.
I don’t tell everyone to go out and sunbathe, because we’ve all heard the warnings about too much sun. Obviously, sun exposure without burning is a good practice (but many months of the year in most American latitudes,the sun isn't strong enough to make Vitamin D. Unless there is a big change in your life in terms of sun exposure, you’ll need to take this vitamin D forever (with yearly levels). With the prescription vitamin D2, you’ll get a printout of side effects from your pharmacy just like you do with every prescription drug. What you need to know is that these side effects don’t occur unless the blood level is over 200. Your level isn’t going to go from 15 to 200; the goal is to have a level of about 50 ng. 6 months from now with the ultimate goal for maximal beneficial effect is up to 80 ng. So the chance of these side effects is zero.
OTHER ISSUES:
1. After 4 years of seeing levels far too low after 6 months, I have learned the technique from studies that have been done of giving a "booster dose" for higher doses for 2 to 4 weeks initially depending on the level. Because these studies were not well publicized, not many people, doctors or non-doctors, know about them. 2. individual variations determine whether I order a DEXA scan or further blood tests. 3.Although recommendations have been made by vitamin D experts that every American of any age should get a yearly 25-hydroxyvitamin D level, people with osteopenia, osteoporosis, an oophorectomy, kidney impairment (with serum creatinine of 1.5 mg. or higher), cancer, coronary bypass surgery, autoimmune diseases including multiple sclerosis, are at particular need to get a level and treat to attain an ideal level. Studies have shown the maximal bone strength requires at least 40 nanograms, which is higher than the lowest "normal" level of 32 nanograms. The maximal level for an anti-cancer effect is at least 52 nanograms. Life span of people with chronic kidney disease has been shown to be extended with vitamin D. A study has shown that 85% of multiple sclerosis patients have decreased exacerbations with correction of their Vitamin D level. A major study published in 2008 showed that women with breast cancers have more aggresive cancers the lower the vitamin D is.
Should everyone with a low vitamin D level take vitamin D? If a routine metabolic profile shows an elevated calcium, the cause should be determined and treated. This occurs very rarely. Cancer, hyperparathyroidism, and sarcoidosis are 3 causes of elevated calcium. More careful monitoring with blood tests are wise for people with an elevated calcium. Studies have shown that the high calcium frequently improves with vitamin D.
Dr. B: Mrs. Smith, your blood work is mostly fine, you cholesterol is excellent. But remember I told you I was going to check your vitamin D level. Yours is low. Let me tell you about vitamin D. The normal level is 32 to 100. That’s a wide range. Ideal is at least 50 to 80. Yours is 15; very low. But we can get the level up easily within 6 months.
Vitamin D comes from the sun acting on the skin. But we’re so far north that we don’t make any vitamin D all winter; we use sun screen to protect our skin; and we wear a lot of clothes. So because of this, 2/3 of people have low levels. I’ve tested 1800 people since 2005, and over 1200 are low. Vitamin D increases the calcium we absorb and puts it in our bones. Osteoporosis is very common as we get older, and it’s not just in 80 year old women; we see it in 50 year olds, both men and women, and the process begins decades earlier. We’ve all of heard of the elderly getting hip fractures, and sometimes they end up in a nursing home and are never the same. The studies show that this is largely preventable.
A lot of people think they just need to buy vitamin D OTC, most commonly 400 units. Other people think they need to drink more milk, but 4 glasses of milk contain only the same 400 units, which raises levels only 5 nanograms; not enough. In fact, I’ve seen many people who take OTC vitamin D or a lot of dairy for years, and their level is still very low. There is a lot of evidence that vitamin D stops abnormal cell multiplication and is a powerful factor in preventing many cancers, (especially breast, prostate, and colon), and prevents many autoimmune diseases. Vitamin D also cuts down death from heart disease.
So how can we treat it? Several ways. With a prescription vitamin D2 capsule, 50,000 units. Recently OTC Vitamin D3 50,000 units has become available on the internet. It should be stressed it's not a daily pill, often it’s prescribed 1 capsule a week for awhile, then rechecking the level. I've seen many people on this dose for years. An alternative method is to take 5000 units of OTC Vitamin D3 daily that you can buy in a health food store (I haven't seen this strength in any pharmacy). (For those who are interested, prescription Vitamin D is vegetarian, and OTC Vitamin D isn't). Any brand from a reliable manufactuer is fine; in particular Solgar makes a bottle of 120Vitamin D3 5000 unit capsules; I buy it for $20,00 and at one a day, it costs $5 a month. The prescription 50,000 unit capsules cost $30 for 20 capsules (about $6 a month), although sometimes people pay a higher copay per capsule with their insurance than if they had just obtained 20 capsules without insurance.Initially blood levels every 6 months, then yearly when stable, should be done to make sure an ideal level is reached.
I don’t tell everyone to go out and sunbathe, because we’ve all heard the warnings about too much sun. Obviously, sun exposure without burning is a good practice (but many months of the year in most American latitudes,the sun isn't strong enough to make Vitamin D. Unless there is a big change in your life in terms of sun exposure, you’ll need to take this vitamin D forever (with yearly levels). With the prescription vitamin D2, you’ll get a printout of side effects from your pharmacy just like you do with every prescription drug. What you need to know is that these side effects don’t occur unless the blood level is over 200. Your level isn’t going to go from 15 to 200; the goal is to have a level of about 50 ng. 6 months from now with the ultimate goal for maximal beneficial effect is up to 80 ng. So the chance of these side effects is zero.
OTHER ISSUES:
1. After 4 years of seeing levels far too low after 6 months, I have learned the technique from studies that have been done of giving a "booster dose" for higher doses for 2 to 4 weeks initially depending on the level. Because these studies were not well publicized, not many people, doctors or non-doctors, know about them. 2. individual variations determine whether I order a DEXA scan or further blood tests. 3.Although recommendations have been made by vitamin D experts that every American of any age should get a yearly 25-hydroxyvitamin D level, people with osteopenia, osteoporosis, an oophorectomy, kidney impairment (with serum creatinine of 1.5 mg. or higher), cancer, coronary bypass surgery, autoimmune diseases including multiple sclerosis, are at particular need to get a level and treat to attain an ideal level. Studies have shown the maximal bone strength requires at least 40 nanograms, which is higher than the lowest "normal" level of 32 nanograms. The maximal level for an anti-cancer effect is at least 52 nanograms. Life span of people with chronic kidney disease has been shown to be extended with vitamin D. A study has shown that 85% of multiple sclerosis patients have decreased exacerbations with correction of their Vitamin D level. A major study published in 2008 showed that women with breast cancers have more aggresive cancers the lower the vitamin D is.
Should everyone with a low vitamin D level take vitamin D? If a routine metabolic profile shows an elevated calcium, the cause should be determined and treated. This occurs very rarely. Cancer, hyperparathyroidism, and sarcoidosis are 3 causes of elevated calcium. More careful monitoring with blood tests are wise for people with an elevated calcium. Studies have shown that the high calcium frequently improves with vitamin D.
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