Among Vit.D and Calcium, Vit.D Is More Effective for Osteoporosis/ Hip Bone Fracture Risk
From our head to our toes, our bones provide support for our bodies and help form our shape.Joints occur where two bones meet. They make the skeleton flexible - without them, movement would be impossible.Together, our bones, muscles, and joints - along with tendons, ligaments, and cartilage - form our musculoskeletal systems and enable us to do everyday physical activities.
The fracture occurs at the upper end of the femur where it meets the pelvic bone. It is a common fracture (thighbone) in people with osteoporosis. Osteoporosis is a condition in which bones become thin after middle age.Hip fractures usually result from a fall. Because osteoporosis weakens the bones and makes them much more likely to break, hip fractures occur more often as men and women get older.
You can break your hip at any age, but most hospitalizations for hip fractures are for people older than age 65. Although the incidence by age group was identical for males and females, the fractures occurred approximately seven years earlier in women than in men.As you age, your bones become less dense as they slowly lose minerals. Gradual loss of density weakens bones and makes them more susceptible to a hip fracture.
Hip fractures are a very debilitating injury for elderly nursing home residents.Mobility and low bone mineral density work together to dramatically increase the risk of fracture.Study found that the women who had bone density levels below the nursing home average were more than twice as likely to suffer a fracture than women with higher than average bone density levels. The risk was more than three times greater for residents with low bone density who also had the ability to move around independently.
Fractures of the proximal end of the femur (hip fractures) are considered to be the most serious consequence of osteoporosis, and the burden posed by this condition has consistently been increasing.
Postmenopausal osteoporosis is a common disorder characterized by an increase in bone resorption relative to bone formation, generally in conjunction with an increased rate of bone turnover. The progressive decrease in bone mass leads to an increased susceptibility to fractures, which result in substantial morbidity and mortality. Vertebral fractures are important not only because they can cause pain, kyphosis, and height loss but also because they predict subsequent, nonvertebral fractures independently of bone mineral density. Although there are several risk factors for fractures, reduced bone mineral density is the strongest predictor. Thus, the ultimate goal of pharmacologic treatment in women with postmenopausal osteoporosis is to reduce the risk of fractures by increasing bone mass of normal quality.
Osteoporosis is a significant complication of stroke.The breakdown occurs more quickly in osteoporosis, resulting in weak and brittle bones. Several studies have shown that regional osteoporosis of a limb paralyzed by stroke occurs rapidly after immobilization. More widespread osteoporosis occurs later.Stroke patients who break their hips also have a higher mortality and morbidity rate than age-matched individuals who have not had a stroke. Moreover, more than half of all strokes occur in people over age 70. They are already at risk for osteoporosis because of their age - they can ill afford to lose further bone.
Bones are made up of calcium, phosphorus, sodium, and other minerals, as well as the protein collagen. Calcium is needed to make bones hard, which allows them to support your weight. Bones also store calcium and release some into the bloodstream when it's needed by other parts of the body. The amounts of certain vitamins and minerals that you eat, especially vitamin D and calcium, directly affects how much calcium is stored in the bones.
Diet appears to have only a moderate relationship to osteoporosis, but calcium and vitaminDare both important, at least in older populations. Calcium is one of the main bone-forming minerals and an appropriate supply to bone is essential at all stages of life.
The risk of hip fracture appears to be reduced by oral vitamin D supplements only if they are accompanied by additional calcium, according to a report in The Journal of Clinical Endocrinology & Metabolism.
"Supplementation should be targeted to individuals with insufficiencies," Dr. Steven Boonen from Katholieke Universiteit Leuven, Belgium told Reuters Health. This includes individuals older than 75 years; those who are home bound or institutionalized; patients with a diagnosis of osteoporosis; and individuals on steroids or other drugs that decrease bone mineral density.
Boonen and his associates compared the risk of hip fracture using data from vitamin D trials and from vitamin D plus calcium trials. Both compared the supplements with placebo or no treatment.
The risk of hip fracture in the vitamin D-only trials was not statistically significant, the authors report. In contrast, the hip fracture risk in the vitamin D plus calcium trials was reduced by 18 percent, the report indicates.
Combining the data yielded a statistically significant 25-percent lower risk of hip fracture, in favor of vitamin D with additional calcium.
With aging comes a negative calcium balance and for most people this is "due to the combination of inadequate calcium intake and suboptimal vitamin D status," Boonen said. "That is why, in most individuals, a combination of calcium and vitamin D is required to restore calcium balance and reduce fracture risk."
"Current evidence indicates that you need at least 800 IU of vitamin D to reduce fracture risk (and that you need additional calcium supplements), but what we don't know is whether 800 IU of vitamin D is the optimal dose for musculoskeletal health," Boonen added. "Future research should focus on this question."
Vitamin D is obtained either from the diet or by synthesis in the skin under the action of sunlight. Overt vitaminDdeficiency causes rickets in children and osteomalacia in adults, conditions where the ratio of mineral to osteoid inbone is reduced.Poor vitaminDstatus in the elderly,at plasma levels of 25-hydroxyvitamin D above those associated with osteomalacia, has been linked to age-related bone loss and osteoporotic fracture, where the ratio of mineral to osteoid remains normal.
The possibility that vitamin D could help protect people from developing multiple sclerosis (MS) has been posited by researchers in recent decades, but evidence to support that link has been scant.Researchers have found an association between higher levels of vitamin D in the body and a lower risk of MS.They suggests that many cases of MS could be prevented by increasing vitamin D levels.
MS is a chronic degenerative disease of the central nervous system. It affects some 350,000 people in the U.S. and 2 million worldwide, and occurs most commonly in young adults.The results of this study converge with a growing body of experimental evidence supporting the importance of vitamin D in regulating the immune system and suppressing autoimmune reactions, which are thought by most experts to play a key role in the development of MS.
In countries with high osteoporotic fracture incidence, a low calcium intake (i.e. below 400-500 mg per day) among older men and women is associated with increased fracture risk.In countries with high fracture incidence, increases in dietary vitamin D and calcium in the older populations can decrease fracture risk. Therefore, an adequate vitamin D status should be ensured. If vitamin D is obtained predominantly from dietary sources, for example, when sunshine exposure is limited, an intake of 5-10 mg per day is recommended.
Although firm evidence is lacking, prudent dietary and some lifestyle recommendations developed in respect of other chronic diseases may prove helpful in terms of reducing fracture risk. These include:
- increase physical activity;
- reduce sodium intake;
- increase consumption of fruits and vegetables;
- maintain a healthy body weight;
- avoid smoking;
- limit alcohol intake.