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Many abstracts on fewer stress and bone fractures with vitamin D

In Sept 2010 one doctor mentioned that bone stress fractures had been increasing in the past few decades.

A short internet search did NOT find any evidence of increased incidence/frequency.
Did find that it occurs more frequently in populations with lower bone density:women, children, and the elderly

Vitamin D and fracture prevention.

Endocrinol Metab Clin North Am. 2010 Jun;39(2):347-53, table of contents.
Bischoff-Ferrari HA.
Centre on Aging and Mobility, University of Zurich, Zurich, Switzerland. Heike.Bischoff at usz.ch

This article discusses the amount of vitamin D supplementation needed and the desirable 25-hydroxyvitamin D level to be achieved for optimal fracture prevention. PMID: 20511056
Note – This meta-analysis found that 650 IU reduced all fractures by 21% and fractures for people ages 65-74 by 33%

Nutritional factors that influence change in bone density and stress fracture risk among young female cross-country runners.

PM R. 2010 Aug;2(8):740-50; quiz 794.
Nieves JW, Melsop K, Curtis M, Kelsey JL, Bachrach LK, Greendale G, Sowers MF, Sainani KL.
Clinical Research Center, Helen Hayes Hospital, Route 9W, West Haverstraw, NY 10993, USA. jwn5 at columbia.edu

OBJECTIVE: To identify nutrients, foods, and dietary patterns associated with stress fracture risk and changes in bone density among young female distance runners.

DESIGN AND SETTING: Two-year, prospective cohort study. Observational data were collected in the course of a multicenter randomized trial of the effect of oral contraceptives on bone health.

PARTICIPANTS: One hundred and twenty-five female competitive distance runners ages 18-26 years.

ASSESSMENT OF RISK FACTORS: Dietary variables were assessed with a food frequency questionnaire.

MAIN OUTCOME MEASUREMENTS: Bone mineral density and content (BMD/BMC) of the spine, hip, and total body were measured annually by dual x-ray absorptiometry (DEXA). Stress fractures were recorded on monthly calendars, and had to be confirmed by radiograph, bone scan, or magnetic resonance imaging.

RESULTS: Seventeen participants had at least one stress fracture during follow-up. Higher intakes of calcium, skim milk, and dairy products were associated with lower rates of stress fracture. Each additional cup of skim milk consumed per day was associated with a 62% reduction in stress fracture incidence (P < .05); and a dietary pattern of high dairy and low fat intake was associated with a 68% reduction (P < .05). Higher intakes of skim milk, dairy foods, calcium, animal protein, and potassium were associated with significant (P < .05) gains in whole-body BMD and BMC. Higher intakes of calcium, vitamin D, skim milk, dairy foods, potassium, and a dietary pattern of high dairy and low fat were associated with significant gains in hip BMD.

CONCLUSIONS: In young female runners, low-fat dairy products and the major nutrients in milk (calcium, vitamin D, and protein) were associated with greater bone gains and a lower stress fracture rate. Potassium intake was also associated with greater gains in hip and whole-body BMD. PMID: 20709302

Reducing fracture risk with calcium and vitamin D.

Note – only mentioned 800 IU
Clin Endocrinol (Oxf). 2010 Sep;73(3):277-85.
Lips P, Bouillon R, van Schoor NM, Vanderschueren D, Verschueren S, Kuchuk N, Milisen K, Boonen S.
Department of Endocrinology and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. P.Lips at vumc.nl

Studies of vitamin D and calcium for fracture prevention have produced inconsistent results, as a result of different vitamin D status and calcium intake at baseline, different doses and poor to adequate compliance. This study tries to define the types of patients, both at risk of osteoporosis and with established disease, who may benefit from calcium and vitamin D supplementation. The importance of adequate compliance in these individuals is also discussed. Calcium and vitamin D therapy has been recommended for older persons, either frail and institutionalized or independent, with key risk factors including decreased bone mineral density (BMD), osteoporotic fractures, increased bone remodelling as a result of secondary hyperparathyroidism and increased propensity to falls. In addition, treatment of osteoporosis with a bisphosphonate was less effective in patients with vitamin D deficiency. Calcium and vitamin D supplementation is a key component of prevention and treatment of osteoporosis unless calcium intake and vitamin D status are optimal. For primary disease prevention, supplementation should be targeted to those with dietary insufficiencies. Several serum 25-hydroxyvitamin D (25(OH)D) cut-offs have been proposed to define vitamin D insufficiency (as opposed to adequate vitamin D status), ranging from 30 to 100 nmol/l. Based on the relationship between serum 25(OH)D, BMD, bone turnover, lower extremity function and falls, we suggest that 50 nmol/l is the appropriate serum 25(OH)D threshold to define vitamin D insufficiency.
Supplementation should therefore generally aim to increase 25(OH)D levels within the 50-75 nmol/l range. This level can be achieved with a dose of 800 IU/day vitamin D, the dose that was used in successful fracture prevention studies to date; a randomized clinical trial assessing whether higher vitamin D doses achieve a greater reduction of fracture incidence would be of considerable interest. As calcium balance is not only affected by vitamin D status but also by calcium intake, recommendations for adequate calcium intake should also be met. The findings of community-based clinical trials with vitamin D and calcium supplementation in which compliance was moderate or less have often been negative, whereas studies in institutionalized patients in whom medication administration was supervised ensuring adequate compliance demonstrated significant benefits. PMID: 20796001

Osteomalacia as a result of vitamin D deficiency.

Endocrinol Metab Clin North Am. 2010 Jun;39(2):321-31, table of contents.
Bhan A, Rao AD, Rao DS.
Division of Endocrinology, Diabetes and Bone & Mineral Disorders, Henry Ford Hospital, Detroit, MI 48202, USA.

Osteomalacia is an end-stage bone disease of chronic and severe vitamin D or phosphate depletion of any cause. Its importance has increased because of the rising incidence of vitamin D deficiency. Yet, not all cases of osteomalacia are cured by vitamin D replacement, and furthermore, not all individuals with vitamin D deficiency develop osteomalacia. Although in the past osteomalacia was commonly caused by malabsorption, nutritional deficiency now is more common. In addition, recent literature suggests that nutritional vitamin D deficiency osteomalacia follows various bariatric surgeries for morbid obesity. Bone pain, tenderness, muscle weakness, and difficulty walking are all common clinical manifestations of osteomalacia. Diagnostic work-up involves biochemical assessment of vitamin D status and may also include a transiliac bone biopsy. Treatment is based on aggressive vitamin D repletion in most cases with follow-up biopsies if patients are started on antiresorptive or anabolic agents. PMID: 20511054


See also VitaminDWiki

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