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Vitamin D is the first of three ways to make unbreakable bones – Oct 2011

Three steps to unbreakable bones on World Osteoporosis Day

For this year's World Osteoporosis Day (October 20), the International Osteoporosis Foundation (IOF) is releasing a 24-page report promoting a three-step strategy for healthy bones and strong muscles.

Professor Heike Bischoff-Ferrari, director Centre on Aging and Mobility at the University of Zurich/Waid City Hospital and author of the report, stated,
"Put simply, no matter how old you are, you can optimize your bone health by following three essential steps.”

  • "First, you must ensure sufficient vitamin D intake.
  • Secondly, your diet should include adequate amounts of calcium and protein.
  • Finally, you should make sure that you're doing daily weight-bearing and muscle strengthening exercise.”

She emphasized that to be effective, all three components are required in combination.
"The benefits of healthy nutrition and adequate vitamin D enhance the benefits of exercise, and visa versa," says Prof Bischoff-Ferrari.

The report raises the critical issue of falls and fall-related fractures in seniors.
In addition, the report also notes:

  • Adequate calcium and protein intake can best be achieved through a nutritious diet that includes dairy products, nuts, beans and certain calcium-rich greens, fruits and mineral waters.
  • Dairy products offer the greatest amounts of calcium and also provide protein.

Seniors with decreased protein intake are more vulnerable to muscle weakness, sarcopenia and frailty – all contributing to an increased risk of falling and fracture.

vitamin D is produced in the skin upon exposure to sunlight. Food sources of vitamin D are rather limited, with small amounts found primarily in fatty fish and eggs.

As evidenced by the high rates of vitamin D deficiency around the world, most people cannot achieve adequate levels of vitamin D from sunlight.
The reasons include:

  • little sunshine in the winter months at latitudes above and below 33°,
  • cloud cover and air pollution,
  • use of sunscreens,
  • wearing clothing that covers most of the body, and the
  • general trend towards indoor lifestyles in both young and old.

Skin production of vitamin D declines with age, leaving seniors with a four-times lower capacity to produce vitamin D compared to younger adults.

In seniors vitamin D supplementation has been found to reduce the risk of falls and fractures by about 20%.
IOF recommends vitamin D levels of 800 to 1000 IU/daily for all people at risk and for everyone aged 60 and older.

Daily physical activity is absolutely essential for bones and muscles strength at all ages.
The most effective exercises are weight-bearing activities such as running, climbing stairs, jumping or brisk walking, as well as muscle-strengthening exercises such as weight-lifting.
Weight-bearing exercise programmes that improve gait speed, muscle strength and balance in seniors can translate into a 25-50% reduction in falls.

Smoking, excessive alcohol and being underweight (body mass index below 19) have been shown to have a negative impact on bone health.
(all three of which use up vitamin D)

Professor Cyrus Cooper, chair of the IOF Committee of Scientific Advisors, says, "Bone health is important at all stages of life.
I urge everyone to follow the recommendations provided by this report.
Adequate calcium and protein, vitamin D and daily exercise are the three key ingredients that help to maximize bone development and growth during childhood and adolescence."

"In adults they help maintain and improve bone mass and muscle strength. For seniors, exercise programmes should specifically include muscle-strengthening and balance training.
Together with adequate protein intake and vitamin D supplementation, this has been shown to be of great benefit in reducing falls and resulting fractures. “

More information: More information about World Osteoporosis Day, and to download the report 'Three Steps to Unbreakable Bones: vitamin D, Calcium and Exercise', visit http://www.worldosteoporosisday.org/ (Factsheets in English, Spanish, Arabic, and Chinese)
Their 10 MB report is available at VitaminDWiki CLICK HERE
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Their vitamin D factsheet


These facts are also provided in PDF format, making it easy to download, share and print.
Sufficient vitamin D is an essential requirement for healthy bones, strong muscles and fall and fracture prevention.
Vitamin D enhances the benefits of staying physically active and a calcium and protein-rich diet.


  • assists in calcium absorption
  • has a downward regulatory effect on parathyroid hormone level resulting in reduced bone loss
  • ensures correct renewal and mineralization of bone
  • has a direct stimulatory effect on muscle tissue and thereby
    • reduces the risk of falling improves strength and function,
    • increases bone mineral density, and
    • reduces the risk of falls and fractures by about 20%, including fracture of the hip


The main source of vitamin D is sunlight (UVB irradiation). It is made in our skin from exposure to sunlight.

For various reasons, sunshine exposure is not a reliable source of vitamin D:

  • Many geographic areas do not get sufficient UVB irradiation intensity during the winter months (e.g. all of Europe from November to end of March).
    As the half-life of vitamin D is 3 to 6 weeks, even if people get sufficient vitamin D during the summer, this will not secure vitamin D status in the winter months and early spring time.
  • Skin production of vitamin D declines with age, leaving seniors with a 4-times lower capacity to produce vitamin D in their skin compared to younger adults.
  • Seniors tend to avoid direct sun exposure which explains why even in southern areas with ample sunshine a large segment of seniors are vitamin D deficient (e.g. Mediterranean, Northern Australia).
  • The use of sunscreen and sun protective clothing reduces skin production of vitamin D independent of age.
    A sunscreen factor of 6 already blocks most of the vitamin D production in the skin.
    Solar elevation angle (i.e. time of day), cloud cover, air pollution, altitude, and surface reflection, all have an impact on vitamin D production in the skin.
  • The UVB exposure time needed to produce 800 IU vitamin D differs by skin type and season.
    For an 8% body surface exposure (face and hands) during midday the exposure time will vary between about 30 minutes to 1 hour in the summer time, and up to about 20 hours in the winter.
    • No: Need far more time in the sun - see chart at the bottom of this page

Vitamin D comes in two forms.

Vitamin D3 (cholecalciferol) is the version of vitamin D that is made in our skin and found in fatty fish and eggs.
Vitamin D2 (ergocalciferol) is a closely related molecule of plant origin.
Vitamin D3 has been shown in clinical trials to be more efficient than vitamin D2 in reducing falls and fractures.

Vitamin D supplements are best absorbed if taken with food as it is a fat-soluble vitamin.

Food sources of vitamin D are limited, and include fatty fish, such as salmon, mackerel, and herring.
One would have to eat two servings of fatty fish a day to reach a recommended intake of 800 IU vitamin D per day for fracture reduction.

Some countries fortify margarines, milk and other foods with vitamin D.


  • It is estimated that 50 to 70 percent of the European and 30 to 50 percent of the US adult population is vitamin D deficient.
  • In some regions, such as South Asia and Middle East, frank vitamin D deficiency is common in all age groups, from neonates to the elderly.

Vitamin D status is determined by measuring 25-hydroxyvitamin D in the blood (measured as 25(OH)D levels).

Vitamin D measurements should be targeted to those at risk for severe vitamin D deficiency and who may need greater doses of vitamin D than generally recommended.

Severe vitamin D deficiency (at levels below 25 nmol/l :< 10 ng/ml) can lead to rickets in infants and osteomalacia in adults.

IOF recommends that those at risk of osteoporosis and generally everyone aged 60 years and older take vitamin D supplements at a dose of 800 - 1000 IU per day.
References are provided in the IOF publication 'Three Steps to Unbreakable Bone: Vitamin D, Calcium and Exercise' (2011) available on www.iofbonehealth.org
Their 10 MB publication is available at VitaminDWiki CLICK HERE


  • seniors in general (especially those living in nursing homes or institutionalized care)
  • individuals living in high latitudes with minimal sunshine exposure
  • individuals who are obese
  • individuals who have a disease that reduces vitamin D uptake from the intestine (i.e. inflammatory bowel disease)
  • individuals who have a darker skin tone
  • individuals who for medical or cultural reasons cannot expose their skin to the sun

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Nice that they increase vitamin D and decrease Calcium to 800 mg (which is far less than the recommendation of IOM)

What is really needed, however is

  • 2X - 10X more vitamin D,
  • co-factors such as Magnesium, Vitamin K2, and Boron essential for Bone development

Minutes of sun to get 40 ng of vitamin D

IoM and Endocine recommendations graph