Dr. Shah Pathology Endocrine Lab
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Dr. Shah Pathology Endocrine Lab

Prevalence of vitamin D deficiency in referred cases in Gujarat –India

 Vitamin D deficiency is widespread throughout the world. There are almost one billion people in the world afflicted with this preventable condition who either have a musculoskeletal pain or more prominently joint pain. This may be one of the reasons for an increase number of knee replacement in the last decade. Few studies reported recently have shown the prevalence of vitamin D deficiency to be as high as 84.7% in subject undergoing hip or knee replacement. Which elucidate the link between vitamin D status in patients undergoing total hip or knee joint replacement therapy or have osteoporosis, osteopenia and decreased bone mineral disease.

We have carried out randomized study of vitamin D (25-OH-D) status by RIA in Gujarati population in the age range of 1 year to 60 and above. This includes 68 female and 29 male. Fifty five percent of patients were in the age group of 20 to 59 year, followed by 35 percent in the age of 60 and above while rest 12 percent were in the age range of 1 to 20 year. Except in the later group, the cause of referral was nonspecific musculoskeletal pain, with predominance of hip and knee joints. Vitamin D deficiency was considered where level less than 25 ng/ml. Fifty five percent of female were and 30% of male were found to have Vitamin D deficiency. This was more prevalent in the younger and middle age group (20 to 59 year) in both the sex. The mean level of Vitamin D was 19.5 ± 2.5 ng/ml in deficient state, while it was 30.0 ± 3.3 ng/ml in subjects without deficiency. The study indicates that female are more prone for Vitamin D deficiency as compared to males and younger and middle age group have more pronounced deficiency of Vitamin D in Gujarat which perhaps explain the increasing number of knee replacement in this part of the country.

Vitamin D3(25-OH-D nmol/L ) deficiency in male and females subjects age wise

Age group

Female

Male

Vitamin D Mean + SD

Less than 20 yrs

9

11.0

16.6+ 3.5

20-40 yrs

55

21

20.5+2.9

41-60 yrs

76

33

19.5+3.2

Greater than 60 yrs

77

27

19.9+2.6

Vitamin D3 (25-OH-D nmol/L) in healthy male and female subjects age wise

Age Group

Female

Male

Vitamin D Mean + SD

Less than 20 yrs

3

0

26.3+ 0.58

21-40 yrs

32

7

27.7+ 2.3

41-60 yrs

22

15

27.8+ 2.1

Greater than 60 yrs

NA

NA

NA

NA: Not Available

Osteoporosis Lifestyle and Prevention

The U.S. Surgeon General's Report on Bone Health and Osteoporosis, published in 2004, projects that by the year 2020, half of all Americans over age 50 will have weak bones unless they make changes in their diets and lifestyles. In India at the estimate 30 of 100 individuals are having Vit D deficiency which can be the culprit for many advanced age related fractures, cognition problems and osteoporosis.


The best way to keep your bones healthy is to establish a healthy lifestyle. This is good advice for everyone, of course, but especially true if you have risk factors for osteoporosis. As a start, you can take steps to reduce your risk:

  • Stop smoking.
  • Avoid drinking alcohol.
  • Get enough calcium and vitamin D through your diet or with supplements.
  • Do weight-bearing exercises to help keep bones strong.
  • Avoid high doses of thyroid hormone or cortisone-like medications. If you must take them, work with your doctor to get the lowest possible dose to treat your condition.

Diet and Exercise Make a Difference

Calcium

Diet makes a difference in the prevention of osteoporosis. Calcium, the main element needed to keep your bones strong and healthy, is found mainly in dairy products.
On average, people get 500 mg to 600 mg of calcium in their diet, largely from dairy products. Unfortunately, that is not enough to meet our needs.


Recommended Daily Intake of Vitamin D and Calcium for Adults

 

Vitamin D

Calcium

Under age 50

400 to 800 International Units (IU)

At least 1,000 milligrams (mg)

Over age 50

800 to 1,000 IU

At least 1,200 mg

 

 

 

 

 

 


To get the calcium that you need to keep your bones healthy, you should eat three to four servings of dairy foods daily. Great calcium sources include milk, yogurt, and cheese. Other sources of calcium include some green vegetables such as broccoli and kale.

If you cannot get all the calcium you need from food alone, you may need to take calcium supplements. Likewise, if you are lactose intolerant or limit dairy foods in your diet for other reasons, you can supplement your diet with calcium tablets.

Vitamin D

To form and maintain strong bones, vitamin D is essential. Vitamin D helps maintain a normal level of calcium in the blood by helping the body absorb calcium properly, and has other health benefits as well.  Fortified milk, egg yolks, liver, saltwater fish, and fish oils are among the few foods that contain vitamin D.

Sunlight on your skin activates the production of vitamin D in your body, but many people do not get enough sun to make sufficient vitamin D. While most people need at least 1,000 IU of vitamin D each day, many men and women need even higher doses.  You many want to have your doctor do a blood test to see if you are getting enough vitamin D and advise you on how to increase your intake if necessary.

Exercise

Exercise is the other important key to keeping your bones healthy. Exercise improves strength and balance, which may decrease the risk of falling. Before beginning any new physical activities, however, check with your doctor. A 55-year-old woman who is healthy would probably not have trouble beginning a weight-bearing regimen, but a 90-year-old woman might get a fracture doing the same type of exercise, because her bones are not as strong.
Once you get your doctor's okay, try walking more and climbing stairs, or jogging and playing racquet sports. Weight-bearing and strength-training exercise can help you stay fit and may lower the risk of fractures. Even men and women in their 90s have benefited from a gradual, personalized weight-training program. Bones remain stronger if they are used in daily weight-bearing activities such as walking or lifting weights. Walking at least 20 minutes a day can reduce bone loss.

Safety Precautions

Preventing fractures is important at any age. Here is a checklist to keep you safe at home:

  • Floors — Remove all loose wires, cords, and small rugs. Make sure your rugs are smooth and anchored. Keep furniture in its place so you won’t bump into or trip over it.
  • Bathrooms — Install non-skid tape in the tub and shower, and install grab bars.
  • Kitchen — Install non-skid mats near sink and stove. Clean spills right away.
  • Stairs — Do not leave piles of clothing or other items on your stairs. Make sure the hand rails and carpeting are secure.
  • Lighting — Install good lighting in your halls, stairways, and entrances. Install night lights in your bathroom. Turn on your lights if you have to get up during the night.
  • Hip protectors — Ask your doctor about hip protectors, which are padded shorts or underwear that are worn over or in place of underwear. They prevent fractures by distributing the force of a fall on the hip to the softer tissue around the buttocks and thigh.
  • In general — Ask your doctor if any of your medications might make you dizzy or more likely to fall. If you drink alcohol, drink only in moderation. If you feel unsteady, wear only flat, rubber-soled shoes.

Bone loss is a natural part of aging, but there are steps you can take to stay strong during every stage of your life. A healthy lifestyle is a great place