Fractured Foot and Osteoporosis
Several months ago I fractured two bones in my foot. Because of this I was evaluated and found to have mild osteoporosis. Since then I have been studying osteoporosis and would like to share what I have found.
Bone is an active tissue which responds to nutrients, level of activity, hormones and drugs fairly quickly. Strong bone is essential to avoid fractures after mild or moderate trauma. Definitive diagnosis of osteoporosis is made with a DXA (formerly DEXA) scan. Bone density which is lower than normal but not osteoporotic is termed osteopenia.
As with all body tissues, bone requires a wide spectrum of nutrients including many vitamins and minerals. Most of these nutrients are in generous supply from a diet which includes vegetables, fruits, legumes, seeds, nuts and whole grains. A few critical nutrients can be lacking even in an otherwise healthy diet. These include vitamin D, vitamin B12, vitamin K2, zinc and iodine.
Calcium is the major mineral involved in bone formation and logically might be an important dietary deficiency in osteoporosis. This is not true for those who regularly eat a variety of green vegetables and/or dairy. Legumes, almonds, tofu and canned fish (Atlantic sardines best) with bones left in are also good calcium sources. Calcium supplementation has been widely studied and debated. For many years it was assumed that supplemental calcium would help people who had osteoporosis, but recent research has not confirmed this. In fact, in some studies calcium supplementation has been associated with higher rates of heart attacks and other vascular disease but not with lower rates of fracture. Current good practice is not to offer calcium supplementation, or, at most, to prescribe a small supplement such as 500 mg a day unless the patient will not eat calcium containing foods. One theory is that supplemental calcium supplies a sudden burst of calcium in the blood which increases clotting so much that blood vessels can be blocked causing a heart attack or stroke.
Another major nutrient for bone formation is vitamin D. This vitamin is critical in all body tissues but has been particularly studied in bone health because it was long ago discovered to be the major cause of rickets, a deforming bone disease that was once common in children. An enormous amount of research on vitamin D has still not resolved many questions. Experts debate the range of adequate serum levels, whether supplementation is a good idea, and, if using supplementation, what is the optimal dose. Hundreds, perhaps thousands, of researchers around the world devote much of their time to study these questions.
Current guidelines for serum vitamin D are a level between 20 and 80 ng/mL. It is generally accepted that below 20 or above 80 are potentially dangerous ranges. Studies of likelihood of dying indicate that people with a level of around 50 have the lowest chance of death. Most people who do not take supplements are healthy with levels between 20 and 80.
Vitamin D is created in the skin after exposure to sunlight and people with adequate sun exposure will not need supplementation. Darker skin pigmentation and increasing age both require more sun exposure or supplementation. Vitamin D is a fat soluble vitamin and therefore is well stored in the body: an excess can be saved for a rainy day. Unfortunately, high levels (when serum values are above 80) are also a problem so that vitamin D cannot be supplemented in very large quantities, but someone who is deficient can take large doses for a few weeks or months to replenish body stores. Tablets with up to 50,000 international units of vitamin D are commercially available. Some suggest 300 to 800 international units a day supplementation, but there is good evidence that doses up to 2000 international units a day are safe and more reliably raise serum levels to optimal. People with little sun exposure will need higher amounts of supplementation than those who are frequently in the sun. Some foods, particularly cows’ milk and soy milk, are fortified with vitamin D but the contribution of food to vitamin D levels is modest for most people. Most supplements are in the form of vitamin D3, which is what is usually recommended. The D2 form can also be used and is as effective for most people.
My experience is that many physicians are confused and poorly informed about appropriate calcium and vitamin D supplementation. I recommend not to take calcium supplements unless your physician has determined that you have a specific reason why you need extra calcium or you are unable or unwilling to eat calcium containing foods. Someone who eats mainly junk food might need 500 mg. a day. The diagnosis of osteoporosis or osteopenia alone is not an indication for calcium supplementation. I would supplement with vitamin D3, the dose dependent on how much sun exposure you have. With little or modest exposure, I suggest 2000 units a day; with good exposure 1000 units a day. Vitamin D should be taken with meals since it is absorbed much better at that time. Even better is to have your vitamin D serum levels checked. If they are in the 40 to 80 range no supplementation is necessary.
I will send future messages about other nutrients, exercise, and other issues relating to osteoporosis.
Several months ago I fractured two bones in my foot. Because of this I was evaluated and found to have mild osteoporosis. Since then I have been studying osteoporosis and would like to share what I have found.
Bone is an active tissue which responds to nutrients, level of activity, hormones and drugs fairly quickly. Strong bone is essential to avoid fractures after mild or moderate trauma. Definitive diagnosis of osteoporosis is made with a DXA (formerly DEXA) scan. Bone density which is lower than normal but not osteoporotic is termed osteopenia.
As with all body tissues, bone requires a wide spectrum of nutrients including many vitamins and minerals. Most of these nutrients are in generous supply from a diet which includes vegetables, fruits, legumes, seeds, nuts and whole grains. A few critical nutrients can be lacking even in an otherwise healthy diet. These include vitamin D, vitamin B12, vitamin K2, zinc and iodine.
Calcium is the major mineral involved in bone formation and logically might be an important dietary deficiency in osteoporosis. This is not true for those who regularly eat a variety of green vegetables and/or dairy. Legumes, almonds, tofu and canned fish (Atlantic sardines best) with bones left in are also good calcium sources. Calcium supplementation has been widely studied and debated. For many years it was assumed that supplemental calcium would help people who had osteoporosis, but recent research has not confirmed this. In fact, in some studies calcium supplementation has been associated with higher rates of heart attacks and other vascular disease but not with lower rates of fracture. Current good practice is not to offer calcium supplementation, or, at most, to prescribe a small supplement such as 500 mg a day unless the patient will not eat calcium containing foods. One theory is that supplemental calcium supplies a sudden burst of calcium in the blood which increases clotting so much that blood vessels can be blocked causing a heart attack or stroke.
Another major nutrient for bone formation is vitamin D. This vitamin is critical in all body tissues but has been particularly studied in bone health because it was long ago discovered to be the major cause of rickets, a deforming bone disease that was once common in children. An enormous amount of research on vitamin D has still not resolved many questions. Experts debate the range of adequate serum levels, whether supplementation is a good idea, and, if using supplementation, what is the optimal dose. Hundreds, perhaps thousands, of researchers around the world devote much of their time to study these questions.
Current guidelines for serum vitamin D are a level between 20 and 80 ng/mL. It is generally accepted that below 20 or above 80 are potentially dangerous ranges. Studies of likelihood of dying indicate that people with a level of around 50 have the lowest chance of death. Most people who do not take supplements are healthy with levels between 20 and 80.
Vitamin D is created in the skin after exposure to sunlight and people with adequate sun exposure will not need supplementation. Darker skin pigmentation and increasing age both require more sun exposure or supplementation. Vitamin D is a fat soluble vitamin and therefore is well stored in the body: an excess can be saved for a rainy day. Unfortunately, high levels (when serum values are above 80) are also a problem so that vitamin D cannot be supplemented in very large quantities, but someone who is deficient can take large doses for a few weeks or months to replenish body stores. Tablets with up to 50,000 international units of vitamin D are commercially available. Some suggest 300 to 800 international units a day supplementation, but there is good evidence that doses up to 2000 international units a day are safe and more reliably raise serum levels to optimal. People with little sun exposure will need higher amounts of supplementation than those who are frequently in the sun. Some foods, particularly cows’ milk and soy milk, are fortified with vitamin D but the contribution of food to vitamin D levels is modest for most people. Most supplements are in the form of vitamin D3, which is what is usually recommended. The D2 form can also be used and is as effective for most people.
My experience is that many physicians are confused and poorly informed about appropriate calcium and vitamin D supplementation. I recommend not to take calcium supplements unless your physician has determined that you have a specific reason why you need extra calcium or you are unable or unwilling to eat calcium containing foods. Someone who eats mainly junk food might need 500 mg. a day. The diagnosis of osteoporosis or osteopenia alone is not an indication for calcium supplementation. I would supplement with vitamin D3, the dose dependent on how much sun exposure you have. With little or modest exposure, I suggest 2000 units a day; with good exposure 1000 units a day. Vitamin D should be taken with meals since it is absorbed much better at that time. Even better is to have your vitamin D serum levels checked. If they are in the 40 to 80 range no supplementation is necessary.
I will send future messages about other nutrients, exercise, and other issues relating to osteoporosis.
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