In a report published on June 19, 2009 in the journal Osteoporosis International, the International Osteoporosis Foundation's expert working group on nutrition revealed the global extent of vitamin D insufficiency. They found that suboptimal vitamin D levels are common in most areas of the world, and appear to be on the rise.
The committee, chaired by Ambrish Mithal of Indraprastha Apollo Hospitals in New Delhi, India, reviewed published literature concerning the vitamin D levels of people residing in Asia, Europe, Latin America, the Middle East and Africa, North America and Oceania. Although there was some of variance in assay methodology and in the definition of vitamin D deficiency and insufficiency, 25-hydroxyvitamin levels below 75 nanomoles per liter, which are generally considered insufficient, were found to be widespread in every region studied. Older age, female gender, higher latitude, winter season, dark skin pigmentation, decreased sun exposure, dietary habits, and a lack of vitamin D fortification were identified as factors contributing to low vitamin D levels. Levels below 25 nanomoles per liter, indicating deficiency, were prevalent in South Asia and the Middle East, where increased urbanization and the wearing of clothing that covers most of the skin are major contributors.
Adequate vitamin D levels are critical to maintain optimal calcium levels in the body, and are essential for normal bone mineralization and growth. Inadequate vitamin D increases the risk of osteoporosis and hip fracture in older individuals, and rickets in children, which can cause deformity and fractures.
"Reports from across the world indicate that hypovitaminosis D is widespread and is re-emerging as a major health problem globally," the authors conclude. The findings indicate that preventive measures, including the encouragement of limited sun exposure, improved dietary intake and food fortification, must be initiated at the national level.
Osteoporosis is defined as a reduction of bone mass, or bone density, which causes the bones to become brittle and fragile. People afflicted with osteoporosis are at increased risk of a range of fractures, including fractures of the hip, spine, and wrist. Fractures associated with osteoporosis are debilitating and costly (Melton LJ 2003; Woolf AD et al 2003). Mortality rates one year after hip and spine fractures have been reported to be as high as 30 percent (Rossell PA et al 2003; Kanis JA et al 2004). Many studies report high rates of institutionalization, loss of function, and death after hip and spine fractures.
Bone is living tissue comprising both organic protein matrix (30 percent) and various minerals (70 percent). Throughout life, cells known as osteoblasts construct bone matrix and fill it with calcium. At the same time, cells called osteoclasts work just as busily to tear down and resorb the bone. This fine balance is regulated by many factors, including systemic hormones and cytokines. Bone mass reaches its peak by the middle of the third decade of life and plateaus for about 10 years. During this time bone turnover is constant, meaning bone formation approximately equals bone resorption.
As our bodies age, this fine balance is lost. As the relative hormone levels shift in midlife—more drastically in women than in men—the osteoclasts gain the upper hand, and bone mass begins dwindling. Some bone is already being lost by the time women reach menopause, but the rate of loss can increase as much as tenfold during the first six years after menopause. This is the essence of primary osteoporosis, or osteoporosis that occurs as a natural part of aging.
From midlife onward, bone health is threatened by overactive osteoclasts. To add to the problem, the osteoblasts may become less active from age 60 onward, causing type II osteoporosis. Whereas trabecular (spongy looking) bone in the vertebrae and elsewhere was formerly at risk from excess osteoclast activity, now the cortical (dense) bone of the hip, shin, pelvis, and other sites becomes more prone to fracturing because osteoblasts do not make enough of it.
Brain Health and Healthy Aging, presented by Eric Braverman, MD
Eric R. Braverman, MD has a fabulous upcoming event that you are invited to:
On Thursday, July 9th at 7:00 PM, he will be giving a seminar on “Brain Health and Healthy Aging.” Participants will learn how to brainprint not only the elderly mind but also the adolescent mind and children. By studying young brains, children can develop a healthier memory and attention and have more wellness throughout the course of their life. This is going to take place at Easthampton’s prestigious Ross School located at: 18 Goodfriend Drive, East Hampton, New York 11937.
Eric R. Braverman, MD, is director of the Place for Achieving Total Health (PATH Medical and the PATH Foundation) in New York City. Dr. Braverman received his BA from Brandeis University Summa Cum Laude/Phi Beta Kappa and his MD from New York University Medical School with Honors. He is the author of Younger You (2006) and Younger Thinner You (2009) and of over 100 research papers and is Clinical Assistant Professor of Integrative Medicine in the Department of Neurosurgery at Cornell Weill Medical College, as well as a lecturer on mild cognitive decline.
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