Managing Skeletal and Extra-skeletal Health of Patient

Vitamin D is known for its role in calcium homeostasis for optimal skeletal health. It was previously believed that only elderly or hospitalized patients were at risk for vitamin D insufficiency, but many people in the general population have insufficient levels of Vitamin D (25-hydroxyvitamin D or in short, 25[OH]D).

We review the role of vitamin D in skeletal health and present data on vitamin D in other extraskeletal diseases, with special emphasis on the rheumatology patient.

Skeletal Benefits

Extraskeletal Benefits

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Skeletal Benefits of Vitamin D

Reduces the incidence of hip and/or non-vertebral fractures².

Extraskeletal Benefits of Vitamin D

Muscle function and fall prevention
Improves myopathy characterized by muscle weakness, wasting, and instability of gait, postural and dynamic balance

Vitamin D plays important roles in the prevention of:

- autoimmune diseases,

- decreased risk of cancer,

- prevention of falls,

- improved immunity,

- prevention of hypertension, and

- diabetes

The exact mechanism of vitamin D–mediated immune modulation remains unclear.

Note:

· The etiology of this myopathy is multifactorial and attributed to secondary hyperparathyroidism, hypocalcemia, hypophosphatemia, and calcitriol deficiency itself.

· Given the widespread prevalence of vitamin D insufficiency in the general population and in patients with rheumatologic diseases, screening for and treating vitamin D insufficiency should become standard.

Recommended Optimal Intake

All the studies that demonstrated efficacy of vitamin D to prevent fracture used at least 800 IU of cholecalciferol in largely vitamin D–deficient populations. Although ergo-calciferol is likely to be effective in preventing fractures, evidence is limited.

In addition, 25(OH)D levels should be maintained above at least 32 ng/mL. Vitamin D should also be taken along with 1000 to 1200 mg per day of calcium to have maximum anti-fracture efficacy³.

Note: Adherence to a daily calcium and vitamin D regimen is extremely important and must be stressed to each patient.

Source:

Islam AKMM, Hasan MN, Rahman KM, Asaduzzaman M, Rahim MA, Zaman S, Islam MR, Jesmin H, Yeasmin L. Vitamin D status in Bangladeshi subjects: a laboratory based study. BIRDEM Med J 2019; 9(3): 202-206.
Bischoff-Ferrari HA, Dawson-Hughes B. Where do we stand on vitamin D? Bone. 2007; 41(1 Suppl 1):S13–19.
Boonen S, Lips P, Bouillon R, et al. Need for additional calcium to reduce the risk of hip fracture with vitamin D supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab. 2007; 92:1415–1423.

[Of importance this meta-analysis demonstrates that vitamin D and calcium together are most effective in preventing hip fractures.] [PubMed] [Google Scholar]

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