Foot Health

Vitamin D and bone health

We have heard a lot of information on vitamin D – especially now during COVID -9 pandemic however, there are many persons with low vitamin D levels. Although many foods are fortified with vitamin D, most people find it surprisingly hard to get enough – even for us in The Bahamas where most of our days are sunny. Many people who work office jobs rarely see the sun because they drive in cars with tinted windows, are in the office all day or use SPF 30 sunscreen to block the sun’s rays; this all adds up to inadequate exposure to sunlight and low vitamin D levels.

Vitamin D is important for maintaining good bone and foot health. It affects bones by controlling the body’s levels of calcium and phosphate, which are critical for building new bone. The body controls phosphate levels in three ways – regulating how much we absorb from our diet, how much is within our bones, and how much we excrete.

We get vitamin D from our diet, sun exposure and oral supplements like multivitamins. Only a few foods naturally contain vitamin D. These include some oil-rich fish, certain mushrooms and egg yolks. Most of our dietary vitamin D comes from fortified dairy products, cereals and bread products. The sun provides a major source of vitamin D, but sunscreen, which protects against sunburn and skin cancer, decreases the skin’s production of vitamin D.

Low vitamin D

Most doctors consider a vitamin D level of less than 30 to be low. Low vitamin D is very common in all regions of the globe. In the United States, approximately 30 percent of the population has a low vitamin D level. Vitamin D insufficiency is more prevalent among African Americans (Blacks) than other Americans, and in North America, most healthy young Blacks do not achieve optimal vitamin D 25 levels at any time of year. This is primarily due to the skin pigmentation reducing vitamin D production in the skin. Also, from about puberty and onward, median vitamin D intakes of American blacks are below recommended levels in every age group, with or without the inclusion of vitamin D from supplements. Despite their low vitamin D levels, Blacks tend to have lower rates of osteoporotic fractures than whites.

Factors that increase the risk of having low vitamin D levels include low dietary intake and low sun exposure, which often occurs in colder climates during the winter months, absorption problems, stomach surgeries, kidney problems or liver disease.

In addition, women and older people are more likely to have low vitamin D levels. Some conditions are associated with low vitamin D, including being overweight, kidney failure, liver failure, dietary mal-absorption syndromes and parathyroid problems. Smoking and taking certain medications such as oral steroids and some seizure medicines can also cause low vitamin D. There are also some genetic disorders that can cause low vitamin D level.

How low vitamin D affects the body

Strong scientific evidence suggests that vitamin D deficiency plays a role in kidney disease, osteomalacia, thyroid disorders, psoriasis and rickets, according to the Mayo Clinic. It is linked to increased risk of respiratory illness such as asthma and whooping cough in newborns and children under five years of age. It is linked to bone disease such as rickets in children and osteoporosis and osteomalacia in adults. Osteomalacia is a condition in which adults experience softening of the bones, often due to severely low vitamin D levels. Patients who present with osteomalacia may be deficient in vitamin D for many different reasons we discussed above.

Several bone health problems are associated with low vitamin D, including low bone density (osteoporosis) and rickets in children. People with chronically low vitamin D are more likely to have low bone density and are more likely to fracture bones. Researchers have also linked low vitamin D levels to broken bones of the foot or ankle. In addition, they suggest that broken bones are less likely to heal when vitamin D levels are low. Low vitamin D levels has also been linked to cognitive impairment in older adults

In recent years, researchers have also linked low vitamin D levels to insulin resistance and diabetes. Overcoming insulin resistance, in particular, could be a way to prevent type 2 diabetes. Low vitamin D levels are also associated with increased risk of cancer such as breast, bowel, colon and pancreatic cancer. It is also linked to cardiovascular diseases, diabetes and obesity, in fact several studies have found that teenage girls who are vitamin D deficient are fatter around the stomach and shorter in stature than their peers. Significantly more research is going on in the area of vitamin D and health. Symptoms of bone pain and muscle weakness can mean you have a vitamin D deficiency.

Who should have a vitamin D level check

Anyone with a low-energy fracture, which is often called a fragility fracture, should speak with their doctor about testing their vitamin D level. Additionally, patients at particular risk of low vitamin D because of medical conditions, such as kidney disease and parathyroid disorders, should also discuss a vitamin D check with their doctor. Post-menopausal, older women who are osteopenic, with bone pain and or fractures can also benefit from having their vitamin D levels checked.


Treatment

The goal of treatment is to raise the vitamin D levels above 30. Several large research studies have shown that taking vitamin D decreases the risk of fractures. This includes foot and ankle fractures as well as hip and wrist fractures. Improved fracture healing has also been found in people taking vitamin D. For this reason, many doctors recommend testing for vitamin D level in people who are at risk of low vitamin D. Vitamin D is measured from a blood test and treatment is typically with oral vitamin D and calcium supplement.


• For more information on foot conditions, visit www.apma.org, healthcentral.com, or email us at
foothealth242@gmail.com. To see a podiatrist, visit Bahamas Foot Centre, Rosetta Street, or telephone 325-2996 for an appointment at Bahamas Surgical Associates Centre, Hilltop Medical, or call 394-5820 for an appointment. You can also visit Lucayan Medical Centre in Freeport, Grand Bahama, or telephone 373-7400 for an appointment.

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