CHICAGO (AP) -- Doctors say vitamin D deficiency is an often overlooked problem that may affect millions of U.S. adolescents. Often undetected and untreated, vitamin D deficiency puts them at risk for stunted growth and debilitating osteoporosis later in life.
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September 2, 2003
By Robert H. Shmerling, M.D.
Harvard Medical School
How does this article relate to me?
You have probably heard of osteoporosis — but how about osteomalacia? While osteoporosis is a common condition marked by a low quantity of bone, osteomalacia is a rarer condition in which the problem is bone quality. The bone in osteomalacia has too little mineral (calcium and phosphorus). People with either condition have an increased risk of fractures. People with osteomalacia may complain of bone pain even before a fracture occurs, while osteoporosis causes no symptoms unless a bone breaks.
Rickets is a form of osteomalacia (literally: "soft bone") that occurs in children, when bones are still developing. While you may have heard of rickets, you may have thought it no longer occurs, or that it occurs so rarely that it is primarily of historical interest. This article reminds us that rickets does still occur and may even be more common than previously appreciated. While the researchers in this article describe rickets in teen-agers, others have noted a surprisingly high incidence of osteomalacia in the elderly as well.
Rickets and osteomalacia develop as a result of vitamin D deficiency, and once detected are readily treatable with vitamin D. However, left untreated, the shape of bones may be abnormal, growth may be stunted and bones may break with poor healing.
What changes do I need to make?
While most people get plenty of vitamin D from their diet and from sun exposure — the sun's rays convert vitamin D in the skin to its most active form — it is worth considering whether you may be at risk for vitamin D deficiency. If you have had bone fractures without significant injury or unexplained bone pain, talk with your health-care provider about whether you should have a blood test to measure vitamin D.
In addition, you may be at risk of vitamin D deficiency if you have any of the following risk factors:
- Minimal dietary vitamin D intake from foods such as milk, certain fish (including salmon, mackerel and sardines), and foods fortified with vitamin D (including many cereals)
- Minimal sun exposure, especially common among "shut-ins," people living in New England, Alaska, nursing homes or people who cover their skin for religious reasons
- Digestive problems, such as colitis, in which there is poor absorption of nutrients (called malabsorption) or people who have had surgical removal of part or all of the stomach
- People taking corticosteroid medications
- Dark skin (because the effects of sunlight are reduced compared with fairer skin)
Keep in mind that vitamin D is one vitamin that can be dangerous when taken in high doses. So, if you take supplements, do not take more than the recommended daily allowance (usually listed as 400 IU but may vary from 200 IU for children to 600 IU for people over 70) unless you are instructed to do so by your health-care provider.
What can I expect in the future?
Expect to hear more about public education programs describing the importance of a diet that contains an adequate amount of vitamin D, use of supplements that contain vitamin D, and how to balance the risks of excessive sun exposure with the benefits of some sun exposure. Many experts already suggest that everyone take a multivitamin supplement containing the recommended daily allowance of vitamin D.
If rickets and osteomalacia are found to be common enough, screening blood tests for vitamin D levels could someday become routine, at least in some parts of the world where the average number of hours of daily sunlight is relatively low. With so much known about who is at risk for vitamin D deficiency, how to test for it and how to treat it, it is surprising to learn that rickets and adult osteomalacia may actually be common. Getting teen-agers to improve their diets and to reduce time spent indoors may not be easy, but, with increased awareness, prevention of vitamin D deficiency should be.
Related Areas:
Osteoporosis
Vitamin And Mineral Supplements For Infants
Vitamin D Fact Sheet From The National Institutes Of Health
