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IOF World Congress News Role of vitamin D in osteoporosis prevention highlighted Osteoporosis, a serious disease associated with significant morbidity and mortality and affecting more than 200 million women worldwide, is largely a preventable disorder, experts in Lisbon agree. Eating a balanced diet that incorporates calcium, vitamin D and several other important vitamins and minerals, especially during the formative years, is an essential preventive strategy that the public continues to be largely unaware of. Finnish researcher Marjo Lehtonen-Veromaa, Turku University Central Hospital, Turku, Finland and colleagues, presenting at the IOF World Congress on Osteoporosis, have reported the results of a three-year prospective study assessing the association between vitamin D status and attainment of peak bone mass among 171 healthy peripubertal (age 9-15 years) Finnish girls. Bone mineral density (BMD) was assessed at the lumbar spine and femoral neck using dual X-ray absorptiometry, and dietary intake of vitamin D and calcium was estimated on the basis of food frequency questionnaires. Among a subgroup of 129 girls with advanced sexual maturation at baseline, the difference in adjusted three-year BMD accumulation from baseline was 4% greater for those with normal vitamin D status as compared with those with severe hypovitaminosis D. The adjusted three-year change in BMD of the lumbar spine was 27% higher among girls in the upper tertile as compared with those in the lowest tertile. Given that attainment of peak bone mass during childhood and adolescence is an important strategy for avoiding osteoporosis later in life, the investigators concluded that dietary enrichment or supplementation with vitamin D warrants serious consideration in order to ensure adequate vitamin D status among all adolescents. Dr. Lehtonen-Veromma emphasized the link between days of sunshine in Finland, vitamin D production and the high incidence of osteoporotic fractures. "We initiated this study in 1997 and are now publishing three-year results. Our next mark in this study is five years", stated Dr. Lehtonen-Veromma. "Vitamin D intake is low in Finnish girls and we believe that dietary supplementation should be seriously considered." Results of a large study conducted in seven European countries suggest that calcium and vitamin D supplementation is equally important in older subjects in terms of preventing hip fractures. The study, which involved 3,270 institutionalized elderly women in Belgium, France, Germany, the Netherlands, Spain, Sweden and the U.K., assessed the cost-effectiveness of daily supplementation with elemental calcium (1,200 mg) plus vitamin D3 (800 IU) as compared with placebo, in terms of reducing the incidence of hip fracture. After 36 months of follow-up, the intent-to-treat analysis demonstrated a 25% reduction in the incidence of hip fractures among women receiving calcium and vitamin D as compared with those administered placebo. The net financial benefit obtained through this preventive strategy was significant, according to lead investigator Pierre J. Meunier, Department of Rheumatology and Bone Diseases, Edouard Herriot Hospital, Lyon, France, with cost-effectiveness established in all countries. National medical costs and local costs of the calcium/vitamin D supplement were taken into account for the analysis. According to Dr. Meunier, prevention strategies should be developed, at no increased cost, but with substantial cost-savings over the long term. "Treating 1,000 institutionalized women with calcium-vitamin D3 continued supplementation can allow to avoid 46 fractures over a 36-month treatment period," says Dr. Meunier. Calcium is essential to bone health. During childhood calcium is required for continued bone growth and, after age 20 when bones typically stop growing in length, calcium continues to be required for the ongoing process of bone remodeling. Adults require at least 1000 mg/day of elemental calcium (1,500 mg/day for teenagers, pregnant or lactating women, women over 50 on hormone replacement therapy and all women over age 65). Vitamin D, which is obtained through some dietary sources as well as being absorbed through the skin during exposure to sunlight, increases calcium absorption by as much as 80%. Most individuals obtain sufficient vitamin D from dietary sources and exposure to sunlight, although supplements may be required for those with limited sun exposure.
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