Vitamin D Can Reduce Risk of Fracture in Osteoporosis

British Medical Journal reported in the March 1, 2003 issue that oral vitamin D supplementation can reduce the risk of fractures in women and men over age 65. ("Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial," Daksha P Trivedi, Richard Doll, and Kay Tee Khaw, BMJ 2003; 326: 469.) The randomized, double-blind controlled trial included 2,037 men and 649 women between the ages of 65 and 85 years. The study group took one capsule of vitamin D containing 100,000 IU vitamin D in the form of cholecalciferol (D3) once every four months for five years. The control group received a placebo capsule.

After five years, 10 percent (268 subjects) had fractures, but when compared with the placebo group, the group taking vitamin D had 22 percent fewer fractures. Of the 268 subjects with fractures, 147 fractures occurred at the hip, wrist, forearm, or vertebrae, the most common sites for osteoporosis. The fracture rate in the vitamin D group was 33 percent lower in these sites.

Daksha P. Trivedi, the lead author of the report, who is from the University of Cambridge, stated, "Safe, effective, feasible, and cost effective primary prevention measures are needed in older men and women, in whom most osteoporotic fractures occur." The authors concluded, "Many interventions effective in high risk groups are not feasible in the general population owing to poor compliance or side effects or are not cost effective. In contrast, the cost of four monthly oral 100,000 IU vitamin D [doses] is minimal (less than £1 annually)."

Comment

Vitamin D's role in facilitating calcium uptake has long been recognized. It is sometimes referred to as the "sunshine vitamin," although you don't exactly absorb vitamin D from sunlight. What actually happens is that the ultraviolet rays in sunshine stimulate a reaction in which cholesterol (yes, I'm talking about that bad stuff we're suppose to avoid eating) is transformed into cholecalciferol or vitamin D. (Vitamin D3, that is. D2, or ergocalciferol, is the synthetic variety.) Thus, the beneficial effect of both sunlight and vitamin D is dependent upon the availability of calcium in the bloodstream which should be obtained through diet and, if necessary, nutritional supplements.

The benefit of this research report is that it has proven (to the extent that a single research study can prove anything, given that researchers must rigidly control variables in order to be reasonably certain that the results actually pertain to what was intended to be tested) what is already generally known and applied in clinical practice. However, now health care providers will be more likely to recommend vitamin D supplementation to at-risk patients.

The paper does not give a reason for administering vitamin D in a single dose of 100,000 IU at four month intervals. Clearly, this would be inconvenient for most people. A previous study in which subjects were given 400 IU vitamin D per day did not demonstrate effectiveness, but studies in which 800 IU per day or equivalent were administered did show reduced risk of fracture with osteoporosis. Combining vitamin D with calcium supplementation may further increase the preventative benefit. However, one study cited in the British Medical Journal paper demonstrated a combined effect similar to the results with vitamin D alone.

Compression fractures in patients treated with spinal manipulation: More than ten years ago, Dr. Scott Haldeman, a chiropractor and medical neurologist, reported on four elderly patients who had compression fractures in their spines following chiropractic adjustments. It was not clear that the adjustments actually caused the fractures which may have occurred prior to visiting the chiropractor. Indeed, the back pain from the fractures may have brought these patients to seek chiropractic care. “What is clear,” stated Dr. Haldeman, “is that failure to diagnose a compression fracture, together with the application of adjustment into the area of fracture, can increase symptoms and prolong disability.” He concluded that patients with osteoporosis (or those at risk, we might add) who have suffered a fall or injury be x-rayed before treatment is given.