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Vitamin D deficiency is a global health problem affecting an estimated 1 billion children and adults worldwide and is recognised as a major public health issue.*
In Portugal, 66% of adults suffer from vitamin D insufficiency or deficiency **.
The main source of vitamin D is the sun. The body obtains vitamin D through skin exposure to sunlight (UVB radiation) and, to a lesser extent, through diet.**
The main cause of vitamin D deficiency is a lack of sun exposure, due to a decrease in outdoor living. Winter, old age, and obesity are important risk factors. **
Vitamin D deficiency and insufficiency pose a negative impact, particularly on musculoskeletal health. This vitamin is crucial in regulating bone metabolism and muscle development. It preserves and even increases bone density and muscle strength, especially in the elderly, preventing falls, fractures, and even more serious conditions, such as osteoporosis.
Sources:
*Duarte C, Carvalheiro H, Rodrigues AM, Dias SS, Marques A, Santiago T, et al. Prevalence of vitamin D deficiency and its predictors in the Portuguese population: a nationwide population-based study. Arch Osteoporos [Internet]. 2020 Mar. 15(1):36.
**DGS [Portuguese General Directorate of Health]. Ordinance No. 4/2019 of 14/08/2019
The term osteoporosis literally means “porous bone” and this is a condition that results from a reduction in the density and quality of our bones. A healthy bone under a microscope looks like a honeycomb. The honeycombs in a bone with osteoporosis, on the other hand, are expanded and much wider.
Please note that as the bones become more porous and fragile, the risk of fracture increases considerably. However, bone loss happens in a silent and progressive way and often there are no symptoms until the first fracture occurs. Sometimes the bones become so weak that they can break in a fall, or in the case of more serious osteoporosis, even after a simple sneeze.
The most common fractures associated with osteoporosis occur in the wrist, hip, and spine. Spinal fractures can have serious consequences such as loss of height, severe back pain, and deformities (including what is known as a hunchback). A hip fracture, on the other hand, often requires surgery and can result in loss of independence or even death.*
Osteoporosis is known for being a silent disease. It is often only diagnosed when the first fracture occurs following minor trauma (in particular to the vertebrae, hip, or wrist).
In any case, sudden, intense, and inexplicable back pain is one of the possible symptoms of the disease.
Also, changes in the shape of the body can be a clear sign of the condition. A person with osteoporosis often “loses height” (more than 2.5 cm), has a curved spine (also known as a hunchback), and has shoulders that slump forward.
As a consequence of this structural change, the ribs “lean” against the hip bones, the waist becomes wider, the abdomen more prominent, and the lower back flatter.
Since osteoporosis has no obvious symptoms, apart from fracturing when the bone is already significantly weakened, it is important for the doctor to assess the degree of bone mineral density, especially if the patient is in a risk group.
Bone densitometry (DEXA scan), a low-radiation X-ray examination, is the most important test for the diagnosis of osteoporosis because it measures bone density, which is directly related to bone mass. This is recommended for women over the age of 65 and for men over the age of 70, or for both sexes over the age of 50 if risk factors are present.
The test makes it possible to assess bone mineral density (BMD) of a given area and can be performed in different regions of the body, including the hips, spine, forearms, wrists, fingers, or heels.
When BMD is below a certain threshold (T-Score < -2.5) it is deemed that the person already has osteoporosis.
Besides being safe (low radiation) and painless, bone densitometry is a test that provides important information about bone health and is a useful tool that can prevent or avert any worsening symptoms of osteoporosis. Early diagnosis can make all the difference in terms of future well-being.
In order to avoid the consequences of osteoporosis—increased mortality following vertebral or hip fractures, chronic pain, loss of autonomy, deformities, and depression—the best thing is to prevent the condition by promoting a bone-healthy lifestyle at all stages in life.
Sources:
*International Osteoporosis Foundation (https://www.iofbonehealth.org/what-is-osteoporosis)
Women, in particular postmenopausal women, are more susceptible to bone loss than men, because their bodies at this stage of life produce less oestrogen, a hormone fundamental to bone formation. They are therefore more likely to suffer an osteoporotic fracture than men. Incidentally, according to the International Osteoporosis Foundation, the lifetime risk of any fracture ranges from 40-50% in women compared to 13-22% in men.
Most hip fractures happen in people aged 50 and over. This is largely due to the progressive reduction in bone mineral density as we age. Age alone is an independent risk factor. In other words, even elderly people with normal bone mineral density are more likely to suffer a fracture than young people.
It is known that factors such as race—osteoporosis is more common in Caucasian and Asian populations—small stature or excessive thinness, or a family history of fractures are also related to a higher incidence of osteoporosis and an increased risk of fracture regardless of bone mineral density.
A sedentary way of life, with a diet low in calcium, smoking, or excessive alcohol consumption can all have an impact on the thickness and quality of our bones. However, the good news is that these are risk factors related to an unhealthy lifestyle, which means they can be modified.
Vitamin D is essential in facilitating the absorption of calcium. In most cases, sun exposure of about 10 to 15 minutes a day is enough to ensure the production of a sufficient amount of vitamin D. However, in older people who do not go out regularly and are not exposed to the sun or people living in northern latitudes during the winter months it is important to boost levels of this vitamin, which can be found in certain foods or supplements.
Certain chronic illnesses such as anorexia nervosa, malabsorption syndromes—including celiac disease and Crohn's disease—chronic liver disease, thyroid problems, chronic renal failure, among others, contribute to the onset of osteoporosis. Also, prolonged use of certain drugs, such as corticosteroids, can weaken bones.
