Calcium and vitamin D3: from osteoporosis to multimorbidity of cardiovascular diseases

October 3, 2019December 17, 2020

Vitamins and minerals are primarily involved in regulating metabolic processes in the body. Depending on age, gender, health status, weight, height, physical activity, and physiological needs, a person needs different amounts of these substances. Therefore, there are standards that help prevent vitamin deficiency and its consequences associated with the development of diseases. Prevention of vitamin D deficiency is an important public health goal. Among the vitamins valuable for a woman’s health, of course, vitamin D (calciferol) plays a special role, existing in two forms - D2 and D3, the activation of which occurs in the liver and kidneys.

Types of vitamin D - D2 and D3

D3 (cholecalciferol) is called “solar” because it is formed in the skin due to exposure to ultraviolet radiation. To do this, children and adults should spend about 15–30 minutes in the sun several times a week. However, intensive production of vitamin D occurs during hours that are harmful to health - from 11:00 to 14:00, when the skin needs protection.

In addition, the natural absorption of the vitamin decreases over time, and people with dark skin absorb it more slowly. Negative factors for the perception of beneficial sunlight are sunscreens and unfavorable ecology, such as air pollution. Therefore, even in the summer months, not always and not everyone can stock up on cholecalciferol.

D2 (ergocalciferol) enters the body along with the usual food. However, not many foods of animal origin are known to be enriched with vitamin D: fatty fish (herring, sardines, salmon, mackerel, tuna, halibut), lamb, eggs (yolk), butter, cream, sour cream, hard cheese, beef liver , seafood, cod liver, red caviar, fish oil. The vitamin is present in limited quantities in plant foods: chanterelle mushrooms, oatmeal, potatoes, oranges, parsley, broccoli, nuts, vegetable oils.

It is important to follow the cooking rules so that the beneficial vitamin is not destroyed. It has also been proven that food cannot provide the body with a sufficient dose of D2, since this requires eating too many foods rich in it, some of which also contain cholesterol. In addition, this list contains things that are advised to be consumed with caution or are not allowed at all for pregnant women and in the first 6 months of lactation.

Sources of Vitamin D

Vitamin D was discovered about 100 years ago during the search for foods needed to combat deficiencies in calcium and phosphorus in bones and teeth. The benefits of taking fish oil, which contains large amounts of vitamin A, have been proven. However, when this vitamin was neutralized, fish oil retained its properties, which led researchers to the conclusion that it also contains other vital substances. Subsequently, the discovered vitamin received the name of the fourth letter of the Latin alphabet - D. But fish in sufficient quantities was not available everywhere, and organizing the industrial production of fish oil took time. Therefore, the research continued. It was soon discovered that the beneficial properties of certain types of food are enhanced by irradiation with ultraviolet rays. Further, it was possible to prove that vitamin D can be synthesized by living cells under the influence of sunlight.

The second wave of vitamin D research began in the 1980s. Nowadays, experts primarily name fatty fish and dairy products, as well as animal by-products as its food sources [1].

If you are intolerant to the protein contained in cow's milk, dairy products made from goat's milk can be a source of vitamin D. They are especially indicated for women during pregnancy and breastfeeding [2]. Quiz: Find out how much vitamin D you get from food.

In adults

For many years it was believed that only children needed vitamin D for the correct functioning of all body systems. Studies have shown that under its influence, calcium enters the bones, promoting their proper formation and development, excluding the appearance of rickets. As for the mature age group, it was believed that there could be no deficiency of the element in men and women over 18 years of age, since the body is sufficiently exposed to sunlight. Further research in this area proved the opposite. In adults, the micronutrient controls cell division, has an anti-inflammatory effect, stimulates the activity of the immune system and promotes the production of antibacterial particles in the body, ensures optimal functioning of the nervous system, and causes the production of “antidepressive” mediators - dopamine and serotonin. When there is a shortage of it, the following occurs:

• brittle bones;
• muscle weakness, periodic cramps;
• frequent colds;
• lack of mood;
• irritability and depression;
• loose teeth, frequent caries;
• loss of appetite.

The benefits of vitamin D and why you need it

Calciferol is considered a women's health vitamin. Indeed, it is important for women. After all, its consumption, like other vitamins in general, is much higher than in the body of men. This is due to the characteristics of the female body and its functions: the menstrual cycle, pregnancy, childbirth, breastfeeding, menopause. Therefore, at different periods of life, the need for D3 and D2 may increase. But the main thing is that women need to maintain an adequate amount of calciferol, avoiding its shortage or excess.

Thus, vitamin D is essential because it:

1. Responsible for the level in the blood of minerals such as calcium and phosphorus, which contribute to the preservation and strengthening of musculoskeletal tissue (bones, joints, muscles, teeth).
2. Important for the musculoskeletal system, including correct posture, which is formed before the age of 20.
3. Controls the functioning of the immune, cardiovascular, endocrine, hormonal, and nervous systems. In particular, it supports the level of innate immunity; acts as a hormone (D-hormone) that regulates carbohydrate metabolism, that is, it is directly related to weight loss issues. This means it is needed for proper metabolism and maintaining optimal body weight.
4. Regulates more than 200 genes.
5. It has anti-inflammatory, antitumor, immunomodulatory effectiveness, slows down the aging process, and fills with energy.
6. Promotes conception, maintenance of pregnancy and normal gestation; it is extremely necessary during pregnancy, as it affects the formation of the immunity of the fetus and its bone tissue.
7. Restores a woman’s body after childbirth, corrects the condition of PMS.
8. Good for vision, concentration and memory.

Who is prescribed

Taking vitamin D during pregnancy is recommended only in special cases; usually, a balanced diet is enough. It is usually prescribed to older people, often women, as a therapy for osteoporosis, or more precisely, for the prevention of osteoporotic fractures.

However, a meta-analysis of studies of this practice in nursing homes showed that many years of eating tablets with calcium and vitamin D does not prevent fractures, but on the contrary, it increases the incidence of heart attacks. Patients with osteoporosis rather lack elastic cartilage tissue on which calcium can settle and accumulate. When cartilage is worn away, this microelement only strengthens the bones, which become not only hard, but also fragile.

“Until the end of the twentieth century, vitamin D was used only in the treatment of rickets and osteoporosis,” recalls Vasily Vlasov. — Partly because we don’t know how to effectively treat osteoporosis with anything. Observations have proven that the number of fractures in older people does not decrease. If there is no real, vital need for vitamin D, no amount of it will improve your health. This situation is similar to the widespread use of multivitamins that has become fashionable. They are taken not for medical reasons, but for prevention, often without the participation of a doctor. Dosages, as in the case of vitamin D, are much lower than therapeutic ones. And the positive effect has also not been proven. But the market share is estimated in billions of dollars.”

Many developed countries solve the problem of vitamin D deficiency by enriching mass-market food products with it: milk, yoghurts and even wheat flour. In the USA and Canada, this began to be practiced back in the 1950s, and for a long time this requirement for manufacturers was in the nature of a legislative requirement. Similar programs are popular in Western European countries. In the UK, for example, it is predicted that adding 100 mcg of the vitamin (4000 IU) to 1 kg of flour will reduce the proportion of people with insufficient vitamin D intake from 93% to 50% over a short period of time.

Lack of vitamin D in a woman’s body

Vitamin D deficiency affects 75% of the world's population, the majority of whom are women and children. The reasons why a woman’s body lacks this substance may be:

• insufficient production of D2 under sun exposure;
• winter-spring period of the year (from October to March);
• mono-diets, protein diets, unbalanced nutrition, vegetarianism, pregnancy;
• breastfeeding: in the first 6 months of breastfeeding, a woman’s vitamin D level drops sharply, which provokes a loss of calcium 4 times more than during pregnancy;
• mature age (after 50 years);
• the presence of diseases of the liver and kidneys, gall bladder, small intestine;
• excess weight;
• lack of physical activity;
• taking antacids (reducing high levels of acidity in the stomach) and anti-cholesterol drugs;
• chronic diseases of the endocrine system, gall bladder, pancreatitis, etc.

Summarize

To maintain the optimal amount of vitamin D in the body, children over one year old need to receive 600 IU per day, and adults – 800 IU. Those who are at risk are recommended to exercise daily, walk during the day (at least 20 minutes), a balanced diet, including foods that contain vitamin D. It is also necessary to maintain a normal weight and monitor the functioning of all body systems , paying special attention to the intestines, liver and kidneys. If osteoporosis is detected in your immediate family or hypovitaminosis D is diagnosed, consult a doctor immediately.

Multidisciplinary medical service means high-precision diagnostics, consultations with the best doctors, prompt and effective treatment of various diseases. Here you can undergo a full course of examination and receive help from highly qualified specialists. To make an appointment and for other questions, please call.

Date of publication: 09.24.2020 16:18:28

Learn more about vitamin D deficiency

The consequences of this condition lead to serious problems - the development of various pathologies of organs and systems. Main problems:

• immunity suffers;
• there is a metabolic disorder;
• malfunctions may occur in the functioning of organs such as the thyroid, parathyroid, pancreas, adrenal glands, kidneys, lungs, heart, intestines, stomach, pituitary gland, hypothalamus, etc.;
• possible complications during pregnancy;
• menstrual irregularities may occur;
• changes begin in bone tissue, which leads to osteomalacia (leaching of minerals from the bones), and then to osteoporosis, which is fraught with fractures and injuries;
• deformation of posture, weakness and muscle pain occurs;
• problems with the ovaries and uterus (endometriosis, fibroids, etc.);
• a hormonal imbalance occurs: the production of testosterone and estrogen may increase, which leads to early menopause;
• the condition of the skin deteriorates (vitamin D is involved in the process of renewal of skin cells), hair, teeth (caries), manifestations of skin diseases may occur;
• excess weight gain occurs;
• there is a feeling of anxiety, insomnia, depression;
• chronic fatigue and headaches are felt;
• hypertension, diabetes, arthritis, multiple sclerosis may occur;
• ARVI and acute respiratory infections become frequent.

Test: Check if you are at risk of vitamin D deficiency.

Main symptoms

Calciferol deficiency can be identified based on the following symptoms:

1. Reduced processing of calcium, magnesium and phosphorus leads to the formation of cramps, muscle pain, and aching bones. The intensity of manifestations depends on the individual characteristics of the organism.
2. Due to impaired calcium metabolism in the body, bones become more brittle and brittle, which causes frequent fractures.
3. Decreased immunity creates susceptibility to viral infections leading to complications. The respiratory tract is especially vulnerable, damage to which can lead to bronchitis and pneumonia.
4. The human body can accumulate sodium salts, the excess of which increases blood pressure. Calciferol actively counteracts this and its deficiency threatens arterial hypertension.
5. With a deficiency of the vitamin, belching, bloating, diarrhea and other disruptions in the gastrointestinal tract are observed.
6. The work of the sweat glands in the back of the head increases.
7. Body weight increases.
8. A lack of vitamin affects healthy sleep; the patient experiences insomnia at night and, as a result, lethargy and low performance during the day.
9. Nervous system disorders are possible, mood swings and depression are observed. This occurs due to a disruption in the production of serotonin.
10. Malfunctions of the cardiovascular system: rapid heartbeat, pain, changes in rhythm.
11. Symptoms also include hair loss and bleeding gums.

A general blood test for vitamin D deficiency will show anemia, low levels of phosphorus, calcium and magnesium, and a high alkaline content.

Excess vitamin D for women

During pregnancy or with the onset of menopause, women begin to take vitamin complexes, synthesized D3 in the form of dietary supplements and medications. However, it is worth knowing that it is fat-soluble and is difficult to eliminate from the body. Due to prolonged overdose of more than 10,000 IU over many days, vitamin D easily reaches the point of toxicity. So its elevated level is also very dangerous. Hypersensitivity to this substance can also provoke an overabundance. Interestingly, the sun usually does not cause an oversaturation of the body with vitamin D.

There are two stages to the problem of hypervitaminosis. Initially, the consequences of intoxication include symptoms such as nausea, thirst, headaches, lack of appetite, weight loss, constipation or diarrhea, frequent urination, dehydration, weakness, fever, cramps, irritability, muscle and joint pain. Then calcium deposits occur in soft tissues, and atherosclerosis may develop. Severe cases include loss of consciousness and coma.

It is worth mentioning that an increased level of calciferol is fraught with infertility and the onset of early menopause, frequent colds, arrhythmia, hypertension, and liver enlargement.

Therefore, the dosage of the vitamin should be prescribed by a doctor after receiving the results of a blood test. In case of long-term use, regular testing is necessary.

Criticism

The wave of publications about the healing properties of vitamin D in medical, semi-medical, and completely non-medical publications began about 30 years ago and shows no sign of abating. If you type “vitamin D” next to the name of any disease in an Internet search engine, you will find many articles about positive effects in treatment or the impact of vitamin D deficiency on the course of the disease. Here, for example, is a study showing that a lack of vitamin D can lead to a more severe course of coronavirus infection. But some experts do not agree with the absolute benefits of taking it.

“All statements about the direct effect of vitamin D on immunity, insulin and general well-being have nothing to do with evidence-based medicine,” says Vasily Vlasov, vice-president of the Society of Evidence-Based Medicine Specialists, Doctor of Medical Sciences. — There are no convincing, reproducible studies regarding the healing properties of calciferols in the prevention, much less treatment, of real diseases. Over the past two to three decades, there have been hundreds of articles about the successful use of vitamin D in the treatment of a variety of diseases: from baldness and impotence to strokes and hypertension. All of them have not been verified by subsequent clinical trials. Therefore, when similar articles now appear annually, the attitude towards them is quite skeptical.”

Severe vitamin D deficiency is often observed in a variety of diseases, such as obesity and type 2 diabetes. But doctors look at restoring normal levels differently.

“The importance of vitamin D for the body is just a fashionable topic,” says Alexander Lavrishchev, a therapist at the Semeynaya clinic. Several years ago, vitamin E was fashionable among hepatologists, after a series of publications on this topic. If a doctor wanted to look progressive, he had to try large doses of vitamin E on the patient. 90% of the Russian population lives with vitamin D deficiency. It is easy and inexpensive to synthesize, and if there is a huge market, then there is a big business. As a medicine, vitamin D is unlikely to be effective: I know of no cases in which a patient with an unclear illness would recover only by replenishing the deficiency of this substance.”

Olga Shamrina, who has repeatedly seen exhausted patients with a noticeable vitamin D deficiency, who had previously seen many doctors who had not found any pathologies, does not entirely agree with her colleague.

“If a person has no complaints, this does not mean that there is no vitamin D deficiency,” says the doctor. - You may never notice him. It’s just that sometimes you will be more tired than usual, have difficulty waking up, and sometimes react more forcefully to changing weather. A married couple who had seen many doctors before came to see me by chance. A 45-year-old woman had been unable to get pregnant for more than 3 years and was planning to do IVF. Vitamin D analysis showed that both spouses had a pronounced deficiency. After a short course of treatment with only vitamin D, everything went well. Now the child is already one and a half years old.”

How to find out your vitamin D level?

You can get information about how saturated your body is with vitamin D by doing a blood test. Typically, this laboratory test is carried out if osteoporosis is suspected, during pregnancy, if the woman spends very little time in the sun, lives in the northern regions, has refused food of animal origin, has chronic diseases or hereditary disorders of the metabolism of this vitamin.

Vitamin D correction

Taking D3 is the prevention of diseases, treatment of pathologies of internal organs, a recipe for good health and longevity. However, its absorption directly depends on physical activity, for example, fitness classes, walking. Interestingly, swimming does not produce vitamin D, since water reduces body weight, relieving stress on it. Vitamin D can only be prescribed by a doctor: his recommendations must be strictly followed. The maximum dose for adult women, as well as pregnant and breastfeeding women, is 4,000 IU per day (100 mg). At the same time, women should pay attention to calcium, magnesium, vitamins A, C, E, B6, which improve the absorption of vitamin D, zinc, phosphorus, and calcium. That is why a vitamin complex is often prescribed for preventive purposes. A nursing young mother or postmenopausal woman can drink special complexes.

The combination of vitamins D2 and D3 has the most lasting effect. Vitamin D2 can accumulate in adipose tissue, forming a valuable reserve for the body. Vitamin D3 is used in metabolic processes faster, ensuring ongoing metabolism. One tablet of NUTRILITE Vitamin D combination product contains 15 mcg of vitamin D2+D3 from natural sources.

One of the popular dietary supplements is NUTRILITE™ calcium, magnesium, vitamin D, which contains the daily requirement of vitamin D. It is recommended to take 1 tablet 3 times a day with meals for a month. It is convenient to purchase and arrange delivery in Moscow or other cities of the country on the official Amway website. When taking such complexes or vitamin D on its own, you should avoid iron, which impairs its absorption. To achieve a more vivid effect and give the body everything it needs, you need to make changes to your diet. In addition, it should be remembered that the absorption of vitamin D is greatly harmed by drinking alcohol and smoking.

Vitamin D deficiency is now a global public health problem, affecting approximately 1 billion people worldwide. It may result from insufficient exposure to sunlight, lack of vitamin D in the diet, accelerated catabolism due to certain medications, or due to various diseases that can affect its absorption and metabolism. In children, vitamin D deficiency can lead to rickets; in adults, this leads to osteomalacia (softening of the bones) and a number of other pathological changes.

Synonyms Russian

Vitamin D hypovitaminosis, vitamin D deficiency, rickets.

English synonyms

Hypovitaminosis D, Vitamin D deficiency, Vitamin D insufficiency.

Symptoms

Hypovitaminosis D can occur at any age, starting in infancy. This fat-soluble vitamin influences mineral metabolism and many other physiological functions. Vitamin D deficiency causes bone demineralization. In children, bones soften and become deformed over time, leading to slower growth, enlarged epiphyses of long bones, and deformities of the legs. Adults with osteomalacia may experience persistent bone discomfort and muscle pain, often leading to misdiagnosis of fibromyalgia, chronic fatigue syndrome, or arthritis. Since vitamin D receptors are present in skeletal muscles, its deficiency can lead to muscle weakness, persistent discomfort in the bones (most often in the sternum and legs), symmetrical lower back pain (more often in older women), and increase the risk of falls and fractures. Common manifestations of hypovitaminosis D include:

• frequent colds;
• chronic fatigue, decreased endurance;
• chronic pain (usually in the bones);
• depression, tearfulness, emotional lability;
• disruption of the normal functioning of the gastrointestinal tract (most often constipation);
• slow regeneration (wounds take longer to heal);
• sweating of the head;
• fragility of bones, fractures easily occur;
• muscle weakness, especially if there is an unexplained change in muscle strength;
• diseases of the teeth and gums (caries, periodontitis);
• hair loss;
• restless intermittent sleep;
• decreased memory and attention;
• unexplained infertility;
• increased blood pressure;
• causeless abdominal pain.

Research shows that suboptimal vitamin D levels are associated with an increased risk of cardiovascular disease. Thus, it was found that the level of 25-hydroxyvitamin D is inversely proportional to the following risk factors for the development of cardiovascular diseases: blood pressure more than 140/90 mm. Hg Art., blood glucose level above 6.5 mmol/l, body mass index 30 kg/m2 or more. Studies have also shown that vitamin D has antiproliferative effects in colon, prostate and breast cancer, reduces inflammation, etc. autoimmune. In children, hypovitaminosis D can manifest as rickets, a disease primarily affecting the bone and nervous systems. It is believed that about 60% of Russian children suffer from it, but since there are often no obvious symptoms or the disease is disguised as other pathological conditions, in many cases it is not diagnosed. Manifestations of rickets depend on the severity of vitamin D deficiency, but the most common of them are tearfulness, shallow intermittent sleep with a long process of falling asleep, increased sweating (especially at night), occipital “wiping” (balding) of hair, muscle weakness (“frog” belly, children do not tolerate walking well). The fontanelles in such children, as a rule, close later, teeth erupt in the wrong order and late, and subsequently they are more often affected by caries and have a risk of developing hypoplasia of tooth enamel. With the further development of the disease, typical bone deformations appear (X-shaped or O-shaped legs, deformation of the pelvic bones, overgrown parietal and frontal tubercles, the skull becomes disproportionately large, rachitic “rosary beads” - thickening of the ribs in the places of transition of bone tissue into cartilaginous tissue, depression of the lower parts of the sternum - “shoemaker's chest”). In severe rickets, on the contrary, protrusion of the sternum is observed. The disease can also affect internal organs, which can be manifested by frequent regurgitation, vomiting, abdominal pain, diarrhea or constipation, enlarged liver, and pallor. Rickets often leads to developmental delays in infants - they later begin to hold their heads, sit, stand independently, crawl and walk. If the disease goes far enough, the consequences will last a lifetime.

Who is at risk?

• People over 65 years of age;
• persons with congenital pathology, which may be the cause of vitamin D deficiency;
• exclusively breastfed children without vitamin D supplementation;
• people with dark skin or who overuse sun protection products with a high protection factor;
• people who, for various reasons, are exposed to insufficient sunlight, for example, those living in northern latitudes;
• taking medications that can accelerate catabolism and actively destroy vitamin D (for example, anticonvulsants, glucocorticoids, rifampicin, oral anticoagulants);
• obese persons (body mass index 30 or more);
• leading a sedentary lifestyle;
• vegetarians or people who do not consume foods containing vitamin D;
• persons with kidney, liver and/or gastrointestinal diseases (for example, celiac disease, Crohn's disease);
• pregnant and breastfeeding women.

Various studies have found that approximately a third of people with known hypovitaminosis D have no identifiable risk factors.

General information about the disease

Vitamin D is a fat-soluble vitamin that is formed when the skin is exposed to sunlight and is also present in a small number of foods, including those specially fortified with it. Vitamin D is one of the four fat-soluble vitamins (A, D, E and K). It acquires the ability to exert various physiological effects only after certain biochemical transformations that occur sequentially in the liver and kidneys. Exists in two forms: D2 and D3. Vitamin D2, also known as ergocalciferol, comes from fortified foods, herbal products, and supplements. Vitamin D3, also known as cholecalciferol, comes from fortified foods, animal products (fatty fish, cod liver, egg yolk, red meat, liver), dietary supplements, and can be synthesized internally if the skin is exposed to ultraviolet radiation from the sun. Both vitamins have different structures. Typically, people get 90% of their vitamin D from sunlight. Interestingly, the cutaneous biosynthesis of vitamin D3 via a feedback mechanism triggers the conversion of vitamin D3 into the inactive metabolites lumisterol and tachisterol, preventing an “overdose” of vitamin D3 under UV irradiation. After less than 1 minimum erythemal dose (the dose of radiation required to cause the skin to become red 24 hours after irradiation), vitamin D3 concentrations reach a maximum level and further exposure to sunlight merely leads to the production of inactive metabolites. Many scientists believe that vitamin D should be classified as a hormone because in the right biological environment it can be synthesized endogenously (by the body itself) and its active form, called calcitriol, is similar to other hormones (such as estrogen, cortisol and testosterone ) and is involved in the regulation of ion homeostasis (calcium, phosphorus and magnesium). Vitamin D controls genes responsible for the regulation of cell differentiation, proliferation, apoptosis and angiogenesis. It may be responsible for regulating up to 200 genes, including those that regulate immune function and the cell life cycle. Vitamin D also helps stimulate insulin production, inhibit renin production, and stimulate macrophage catechicidin production. Vitamin D receptors are found in most tissues of the body, it has endocrine effects on calcium metabolism and bone health, and is considered important for maintaining normal muscle function (including heart muscle) and immune function. Research has also shown that it may be useful as an adjuvant in the treatment of tuberculosis, psoriasis and multiple sclerosis, or in the prevention of certain types of cancer (eg, colon, prostate). Hypovitaminosis D is a common syndrome with well-established risk factors. Without the presence of activated vitamin D, normal bone metabolism is altered such that only 10% calcium and 60% phosphorus are absorbed. As a result, the skeleton becomes the body's main source of calcium and osteoclasts have to “dissolve” bone to raise serum calcium levels in the blood. In addition, vitamin D is necessary for normal absorption of calcium in the intestine. Therefore, its hypovitaminosis leads to osteomalacia and aggravates osteopenia and osteoporosis. Even subclinical (no symptoms) vitamin D deficiency is associated with significant health problems. Vitamin D deficiency leads to secondary hyperparathyroidism (increased function of the parathyroid glands), which entails a series of pathological processes.

Diagnostics

Diagnosis of hypovitaminosis D should be carried out in the presence of symptoms of deficiency, in people at risk, and also if low levels of calcium (hypocalcemia) or phosphorus (hypophosphatemia) are detected in the blood. The best indicator of vitamin D status is 25-hydroxyvitamin D, since it is a precursor to 1,25-dihydroxyvitamin D (the most active metabolite), the main circulating form of the vitamin and immediately reflects its intake both through the skin and through food.

25(OH)D and 1,25(OH)2D are a mixture of vitamin D2 and D3 metabolites. In most cases in clinical practice, there is no need for their separate determination and the study of the concentration of total 25(OH)D and 1,25(OH)2D allows us to obtain all the necessary information about the balance of vitamin D. Separate determination of vitamins D2 and D3 is carried out when assessing the dynamics of 25- hydroxyvitamin D in patients receiving vitamin D2 supplements. In addition, it is recommended to determine the concentration of calcium, phosphorus and magnesium in the blood and urine. When monitoring vitamin D therapy in children in the first year of life, as well as during annual preventive examinations, it is recommended to perform the Sulkowicz test. So, if there is an excess of the vitamin, the test will be sharply positive (3 or 4 points), and if there is a deficiency, it will be negative. In addition to a physical examination and laboratory diagnostics, instrumental research methods may also be needed: ultrasound or X-ray/densitometry of bones, ultrasound of internal organs.

Treatment

The goal of treatment is to normalize vitamin D levels, as well as to prevent recurrent hypovitaminosis. There are several types of drugs available to treat this condition. It is considered best to take vitamin D3 if possible because it is a natural form of the vitamin, binds more strongly to vitamin D binding protein, and is cleared more slowly from the bloodstream. In people with concomitant diseases or conditions that impair the absorption of the vitamin, the recommended dose should be selected individually, monitoring the concentration of vitamin D in the blood. Also, the dosage of drugs depends on the nature and severity of hypovitaminosis D. For example, an adult may be prescribed oral ergocalciferol (vitamin D2) at a dosage of 50,000 IU per week for eight weeks. After normalization of vitamin levels, it is recommended to switch to maintenance doses of cholecalciferol (vitamin D 3) at a dosage of 800-1000 IU per day from dietary and additional sources. If, after eight weeks of treatment, serum 25-hydroxyvitamin D levels still do not increase, the most likely cause is noncompliance with therapy or malabsorption (impaired absorption). During treatment, it is important to consume at least 1000 mg of calcium per day for premenopausal women and men and 1200 mg per day for postmenopausal women. In some cases, especially in children, physiotherapy - UV irradiation - may be prescribed. Oral vitamin D is contraindicated in individuals with granulomatous diseases (eg, tuberculosis), metastatic bone disease, sarcoidosis, Williams syndrome. Keep in mind that vitamin D is fat-soluble, meaning there are concerns about toxicity if taken in excess. Therefore, it is important to monitor the level of vitamin D in the blood and promptly diagnose its deficiency or excess. Prevention

Children under one year of age require 8.5-10 mcg of vitamin D per day. It is usually recommended to take oral drops (Vigantol, Aquadetrim) from September to April, 400 international units (IU) of vitamin D per day. To maintain normal vitamin D levels, children over one year old need 600 IU per day, and adults need 800 IU. Also recommended are daily physical activity, walks during the day (20 minutes or more depending on where you live), a balanced diet with foods containing vitamin D. In addition, it is necessary to maintain a healthy weight and monitor your health (especially the intestines, liver and kidneys). If your immediate family has osteoporosis or has previously been diagnosed with hypovitaminosis D, you should consult a doctor.

Also recommended

[40-167] Laboratory diagnosis of rickets

[02-032] Sulkowicz test

[06-106] Vitamin D, 25-hydroxy (calciferol)

[06-240] Vitamin D metabolites (25-hydroxycholecalciferol and 1,25 dihydroxycholecalciferol)

[06-020] Serum calcium

[08-033] Parathyroid hormone, intact

[06-031] Serum magnesium

[06-046] Serum phosphorus

[06-056] Phosphorus in daily urine

Children and the “sunshine” vitamin

The history of the discovery of vitamin D, which occurred about a century ago, was connected precisely with the search for a treatment for childhood rickets. It was found that this disease is a sign of calciferol deficiency. The level of this substance begins to affect the child in the womb, then during breastfeeding. Therefore, prevention of calciferol deficiency in pregnant and lactating mothers is so necessary. A deficiency can result in significant problems that are associated with the formation of the skeletal system and the baby’s susceptibility to diseases after birth, which often manifests itself after some time, including in adulthood. There is also a risk of having low birth weight babies. Prematurity, untimely cessation of breastfeeding, lack of sun, and poor nutrition deprive the baby of the necessary vitamin. But it is necessary not only to increase bone strength, growth, but also general development: vitamin D interacts with the level of cognitive potential and affects a child’s performance at school. Learn more about the symptoms of vitamin D deficiency in children.