Vitamin D through its active form (1,25-dihydroxyvitamin D) is essential for intestinal Ca absorption and plays a central role in maintaining Ca homeostasis and skeletal integrity1
In vitamin D deficiency there is a decrease in the concentration of 25(OH) vitamin D (25-hydroxy vitamin D) and an increase of varying degrees in the parathyroid hormone (PTH) level2
The increased serum PTH stimulates bone turnover, leading to bone loss3
In periods of protracted vitamin D deficiency, bone loss is increased and this may lead to osteoporosis3
“There is widespread acknowledgement of the presence of vitamin D deficiency in the community and the pressing need to address this deficiency1"
Prof Kevin Cashman, UCC, commenting on the results of the Irish NANS Study 2013.
Impact of bone structure on osteomalacia11
Osteomalacia is softening or weakening of the bones due to a lack of vitamin D or due to a problem with the body's ability to break down and absorb vitamin D.
The pathophysiologic pathways from vitamin D deficiency to osteoporosis, osteomalacia, falls and fractures:3
1. Cashman K et al. Vitamin D status of Irish adults: findings from the National Adult Nutrition Survey. British Journal of Nutrition (2013), 109, 1248-1256.
2. Haroon M and Regan M. Vitamin D deficiency: the time to ignore it has passed. International Journal of Rheumatic Diseases 2010; 13: 318-323.
3. Lips et al. The effect of vitamin D on bone and osteoporosis. Best Practice & Research Clinical Endocrinology & Metabolism 25, (2011), 585-591.
4. National Osteoporosis Society. Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management. April 2013. V1.1.
5. Holick M et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab; July 2011; 96(7): 1911-30.
6. Recommendations Abstracted from the American Geriatrics Society Consensus Statement on Vitamin D for Prevention of Falls and Their Consequences. J Am Geriatr Soc 62: 147-152, 2014.
7. Hanley D et al. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada (summary). CMAJ 2010, Sep 7; 182(12): 1315-1319.
8. Wagner C et al. Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents. Paediatrics Vol 122: No. 5 November 1, 2008, 1142-1152.
9. Godel J et al. Recommendations for Canadian mothers and infants. Paediatr Child Health 2007; 12(7): 583-9.
10. Tangpricha V et al. An Update on the Screening, Diagnosis, Management and Treatment of Vitamin D Deficiency in Individuals with Cystic Fibrosis: Evidence-Based Recommendations from the Cystic Fibrosis Foundation. J Clin Endocrinol Metab April 2012, 97(4): 1082-1093.
11. http://blogs.longwood.edu/osteomalacia/2012/07/06/what-is-osteomalacia/ accessed 24/10/17