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Research presented at the IOF World Conference on Osteoporosis reveals dramatic vitamin D insufficiency in Northern European countries and emphasizes the challenge of successfully boosting vitamin D levels.

May 17, 2004

Nearly all the adolescent girls in a study from Northern Europe had low levels of vitamin D during winter months, researchers reported this week at the IOF World Congress on Osteoporosis in Rio de Janeiro, Brazil. Prospects for correcting these insufficiencies remain clouded however, as an eagerly awaited trial of once-yearly vitamin D injections reported disappointing results.

These studies are particularly important because "vitamin D and calcium are much less expensive than other anti-osteoporotic drugs, and they decrease fracture risk when used in the appropriate doses," according to Dr. Pawel Szulc, lead author on one of the studies presented in Rio.

Vitamin D deficiencies a serious problem in northern Europe

A major epidemiologic study shows that girls in northern Europe do not get sufficient vitamin D, a fact that could have serious implications for their bone development.

Vitamin D has become an important focus in the fight against osteoporosis because of its role in helping calcium to reach bones. Although minor amounts of vitamin D can be obtained from some fish and vitamin-fortified milk, over 70 percent is typically synthesized in the skin in response to sunlight.

In conjunction with calcium, daily vitamin D supplementation appears to help build peak bone mass and, in later life, protect against fractures.

In latitudes above 40ºN (roughly the latitude of Madrid or Rome) little, if any, production of vitamin D in the skin occurs during the winter according to Rikke Andersen of the Danish Institute of Food and Veterinary Research in Söborg. "This means that almost all of Europe is essentially 'in the dark' during the winter as far as solar skin production of vitamin D," said Andersen.

Andersen presented data from the European Union-financed OPTIFORD project, an effort to assess vitamin D status throughout a year in groups of adolescent girls and elderly women in Denmark, Finland, Ireland, and Poland (conference abstract OC8). Adolescents are of particular interest because much evidence suggests that the risk of osteoporosis in later life can be reduced by building healthy bone mass during the teenage years.

The OPTIFORD researchers intend to determine how factors such as sun exposure and vitamin D from food and supplements impact on vitamin D levels in the study participants.

At the IOF WCO, the researchers presented their initial set of data. Their alarming finding: 92% of the 200 girls between the ages of 11 and 13 -- and 67 percent of the 200 elderly women -- had low levels of vitamin D (termed "insufficiency") during the winter months. In fact, 37 percent of the girls were considered to have extremely low levels of vitamin D (or "deficiency").

"Clearly, additional vitamin D intake is needed to prevent vitamin D insufficiency during the winter in Northern Europe," said Andersen. "In the reasearch community, we hope that this will prevent osteoporosis in later life."

These results are reinforced by another study of adolescent girls (conference abstract OC25), led by Dr. Marjo Lehtonen-Veromaa of the University of Turku in Finland, who confirmed the bone-beneficial effects of exercise, but also showed that reduced vitamin D levels were associated with lower levels of bone mineral density. (This study is described in more detail in a separate news release focusing on the development of bone mass in the critical early teenage years.)

Men's bones are at risk from vitamin D insufficiency as well, according to another study presented at the same oral session (conference abstract OC9). Led by Szulc and Pierre D. Delmas, president of the IOF, researchers of the MINOS study at INSERM Unit 403 in Lyon, France, found evidence to support the use of vitamin D supplementation in elderly men. (This study is described in more detail in a separate news release focusing on osteoporosis in men.)

Overcoming vitamin D insufficiency – mixed results

Finding the most effective route to addressing vitamin D insufficiency has proved a thorny issue. Increased sun exposure is one answer, though this may be difficult to achieve in northern climes.

Vitamin D supplementation is another option, but the most reliable method has not been clearly identified. One prominent hope was that intramuscular injection of vitamin D, at long intervals, could provide significant protection. Unfortunately, a study from Wessex, United Kingdom, appears to have dampened these hopes (conference abstract OC10).

For three years, researchers gave annual autumnal injections of either vitamin D or a placebo to almost 10,000 men and women, aged 75 years and older, and tracked the incidence of fractures.

While the injections did result in significant decreases in parathyroid hormone, which can accelerate bone loss, this did not translate into a significant reduction in fractures.

"These results do not rule out vitamin D supplementation in general, but they do suggest that an annual intra-muscular injection in the healthy elderly is unlikely to be effective," said study director Prof. Cyrus Cooper of Southampton General Hospital in the United Kingdom.

On the other hand, supplementation with synthetic D-hormone -- the active form of vitamin D -- may protect some elderly people against fractures, according to a study from Switzerland (conference abstract OC11).

Dr. Laurent Dukas of the Geriatric University Clinic in Basel, Switzerland, presented data on a group of 378 elderly men and women who had participated in a trial comparing a form of D-hormone called alfacalcidol to a placebo. Dukas and his colleagues used the frequency of falls, rather than measures of bone strength or fractures, as their index. Recent research has suggested that D-hormone may have beneficial effects on muscle mass and strength, as well as balance, in addition to its beneficial effects on bone.

Confirming previous results, the Swiss researchers found that D-hormone treatment could reduce falls by 71 percent. A particularly interesting new finding was that the frequency of falls was four-fold higher in subjects with impaired kidney function. Conversion of vitamin D to D-hormone begins in the kidney, and according to Dukas, "Those elderly with impaired kidney function should be treated with D-hormone to prevent falls rather than vitamin D, which would not be converted properly by the kidneys."

For more information about the IOF World Congress on Osteoporosis, and to read the abstracts of presentations please visit:


The International Osteoporosis Foundation (IOF) is a worldwide organization dedicated to the fight against osteoporosis. It brings together scientists, physicians, patient societies and corporate partners. Working with its 165 member societies in more than 85 locations, and other healthcare-related organizations around the world, IOF encourages awareness and prevention, early detection and improved treatment of osteoporosis.

Osteoporosis, in which the bones become porous and break easily, is one of the world's most common and debilitating diseases. The result: pain, loss of movement, inability to perform daily chores, and in many cases, death. One out of three women over 50 will experience osteoporotic fractures, as will one out of eight men(1). Unfortunately, screening for people at risk is far from being a standard practice. Osteoporosis can, to a certain extent, be prevented, it can be easily diagnosed and effective treatments are available.

1 Melton U, Chrischilles EA, Cooper C et al. How many women have osteoporosis? Journal of Bone Mineral Research, 1992; 7:1005-10

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