The American Medical Women's Association (AMWA) today issued physician recommendations to generate greater understanding of the role of vitamin D in bone health in women and men over 50, calling for an increase in currently recommended vitamin D intake and encouraging individualized treatment in patients. According to an analysis published in 2004 and based on the Third National Health and Nutrition Examination Survey (NHANES III), over 70 percent of women ages 51-70 and nearly 90 percent of women over 70 are not getting the recommended adequate intake of vitamin D. For this reason, AMWA recently convened a panel of experts to discuss the importance of vitamin D for overall bone health, the challenges of ensuring adequate vitamin D intake and how to best communicate this information to primary care physicians, specialists and patients.

Vitamin D, an essential component in bone health, helps ensure that the body absorbs and retains calcium, which is critical for building strong, healthy bones. Vitamin D deficiency has often been linked to osteoporosis, a condition that affects more than 10 million Americans and threatens 34 million others.

?We agreed that there is a need for increased awareness of the role of vitamin D in osteoporosis treatment,? said Felicia Cosman, MD, clinical director of the National Osteoporosis Foundation and associate professor of clinical medicine at Columbia University School of Medicine, and chair of the expert panel. ?These recommendations will serve to call attention to the high prevalence of vitamin D deficiency and help ensure that patients, particularly women and men over 50, receive optimal care for bone health.?

The panel outlined the following action points regarding vitamin D and its role in bone health for physicians treating women and men over 50, including:

-- Optimum treatment for bone health should be individualized and may include a combination of exercise, healthy diet, vitamin D and calcium supplements, and potentially, prescription medications.

-- Women and men over 50 receiving treatment for osteoporosis need to receive adequate vitamin D. Supplements are recommended as one of the best sources of vitamin D.

-- Current daily vitamin D intake requirements for women and men over 50 should be increased to 800-1,000 International Units (IU).

An Increase in Current Vitamin D Intake

Current recommendations from the Institute of Medicine (IOM) for vitamin D intake are 400 IU for women and men ages 51-70 and 600 IU for women and men over 70. The roundtable panelists expressed concern that current recommendations do not provide for optimal bone health and recommended that intake levels be increased to 800-1,000 IU per day for patients over age 50. In addition to the government data that found 70-90 percent of postmenopausal women are not taking the recommended adequate intake of vitamin D, an additional study found that over half of postmenopausal women already being treated for osteoporosis have inadequate levels of vitamin D, underscoring the need for more aggressive treatment guidelines and greater overall awareness of the role of vitamin D in bone health.

?The recommendations we provided are designed as a guide for primary care physicians and specialists and are sufficient for most patients. However, some patients may need to obtain serum levels of vitamin D, as determined by their physician, to ascertain vitamin D adequacy. Vitamin D deficiency should ultimately be treated on a patient-by-patient basis? said Kimberly Templeton, MD, AMWA representative and associate professor of orthopedic surgery at the Kansas University Medical Center and fellow of the American Academy of Orthopaedic Surgeons (AAOS). ?I encourage people to speak to their physicians about whether vitamin D supplementation may be appropriate. In addition, patients can access an online brochure on the AMWA web site to learn more about the role of vitamin D in overall bone health.?

Obtaining Adequate Levels of Vitamin D

Vitamin D is produced in the body after exposure to UVB rays. Indeed, individuals can obtain over 90 percent of vitamin D through sun exposure, but the panel agreed that this is becoming increasingly difficult as a result of the wide use of sunscreen and protective clothing, due to concerns about skin cancer and other skin diseases, aging and geographic limitations. Vitamin D is also found naturally in a limited number of foods, such as fatty fish, and in certain fortified foods such as milk, orange juice and ready-to-eat cereal. However, many of these foods are not part of most people's diets or must be consumed in large volumes to meet the requirement. Therefore, supplements were recommended as one of the best sources of vitamin D for many older Americans.

In using supplements, the panel advised that physicians should help their patients choose the supplement that is right for them by explaining the medical terms associated with the different forms of vitamin D.

Although bone health was the primary focus of the recommendations, the panelists also reviewed other research studies published in the recent months that reflect on vitamin D's ability to potentially protect against lymphoma and cancers of the prostate, breast, colon, ovary and other cancers, and noted that a variety of research is currently underway to examine the effects of vitamin D on other health conditions.

The Fundamentals of Vitamin D in Bone Health

Vitamin D plays an important role in building and maintaining healthy bones by promoting calcium absorption. Suboptimal levels of vitamin D are associated with reduced calcium absorption, bone loss and an increased risk for osteoporosis - a condition characterized by low bone mass, bone fragility and susceptibility to fractures, especially of the hip and spine. In fact, the first-ever Bone Health and Osteoporosis: A Report of the Surgeon General (2004) listed vitamin D, along with calcium and physical activity, as the three key elements to maintaining optimal bone health. Based on relevant clinical practice experience and involvement in various research that highlights the role of vitamin D in bone health, the panel concluded that it is of paramount importance that vitamin D be considered in patients being treated for osteoporosis and other bone diseases.

To find out more about the recommendations and vitamin D's role in bone health, talk to your physicians or visit to view/download an online patient brochure.

About AMWA

The American Medical Women's Association (AMWA) -- Founded in 1915 as the oldest and largest only national medical association dedicated to women physicians, residents and medical students, AMWA today represents a community of professionals working to promote health, encourage the professional and personal development of those in medicine, healthcare and health-related fields and provide a range of educational, charitable and awards programs that make a difference.

AMWA believes that medical decisions should be the decision of a woman and her health care provider based on her individual needs. AMWA does not endorse specific products or services.

Funding for this initiative has been provided by Merck & Co., Inc.

Jill Birdwhistell Pierce, PhD
American Medical Women's Association