This document summarizes a thesis submitted by Eliot Mar examining whether the amount of naturally occurring UV radiation affects stress fracture rates in female athletes via changes in vitamin D production. The document provides background on vitamin D production and role in bone health, defines stress fractures and the female athlete triad, and reviews studies examining the relationship between UV exposure, vitamin D levels, and stress fracture rates in female athletes and military recruits. The thesis examines whether female athletes in areas with lower annual UV radiation are at higher risk of stress fractures compared to those in areas with higher UV radiation.
This document summarizes osteoporosis, including its definition, prevalence, risk factors, pathogenesis, diagnosis, and treatment options. It discusses how osteoporosis is a widespread condition characterized by compromised bone strength and increased fracture risk. Diagnostic tools like DXA scans and emerging methods like multi-detector CT are used to assess bone mineral density and structure. Treatment involves lifestyle changes as well as pharmacotherapy like bisphosphonates, calcitonin, PTH, and emerging drugs. Overall the document provides a comprehensive overview of osteoporosis from causes and diagnosis to current and novel treatment approaches.
This patient is a 28-year-old male who was admitted to the hospital for exertional rhabdomyolysis and acute renal failure after participating in a soccer tournament. He had a history of heat exhaustion from soccer previously. During his hospital stay he was aggressively hydrated and his renal function and creatine kinase levels gradually improved. Nutrition education was provided regarding adequate carbohydrate intake for his high activity levels and future prevention of similar issues.
This document discusses stress fractures during initial military training (IET). It finds that stress fracture rates may be significantly underreported, especially for women, and can be difficult to diagnose. Multiple factors are hypothesized to contribute to high stress fracture rates, including overtraining with too much mileage too soon, underlying osteopenia in new recruits, calcium and nutrient deficiencies, and other lifestyle and genetic risk factors. Proposed solutions that have shown success include supplementing calcium and vitamin D, upgrading clinical guidelines to screen for osteopenia, and reducing running mileage during training.
The document summarizes research on the relationship between UV radiation exposure, vitamin D levels, and stress fracture risk in female athletes. It finds that female athletes in areas with low annual UV radiation have a higher risk of stress fractures than those in high UV radiation areas, as UV exposure is needed for the body to naturally produce vitamin D. A lack of vitamin D can lead to lower bone density and increase stress fracture probabilities. The document reviews multiple studies that show athletes with less outdoor exposure and darker skin tones are more likely to have vitamin D deficiencies that raise their fracture risks.
This document discusses how genetic testing and DNA profiling can be used to individualize training programs and nutrition for athletes to optimize performance. It describes several genes associated with endurance ability, muscle performance, power/sprint performance, and how variations in these genes like ACTN3, ACE, NOS3, and PPARA impact athletic traits. The document also discusses using genetic testing for early talent identification and how knowledge of an athlete's genetic profile can guide their specialized training and help achieve their potential.
This document summarizes guidelines for screening and managing osteoporosis. It defines osteoporosis as a bone density T-score of -2.5 or lower according to WHO standards. All women over 65 should be screened by DXA scan, while younger women are screened if their 10-year fracture risk equals or exceeds an average 65-year-old woman. First-line treatment includes bisphosphonates along with lifestyle modifications like calcium and vitamin D. Screening and treatment decisions are also based on additional risk factors like prior fractures, smoking, glucocorticoid use, and family history.
Everything you should know about Osteoporosis?
What is Osteoporosis?
Osteoporosis is a disorder of bones characterized by low bone density and a deterioration of bone micro- architecture that enhances bone fragility and increases the risk of fracture
Osteoporosis becomes a serious health threat for aging men & postmenopausal women by predisposing them to an increased risk of fracture
Do you know that?
Osteoporosis is responsible for >1.5 million vertebral and non-vertebral fractures per year
Spine, hip, and wrist fractures are most common.
This document summarizes osteoporosis, including its definition, prevalence, risk factors, pathogenesis, diagnosis, and treatment options. It discusses how osteoporosis is a widespread condition characterized by compromised bone strength and increased fracture risk. Diagnostic tools like DXA scans and emerging methods like multi-detector CT are used to assess bone mineral density and structure. Treatment involves lifestyle changes as well as pharmacotherapy like bisphosphonates, calcitonin, PTH, and emerging drugs. Overall the document provides a comprehensive overview of osteoporosis from causes and diagnosis to current and novel treatment approaches.
This patient is a 28-year-old male who was admitted to the hospital for exertional rhabdomyolysis and acute renal failure after participating in a soccer tournament. He had a history of heat exhaustion from soccer previously. During his hospital stay he was aggressively hydrated and his renal function and creatine kinase levels gradually improved. Nutrition education was provided regarding adequate carbohydrate intake for his high activity levels and future prevention of similar issues.
This document discusses stress fractures during initial military training (IET). It finds that stress fracture rates may be significantly underreported, especially for women, and can be difficult to diagnose. Multiple factors are hypothesized to contribute to high stress fracture rates, including overtraining with too much mileage too soon, underlying osteopenia in new recruits, calcium and nutrient deficiencies, and other lifestyle and genetic risk factors. Proposed solutions that have shown success include supplementing calcium and vitamin D, upgrading clinical guidelines to screen for osteopenia, and reducing running mileage during training.
The document summarizes research on the relationship between UV radiation exposure, vitamin D levels, and stress fracture risk in female athletes. It finds that female athletes in areas with low annual UV radiation have a higher risk of stress fractures than those in high UV radiation areas, as UV exposure is needed for the body to naturally produce vitamin D. A lack of vitamin D can lead to lower bone density and increase stress fracture probabilities. The document reviews multiple studies that show athletes with less outdoor exposure and darker skin tones are more likely to have vitamin D deficiencies that raise their fracture risks.
This document discusses how genetic testing and DNA profiling can be used to individualize training programs and nutrition for athletes to optimize performance. It describes several genes associated with endurance ability, muscle performance, power/sprint performance, and how variations in these genes like ACTN3, ACE, NOS3, and PPARA impact athletic traits. The document also discusses using genetic testing for early talent identification and how knowledge of an athlete's genetic profile can guide their specialized training and help achieve their potential.
This document summarizes guidelines for screening and managing osteoporosis. It defines osteoporosis as a bone density T-score of -2.5 or lower according to WHO standards. All women over 65 should be screened by DXA scan, while younger women are screened if their 10-year fracture risk equals or exceeds an average 65-year-old woman. First-line treatment includes bisphosphonates along with lifestyle modifications like calcium and vitamin D. Screening and treatment decisions are also based on additional risk factors like prior fractures, smoking, glucocorticoid use, and family history.
Everything you should know about Osteoporosis?
What is Osteoporosis?
Osteoporosis is a disorder of bones characterized by low bone density and a deterioration of bone micro- architecture that enhances bone fragility and increases the risk of fracture
Osteoporosis becomes a serious health threat for aging men & postmenopausal women by predisposing them to an increased risk of fracture
Do you know that?
Osteoporosis is responsible for >1.5 million vertebral and non-vertebral fractures per year
Spine, hip, and wrist fractures are most common.
For info log on to www.healthlibrary.com. Osteoporosis of Bones By Dr. Prakash Khalap
OSTEOPOROSIS which is more in Elderly, Osteoporosis is Common in both females and males after 60 yrs. Fractures, reduction in height, Backache, vague Pain of body are common symptoms which many elderly suffers unknowingly.
Inflammation plays a central role in the aging process. Chronic low-level inflammation that increases with age is thought to be both a cause and effect of aging. Multiple mechanisms contribute to age-related inflammation, including mitochondrial damage and dysfunction, immune system decline, changes in hormone levels, cellular senescence, epigenetic alterations, and disease processes that have inflammatory components like atherosclerosis and dementia. Lifestyle factors like diet and stress can also influence inflammation and aging.
Role of genetic factors in sport performance, short course MARIA VRANCEANU
This document discusses the role of genetic factors in sport performance. It outlines that genetics and heredity play an important role in determining aspects of sport performance. Family studies have shown high heritability for aerobic performance, muscular fitness, body composition and other performance related phenotypes. Certain ethnic groups like those from Kenya frequently dominate long distance running events, likely due to genetic advantages. The document examines key performance genes and how genetic testing and variations can provide insights into injury risk, nutrition needs and potential for performance enhancement.
This was a lecture in the course "Significant Medical Conditions in Seniors" presented at Peer Learning in Chapel Hill, NC, USA in 2016 by Michael C. Joseph, MD, MPH.
Osteoporosis is a disease where bones become fragile and porous, increasing the risk of fractures. It is most common in women after menopause when estrogen levels drop and accelerate bone loss. Preventing osteoporosis requires building strong bones through exercise and nutrition, especially calcium and vitamin D, during childhood and early adulthood to achieve peak bone mass. Lifestyle factors like smoking, excess alcohol, and a sedentary lifestyle can increase osteoporosis risk. Diagnosis involves bone density scans and treatment focuses on lifestyle changes and medications to prevent fractures.
This document discusses osteoporosis and osteomalacia. It provides information on:
- A case of a 68-year-old woman who presents with a wrist fracture following a fall.
- Risk factors for osteoporosis including corticosteroid use, menopause, family history of fractures.
- Diagnostic tests for osteoporosis including DXA scan, FRAX score to evaluate 10-year fracture risk.
- Treatment involves lifestyle changes like exercise, calcium and vitamin D supplementation, as well as pharmacologic therapies like bisphosphonates or teriparatide.
This document provides an overview of osteoporosis, including its definition, bone structure, epidemiology, pathophysiology, risk factors, clinical features, investigations, treatment, and management. It defines osteoporosis as a reduction in bone strength that increases fracture risk. Key points include that it occurs more in women after menopause due to estrogen loss, common risk factors, the roles of osteoblasts and osteoclasts in bone remodeling, biochemical markers used in diagnosis, DXA scans to measure bone mineral density, and first-line pharmaceutical treatments including bisphosphonates.
The document discusses the effects of aging on nutrition and immunity. It notes that the proportion of elderly individuals is rising globally and aging is associated with increased illness and health costs. Primary aging immune deficiency refers to normal immune changes seen in healthy elderly individuals. Key immune changes include reductions in T-lymphocytes and cell-mediated immunity as well as alterations in cytokine secretions. Nutritional status is affected by physiological, physical, psychological, social, economic and cultural factors in older adults. Common nutritional deficiencies include vitamins and minerals. Physiological changes like reduced digestion and senses can impair nutrition. Maintaining good nutrition is important for quality of life in the elderly.
Osteoporosis is a systemic skeletal disease characterized by low bone mass and deterioration of bone structure, leading to an increased risk of fractures. The World Health Organization defined osteoporosis based on bone mineral density measurements, with osteoporosis occurring when bone density is more than 2.5 standard deviations below the mean for young healthy adults. Osteoporosis affects over 200 million women worldwide and is a major cause of morbidity. Risk factors include age, gender, ethnicity, family history, smoking, low body weight, and lack of exercise.
Due to its prevalence worldwide, osteoporosis is considered a serious public health concern. Currently it is estimated that over 200 million people worldwide suffer from this disease.
This document discusses methods for assessing fracture risk in patients with primary osteoporosis. It outlines that fracture risk is determined by bone mineral density as well as clinical risk factors related to bone quality. The document recommends using FRAX, a WHO fracture risk assessment tool, which calculates 10-year fracture probability based on clinical risk factors with or without a bone mineral density scan. FRAX is presented as the most important algorithm for assessing osteoporosis and determining treatment based on an individual's estimated fracture risk.
Zoledronic acid administered once yearly through intravenous infusion was found to significantly reduce fractures more effectively than placebo. Over six years, yearly zoledronic acid preserved bone mass and continued fracture protection compared to discontinuing treatment after three years. It provided reductions in hip, vertebral, and non-vertebral fractures with no increase in safety risks like atrial fibrillation or renal impairment. A single infusion also reduced bone turnover markers more rapidly than weekly oral bisphosphonates.
The aging process causes changes in cells and organs over time through a combination of genetic and environmental factors. As people age, cells divide more slowly, immune function declines, and regulation of cell death is disrupted. Physically, aging is associated with loss of height, weight gain until late adulthood, increased body fat, and slower reaction times. While some organ decline is normal, lifestyle factors influence diseases like heart disease and cataracts. The aging process varies between individuals.
Frailty applications in clinical practice. Assessing level of frailty can help identify underlying risks to contextualize conversations with patients and their caregivers.
This document discusses genetic factors that influence obesity and eating behaviors. It begins by outlining learning objectives around understanding the molecular basis of obesity and evaluating genetic influences on food attitudes and satiety. It then provides background on the global prevalence of obesity in various countries. The rest of the document discusses several specific genes like LCT, TCF7L2, PPARG, and ACE that influence traits like lactose intolerance and response to dieting. It emphasizes that genetics can help tailor diets and lifestyle recommendations based on an individual's genetic profile to increase success with weight loss and management.
Osteoporosis is a systemic bone disease characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and risk of fractures. It is most common in postmenopausal women. Risk factors include smoking, low body weight, steroid use, excess alcohol intake, and family history of fractures. Diagnosis involves measuring bone mineral density via DEXA scan. Treatment aims to prevent fractures and bone loss, and includes adequate calcium and vitamin D, weight-bearing exercise, falls prevention, pharmacologic agents like bisphosphonates, and surgery for fractures. Regular screening and monitoring of at-risk individuals is important.
The Relationship of Hip and Trunk Muscle Function to Single Leg Step-Down Per...Jeremy Burnham
The Single Leg Step-Down Test (SLSD) is a screening test used to identify athletes with hip and trunk strength deficits who may be at risk for lower extremity injury such as anterior cruciate ligament (ACL) tear.
Osteoporosis: Classification, Causes, Symptoms, Treatment & Prevention
In this article, we’ll discuss what osteoporosis is, osteoporosis definition, osteoporosis types, osteoporosis causes, osteoporosis symptoms, osteoporosis medicine, osteoporosis treatment and osteoporosis prevention.
Osteoporosis:
Osteoporosis is a condition of low bone mass and decay of bone tissue prompting bone delicacy and conceivably breaking with numerous preventable and intrinsic danger factors. Osteoporosis influences bones and makes them more defenseless against sudden and unanticipated breaks and breakage. The term osteoporosis is derived from the Greek words osteon (bone) and poros (pore). For complete article, click on the given link, https://diseases8804.blogspot.com/2021/08/all-you-need-to-learn-about-osteoporosis.html
1. Calcium and vitamin D supplements are effective at reversing secondary hyperparathyroidism in older individuals and are associated with increased bone mineral density and reduced bone loss.
2. Vitamin D supplementation lowers the risk of falling by 14-23% and a daily dose of at least 800 IU is most effective. While data is limited in men, they appear to benefit similarly to women in terms of fall reduction.
3. Calcium and vitamin D supplementation have proven antifracture efficacy when targeted to individuals with documented deficiencies or insufficiencies, through mechanisms of reducing bone loss and fall risk.
This document discusses osteoporosis, including its definitions, epidemiology, risk factors, pathophysiology, clinical manifestations, diagnosis, and treatment options. Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue, leading to fragile bones and increased risk of fractures. It affects millions of people worldwide, especially postmenopausal women, and can be caused by aging, genetics, lifestyle factors, and certain medical conditions or medications. Treatment involves lifestyle modifications like diet, exercise and fall prevention as well as pharmacologic options like calcium, vitamin D, bisphosphonates, and drugs that modify bone metabolism.
For info log on to www.healthlibrary.com. Osteoporosis of Bones By Dr. Prakash Khalap
OSTEOPOROSIS which is more in Elderly, Osteoporosis is Common in both females and males after 60 yrs. Fractures, reduction in height, Backache, vague Pain of body are common symptoms which many elderly suffers unknowingly.
Inflammation plays a central role in the aging process. Chronic low-level inflammation that increases with age is thought to be both a cause and effect of aging. Multiple mechanisms contribute to age-related inflammation, including mitochondrial damage and dysfunction, immune system decline, changes in hormone levels, cellular senescence, epigenetic alterations, and disease processes that have inflammatory components like atherosclerosis and dementia. Lifestyle factors like diet and stress can also influence inflammation and aging.
Role of genetic factors in sport performance, short course MARIA VRANCEANU
This document discusses the role of genetic factors in sport performance. It outlines that genetics and heredity play an important role in determining aspects of sport performance. Family studies have shown high heritability for aerobic performance, muscular fitness, body composition and other performance related phenotypes. Certain ethnic groups like those from Kenya frequently dominate long distance running events, likely due to genetic advantages. The document examines key performance genes and how genetic testing and variations can provide insights into injury risk, nutrition needs and potential for performance enhancement.
This was a lecture in the course "Significant Medical Conditions in Seniors" presented at Peer Learning in Chapel Hill, NC, USA in 2016 by Michael C. Joseph, MD, MPH.
Osteoporosis is a disease where bones become fragile and porous, increasing the risk of fractures. It is most common in women after menopause when estrogen levels drop and accelerate bone loss. Preventing osteoporosis requires building strong bones through exercise and nutrition, especially calcium and vitamin D, during childhood and early adulthood to achieve peak bone mass. Lifestyle factors like smoking, excess alcohol, and a sedentary lifestyle can increase osteoporosis risk. Diagnosis involves bone density scans and treatment focuses on lifestyle changes and medications to prevent fractures.
This document discusses osteoporosis and osteomalacia. It provides information on:
- A case of a 68-year-old woman who presents with a wrist fracture following a fall.
- Risk factors for osteoporosis including corticosteroid use, menopause, family history of fractures.
- Diagnostic tests for osteoporosis including DXA scan, FRAX score to evaluate 10-year fracture risk.
- Treatment involves lifestyle changes like exercise, calcium and vitamin D supplementation, as well as pharmacologic therapies like bisphosphonates or teriparatide.
This document provides an overview of osteoporosis, including its definition, bone structure, epidemiology, pathophysiology, risk factors, clinical features, investigations, treatment, and management. It defines osteoporosis as a reduction in bone strength that increases fracture risk. Key points include that it occurs more in women after menopause due to estrogen loss, common risk factors, the roles of osteoblasts and osteoclasts in bone remodeling, biochemical markers used in diagnosis, DXA scans to measure bone mineral density, and first-line pharmaceutical treatments including bisphosphonates.
The document discusses the effects of aging on nutrition and immunity. It notes that the proportion of elderly individuals is rising globally and aging is associated with increased illness and health costs. Primary aging immune deficiency refers to normal immune changes seen in healthy elderly individuals. Key immune changes include reductions in T-lymphocytes and cell-mediated immunity as well as alterations in cytokine secretions. Nutritional status is affected by physiological, physical, psychological, social, economic and cultural factors in older adults. Common nutritional deficiencies include vitamins and minerals. Physiological changes like reduced digestion and senses can impair nutrition. Maintaining good nutrition is important for quality of life in the elderly.
Osteoporosis is a systemic skeletal disease characterized by low bone mass and deterioration of bone structure, leading to an increased risk of fractures. The World Health Organization defined osteoporosis based on bone mineral density measurements, with osteoporosis occurring when bone density is more than 2.5 standard deviations below the mean for young healthy adults. Osteoporosis affects over 200 million women worldwide and is a major cause of morbidity. Risk factors include age, gender, ethnicity, family history, smoking, low body weight, and lack of exercise.
Due to its prevalence worldwide, osteoporosis is considered a serious public health concern. Currently it is estimated that over 200 million people worldwide suffer from this disease.
This document discusses methods for assessing fracture risk in patients with primary osteoporosis. It outlines that fracture risk is determined by bone mineral density as well as clinical risk factors related to bone quality. The document recommends using FRAX, a WHO fracture risk assessment tool, which calculates 10-year fracture probability based on clinical risk factors with or without a bone mineral density scan. FRAX is presented as the most important algorithm for assessing osteoporosis and determining treatment based on an individual's estimated fracture risk.
Zoledronic acid administered once yearly through intravenous infusion was found to significantly reduce fractures more effectively than placebo. Over six years, yearly zoledronic acid preserved bone mass and continued fracture protection compared to discontinuing treatment after three years. It provided reductions in hip, vertebral, and non-vertebral fractures with no increase in safety risks like atrial fibrillation or renal impairment. A single infusion also reduced bone turnover markers more rapidly than weekly oral bisphosphonates.
The aging process causes changes in cells and organs over time through a combination of genetic and environmental factors. As people age, cells divide more slowly, immune function declines, and regulation of cell death is disrupted. Physically, aging is associated with loss of height, weight gain until late adulthood, increased body fat, and slower reaction times. While some organ decline is normal, lifestyle factors influence diseases like heart disease and cataracts. The aging process varies between individuals.
Frailty applications in clinical practice. Assessing level of frailty can help identify underlying risks to contextualize conversations with patients and their caregivers.
This document discusses genetic factors that influence obesity and eating behaviors. It begins by outlining learning objectives around understanding the molecular basis of obesity and evaluating genetic influences on food attitudes and satiety. It then provides background on the global prevalence of obesity in various countries. The rest of the document discusses several specific genes like LCT, TCF7L2, PPARG, and ACE that influence traits like lactose intolerance and response to dieting. It emphasizes that genetics can help tailor diets and lifestyle recommendations based on an individual's genetic profile to increase success with weight loss and management.
Osteoporosis is a systemic bone disease characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and risk of fractures. It is most common in postmenopausal women. Risk factors include smoking, low body weight, steroid use, excess alcohol intake, and family history of fractures. Diagnosis involves measuring bone mineral density via DEXA scan. Treatment aims to prevent fractures and bone loss, and includes adequate calcium and vitamin D, weight-bearing exercise, falls prevention, pharmacologic agents like bisphosphonates, and surgery for fractures. Regular screening and monitoring of at-risk individuals is important.
The Relationship of Hip and Trunk Muscle Function to Single Leg Step-Down Per...Jeremy Burnham
The Single Leg Step-Down Test (SLSD) is a screening test used to identify athletes with hip and trunk strength deficits who may be at risk for lower extremity injury such as anterior cruciate ligament (ACL) tear.
Osteoporosis: Classification, Causes, Symptoms, Treatment & Prevention
In this article, we’ll discuss what osteoporosis is, osteoporosis definition, osteoporosis types, osteoporosis causes, osteoporosis symptoms, osteoporosis medicine, osteoporosis treatment and osteoporosis prevention.
Osteoporosis:
Osteoporosis is a condition of low bone mass and decay of bone tissue prompting bone delicacy and conceivably breaking with numerous preventable and intrinsic danger factors. Osteoporosis influences bones and makes them more defenseless against sudden and unanticipated breaks and breakage. The term osteoporosis is derived from the Greek words osteon (bone) and poros (pore). For complete article, click on the given link, https://diseases8804.blogspot.com/2021/08/all-you-need-to-learn-about-osteoporosis.html
1. Calcium and vitamin D supplements are effective at reversing secondary hyperparathyroidism in older individuals and are associated with increased bone mineral density and reduced bone loss.
2. Vitamin D supplementation lowers the risk of falling by 14-23% and a daily dose of at least 800 IU is most effective. While data is limited in men, they appear to benefit similarly to women in terms of fall reduction.
3. Calcium and vitamin D supplementation have proven antifracture efficacy when targeted to individuals with documented deficiencies or insufficiencies, through mechanisms of reducing bone loss and fall risk.
This document discusses osteoporosis, including its definitions, epidemiology, risk factors, pathophysiology, clinical manifestations, diagnosis, and treatment options. Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue, leading to fragile bones and increased risk of fractures. It affects millions of people worldwide, especially postmenopausal women, and can be caused by aging, genetics, lifestyle factors, and certain medical conditions or medications. Treatment involves lifestyle modifications like diet, exercise and fall prevention as well as pharmacologic options like calcium, vitamin D, bisphosphonates, and drugs that modify bone metabolism.
Osteroporosis - clinical features and managementRohit Rajeevan
Osteoporosis is defined as low bone mass and deterioration of bone tissue, leading to increased bone fragility and fracture risk. It is diagnosed based on bone mineral density measurements. Risk factors include older age, female sex, family history, smoking, excessive alcohol, low body weight, and medications like glucocorticoids. The disease results from an imbalance between bone resorption by osteoclasts and bone formation by osteoblasts. Treatment involves lifestyle modifications like calcium, vitamin D, and exercise as well as pharmacologic therapies such as bisphosphonates, SERMs, calcitonin, PTH, and strontium which reduce resorption or stimulate formation to increase bone mineral density and reduce fractures.
Vitamin D deficiency is common worldwide and can cause many health issues. It is involved in calcium absorption and bone health. Deficiency leads to osteomalacia and rickets in children, and increases risk of fractures in adults. It may also play roles in cardiovascular disease, diabetes, cancer prevention, autoimmune disease, pregnancy complications, muscle weakness, and mortality. Treatment involves dietary sources of vitamin D, supplementation, and sunlight exposure.
This document summarizes research on the relationship between calcium, vitamin D, and bone health. It discusses how calcium and vitamin D are important for bone health, and reviews epidemiological studies showing links between vitamin D and calcium intake and bone diseases. Animal and human studies are also summarized, providing evidence that calcium and vitamin D supplementation can help prevent bone loss and fractures. The document concludes that current nutrient guidelines for calcium and vitamin D intake are generally sufficient for bone health, based on the literature reviewed.
Calcitriol hormone and its up and down regulationArubSultan
Description: these slides explain the calcitriol hormone production and regulation. The effects of calcitriol on body and the related disorders. and also explain the up and down regulation of calcitriol hormone.
Recent updates about Vitamin D (sunshine vitamin) & bone health. Co-testing of vitamin D(25-OH vitamin D) along with PTH is a scientific, holistic approach for diagnosis & monitoring of vitamin D deficiency.
Vitamin D has increasingly been recognized for its importance beyond bone health. It may help prevent over 100 disorders ranging from cancer to diabetes to depression. Many people have deficient or insufficient vitamin D levels. While sunlight is the best source, factors like sunscreen use, age, and skin pigmentation can reduce natural vitamin D production. Supplementation is often recommended. Vitamin D is involved in processes throughout the body like immune function, cell growth, neuromuscular and immune functioning. Low levels are linked to higher risk of diseases like cancer, heart disease, diabetes, and autoimmune conditions like multiple sclerosis. Testing levels and supplementing to reach optimal levels may provide significant health benefits.
Asthma, allergy and respiratory infections: the vitamin D hypothesisAriyanto Harsono
The document discusses the relationship between vitamin D and respiratory conditions like asthma. It suggests that vitamin D deficiency has been associated with increased risk of respiratory infections and asthma exacerbations. This may be because vitamin D plays important roles in immune function and lung development. The document reviews studies showing links between low vitamin D levels and higher risks of respiratory infections, asthma symptoms, and impaired lung function. However, the relationships are complex and not fully understood, as some studies have also linked high vitamin D supplementation to increased asthma risk. More research is still needed to clarify the roles and optimal levels of vitamin D.
This document discusses calcium supplementation for post-menopausal women. It states that supplementation is not needed for most women as calcium levels are tightly regulated by hormones. Supplementation may be needed for women who are calcium or vitamin D deficient, or who have a higher body mass index (BMI) putting mechanical stress on bones. Weight-bearing exercise can also create mechanical demand where calcium supplementation may be beneficial.
Raccomandazioni della iof (international osteoporosis foundation) sull’impieg...Merqurio
This position paper from the International Osteoporosis Foundation makes recommendations for vitamin D intake in older adults. Based on randomized controlled trials, daily vitamin D intake of 20-25 μg (800-1000 IU) is estimated to achieve a target serum 25OHD level of 75 nmol/L (30 ng/ml), which is associated with reduced risk of falls and fractures. Higher daily intakes may be needed for those with risk factors like obesity, limited sun exposure, or malabsorption. Doses above 20 μg/day have not been thoroughly evaluated, so higher intakes cannot be generally recommended at this time.
—Chronic patients of spinal cord injury has been detected severe reduction of bone density. Patients with SCI show mostly osteopenia or osteoporosis of the hip and spine. Vitamin D deficiency may contribute to development of osteoporosis in SCI. So a study was conducted on 100 chronic SCI patients to find out status of correlation of Vitamine D and bone mineral density (BMD). Blood samples were collected and investigated routine biochemistry with serum 25(OH)D. DXA scan of hip and spine was also done. This study observed that 55% patients had suboptimal vitamin D. Positive correlation was found between vitamin D & bone mineral density. It is concluded from this study that monitoring of Serum 25(OH)D levels and annual surveillance of bone mineral density is crucial among persons with chronic SCI to reduce progression of osteoporosis and minimize the risk for further fractures. Keywords: 25(OH)D: 25 Hydroxy Vitamin D, DXA: Dual Energy X-Ray Absorptiometry, BMD: Bone Mineral Density.
This document discusses vitamin D deficiency in India. It provides the following key points:
1. More than 80% of adults in India do not get enough vitamin D, despite India's sunny climate, due to factors like skin pigmentation and low dietary intake.
2. The most common disorders caused by vitamin D deficiency in India are osteomalacia and rickets, which are bone diseases characterized by softening of the bones.
3. Good food sources of vitamin D include cod liver oil, fatty fish like salmon and tuna, and fortified foods like milk, cereal and orange juice. However, dietary intake of vitamin D is still low for most Indians.
Osteoporosis is often asymptomatic until a fracture occurs. Several risk factors increase the risk of osteoporosis and fractures, including older age, female gender, low body weight, smoking, excessive alcohol, and lack of exercise. Simple interventions like calcium and vitamin D supplementation, exercise, smoking cessation, and falls prevention can help maintain bone mineral density and reduce fracture risk. BMD testing is recommended for those over 65, younger postmenopausal women or men with risk factors, and anyone with prior fractures or conditions affecting bone health to diagnose osteoporosis based on T-scores and estimate 10-year fracture risk using FRAX.
Vitamin D plays an important role in regulating calcium levels and bone health. It is also involved in insulin regulation and may protect against cancer, cardiovascular disease, and infections. Vitamin D deficiency can lead to rickets in children and osteomalacia in adults as well as increased risk of falls in older adults. Supplementation is recommended for those with inadequate sunlight exposure or dietary intake, with dosage depending on age.
This document discusses possible links between vitamin D deficiency and various geriatric syndromes and common comorbidities. It begins by outlining how vitamin D receptors are present in many tissues beyond the musculoskeletal system. It then examines potential associations between vitamin D deficiency and increased risks of frailty, urinary incontinence, dementia/cognitive impairment, and depression in elderly populations. While evidence is limited and relationships are not clearly causal, several observational studies have found correlations between low vitamin D levels and higher rates of these conditions. More research is still needed, but maintaining adequate vitamin D status may help reduce risks of age-related diseases and functional decline.
Vitamin D Deficiency is linked to bone disorders. However, there is insufficient data for establishing guidelines for "adequate levels". Its been close to a century since it was first discovered. But how much do we actually know about it?
This document summarizes key information about osteoporosis. It defines osteoporosis as a systemic skeletal disease characterized by low bone mass and deterioration of bone tissue, leading to fragile bones and increased risk of fractures. It discusses risk factors like age, estrogen levels, family history and lifestyle factors. It also covers the global incidence of osteoporosis, noting that 200 million women worldwide are affected. Future directions are identified like better understanding nutrient requirements in different populations and roles of nutrients beyond calcium and vitamin D in bone health.
This document discusses the importance of vitamin D and other micronutrients for orthopedic patients. It summarizes that vitamin D plays a key role in bone metabolism and calcium homeostasis. Vitamin D deficiency has been linked to impaired fracture healing and increased risk of falls. The document recommends maintaining vitamin D levels of 30-35 ng/mL or higher for optimal bone health in orthopedic patients. Other micronutrients discussed include calcium and the roles of various vitamins and minerals in bone health and orthopedic outcomes.
This document discusses vitamin D deficiency as a global health problem, definitions of vitamin D deficiency, sources and requirements of vitamin D, and consequences of vitamin D deficiency such as osteomalacia and rickets. It provides treatment recommendations for vitamin D deficiency in adults, including initiating treatment at vitamin D levels below 20 ng/mL, recommended dosages of 6000 IU/day, duration of treatment of 4-12 weeks, and follow-up maintenance dosages. Higher dosages may be needed for certain high-risk individuals. Oral cholecalciferol is the preferred route of treatment.
1. Does the amount of naturally occurring UV radiation affect stress fracture rates in female
athletes via changes in vitamin D production?
by
Eliot Mar
A thesis submitted to the General Science Department of Seattle University in Partial
Fulfillment of the Requirements for the Degree
BACHELOR OF SCIENCE
Seattle, WA
2014
2. Final Draft
1
Abstract:
Vitamin D deficiency, also known as hypovitaminosis D, is a common health
affliction of a large part of the American population. Vitamin D is produced naturally by
the body in response to sunlight via photolytic reaction in the skin and regulates calcium
levels in the body as well as bone health and density. Women are biologically more at
risk than men to be vitamin D deficient and are at greater risk for bone related injuries.
Studies have shown difference in bone health between genders, as well as the production
of vitamin D via UV radiation. The effect, however, of UV radiation on female athletes in
high physical intensity environments involving risk of bone injury have not been as
thoroughly tested. Given that vitamin D controls bone health, female athletes who are in
environments high of risk of bone related injury such as stress fracture, amounts of UV
radiation should affect the percentage occurrence of injury.
Introduction:
Vitamin D deficiency is a major health issue for people in the United States. A
study by Leidig-Bruckner et al. in 2011 suggested that as few as 20% of ambulatory
(mobile) patients 14-60 years old had high enough vitamin D levels to prevent vitamin D
related bone diseases and bone injury.i A previous study of a larger survey population
from Karl McClung suggested that hypovitaminosis D, could affect up to 40% of men
and 51% of women with levels being “significantly higher for women and minorities as
compared to white men.”ii The primary concern with hypovitaminosis D is in vitamin D’s
3. Final Draft
2
regulatory role in parathyroid hormone (PTH) and calcium levels in bone tissue. Vitamin
D is directly related to the production of PTH in the parathyroid gland. This hormone is
responsible for controlling the levels of calcium in bone tissue which, in turn, can be used
as indicators of bone density and strength. For this reason, the most common type of bone
related injury occurs in the form of stress fractures, or injury brought about by “recurring
excessive strain caused by repetitive micro-trauma to bone at a rate greater than bone
repair.”iii It is an overuse injury, where “the muscles of the affected area become
fatigued,” and the impact or stress is then “transferred to the bone, resulting in a small
crack…”iv The role of sunlight as it pertains to stress fractures is therefore paramount as
it directly relates to the amount of vitamin D produced. The more vitamin D in the body,
the greater the rate of bone repair in relation to the rate of the micro-traumas caused by
the impact and excessive strain that can lead to stress fractures.
According to Rosenbloom, "40% of athletes report a stress fracture at some time
in their career.”4 Bone density loss, the cause of the stress fracturing, is a part of what is
known as the “female athlete triad.” This triad is composed of three deficiencies resultant
of rigorous physical activity: Menstrual dysfunction, (defined as oligomenorrhea or less
than 9 periods per year), which causes suppression of hormone production and bone loss;
low energy availability, and overall loss of bone density. Though being afflicted with the
female athlete triad is not prevalent among female athletes, almost one in four female
athletes suffer from at least one component of the triad due to their training regiment
leading to an according loss in bone density. This bone loss related to the female athlete
triad has been thoroughly studied and the long term effects have been recorded to
include, amenorrhea, infertility, increased fracture risk, bone disease such as osteoporosis
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and osteoarthritis and even diminished capacity for arterial vasodilation leading to
cardiovascular disease and disorders.4
Much of the research regarding stress fractures and hypovitaminosis D has
focused on comparison of dietary and supplemental vitamin D intake. As popular and as
highly contested as daily recommended healthy amounts of vitamin D are, comparison of
stress fracture rate and relative UV radiation exposure has not been as extensively
studied. Given the prevalence of vitamin D deficiency and that women are more likely to
experience hypovitaminosis D, the most at risk populations for stress fracture are those of
women in environments involving high volumes of strenuous, consistent physical activity
and lacking stimulation of vitamin D production. Women in the armed forces and female
athletes are therefore included as high-risk groups. Due to the aforementioned factors,
female athletes in areas of low annual UV radiation and exposure are at a higher risk than
those athletes in areas of high annual UV radiation and exposure for stress fracture.
Background:
Vitamin D is responsible for controlling the feedback loop between parathyroid
hormone, (PTH), and calcitonin hormone
levels in blood plasma. Both hormones
regulate absorption of calcium by the
intestines and osteoclast activity in breaking
down bone material to release calcium from
the bone matrix. Production of vitamin D
occurs naturally in the body in response to
Figure 1: UV radiation to vitamin D
mechanism6
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skin’s exposure to UV radiation from sunlight. This photolytic reaction converting
ultraviolet radiation into vitamin D involves conversion of 7-dehydrocholesterol into two
types of vitamin D commonly found in the blood: 25-hydroxyvitamin D, (25(OH)D), and
1,25-dihydroxyvitamin D, (1,25(OH)2D)).v Mechanistically, the interaction of vitamin D
binding to the vitamin D receptors, (VDR), in the body acts to keep calcium absorption
rates of the body in homeostasis. When more vitamin D is bound to VDR, the intestines
absorb more calcium and osteoclast activity is suppressed leading to maintained or
increased bone density and health. Less vitamin D bound to VDR, as is the case when
hypovitaminosis D occurs, leads to an increase in PTH secretion and osteoclast
breakdown of bone resulting in a decrease in bone density. More specifically, sunlight
causes activation of 7-dehydroxycholesterol which is converted to cholecalciferol steroid
hormone or vitamin D3. Cholecalciferol is then converted in the liver to 25-
Dihydroxyvitamin D3 where it is further processed by the kidneys into 1.25-
Dihydroxyvitamin D3 or, as it has been referred to earlier in this paper, (1,25(OH)2D)).vi
From the kidneys, PTH acts on feedback from the body in response to calcium blood
plasma levels to regulate release of (1,25(OH)2D)) to bind to VDR receptors in the body
and VDR receptors in the intestines. Exposure to sunlight leads to production of the
steroid hormone cholecalciferol and production of (1,25(OH)2D)). High levels of
(1,25(OH)2D)) binding to VDR causes an increase in calcium absorption in the small
intestine, an increase in reabsorption of calcium in the kidneys and suppression of
osteoclast activity leading to an increase or maintenance in bone density.
Though the causality of hypovitaminosis is well known, a current consensus on
minimum daily-recommended amounts of vitamin D for a person has yet to be agreed
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upon. Currently, blood concentration levels greater than or equal to 75 nmol/L for blood
plasma concentration are the most widely agreed upon but still does not address the
problem of the affect metabolic rates. Studies involving participants in environments of
high physical stress with a range of low to high concentrations of UV radiation have been
done to compare the hypothesized adverse affects to bone health in areas of low UV
radiation may have. UV radiation is most commonly measured by the intensity of
sunlight per year as is given by the UV index provided by organizations such as NOAA
or the national weather service.vii
Vitamin D deficiency, (hypovitaminosis D), is “unique in that it may be obtained
from the diet or synthesized in the skin in the presence of ultraviolet B (UVB) light (290-
315 nm).”viii Hypovitaminosis D can be caused by a plethora of different contributing
factors aside from lack of sunlight though. Besides its effect on PTH regulation, vitamin
D is responsible for “calcium handling and transport, phosphate metabolism, cytoskeletal
protein expression, and the activation of mitogen activate protein kinase signaling
pathways in skeletal muscle.”2 As was previously mentioned by Rosenblom, stress
fractures result from muscular fatigue leading to displacement of force upon the bones of
the body.4 Hypovitaminosis can also be caused by moderate to severe lack of dietary
consumption of vitamin D. As in the case in female athletes with one or more aspects of
the female athlete triad, aesthetic concern about appearing “thin” and the caloric and
energy demands of intense training cause an imbalance in nutritional intake less than
what is necessary for the body to healthily function.
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Female Athlete Triad:
“Low energy availability, menstrual disturbances and low bone mineral density,”
is known as the “female athlete triad.”ix The triad is comprised of three parts being
amenorrhea, osteoporosis or bone disease, and low energy availability.4 A primary cause
of any of the three components of the female athlete triad includes a high demand and
physical taxation on the body coupled with an aesthetic desire for thinness that may limit
energy availability through dietary deficiency. Components of the female athlete triad can
be brought about by hypovitaminosis D. Most notably, menstrual disturbances and low
bone mineral density can be symptoms brought about by vitamin D deficiencies. An
irregular menstrual cycle, (oligorrhoea), or not having menses for 3 month periods,
(amenorrhea), as a part of the female athlete triad causes hormonal imbalances that
disrupt the activity of hormones such as PTH and calcitonin that maintain bone density
and Calcium blood plasma levels.8 It is estimated that, although percentages of female
athletes suffering from all three aspects of the “female athlete triad are low, almost 20-
25% of female athletes have at least 1 component of the triad.”4
Despite the variability of factors affecting cutaneous or skin exposure to UV
radiation for female athletes across all sports, observation of vitamin D levels in athletes
as a contributing factor to stress fracturing has not been widely tested. The general
consensus for treating amenorrhea brought about by hypovitaminosis D and calcium
deficiency has been through dietary supplementation in calcium and vitamin D.4 Studies
have shown a trend in female athletes over time for greater incidence of stress fractures to
occur. In an analysis of incidences of stress fracture at the collegiate level, athletes in
running sports such as track or distance running experienced up to a 21% stress fracture
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rate among female athletes within a one year period. Though the difference in
occurrences of stress fractures by gender was not statistically significant for most of the
studies done by female and male populations in athletics and the military, the parts of the
studies that were conducted over a 10 year minimum period did show large differences
between genders with female athletes reporting cases of stress fractures in lower limb
bones at higher frequency than males. This data showed averages of ~6.5% in males and
~9.2% in females.3
Affects of the female athlete triad on susceptibility for stress fracture may be
higher than reported due to the fact that many sports are not as lower body intensive. The
most common injuries, for biomechanical reasons relating to hip angle and displacement
of force and weight on the lower limb bones in females, are at the tibia, metatarsals,
femur, and calcaneus, bones.3 Women are at a higher risk of lower body injury due to
having a wider pelvis which “alters the angular tilt on the hips and knees, increasing the
stress” on the lower body bones.3 The difference in the anatomy of the female pelvis
leads to an increase in distribution of weight or “loading strain” on the lower limbs and
therefore an increase in occurrence of stress fractures among female athletes as compared
to their male counterparts undergoing similar levels of activity.3 Statistically the
percentages of female athletes who have calcium deficiencies and/or hypovitaminosis D
support that all female athletes are at least at risk for stress fracture and not just female
runners.
Sunlight deprivation:
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Vitamin D deficiency on the basis of lack of sunlight can be determined by
controlling the variables of race, gender, and dietary supplementation. A study by
Iuliano-Burns et al. suggested that insufficient exposure to sunlight can cause
hypovitaminosis D.5 In the study, Antarctic expeditioners were in environments of both
intense and predictable sunlight seasonal patterns. The climate of the Antarctic was ideal
to measure prolonged exposure to sunlight against prolonged periods of no or low
sunlight, from approximately March to September, when “negligible” UV sunlight is
available. Their hypothesis was that, as the diets of the Antarctic expeditioners5 were
simultaneously and randomly (double blind test) withheld vitamin D dietary
supplementation, a consistent (monthly) doses of supplemental vitamin D would result in
a decrease in PTH activity and conserve bone density. Baseline averages of 1,600 IU, 800
IU, and 100 IU per day were used and measurements of bone density were taken at the
proximal femur and lower spine as the lower body is the most common site of fracture
associated with hypovitaminosis D.v The major problem encountered by this study was in
the inability to create a true a group of expeditioners who did not receive any
supplemental vitamin D in combination with lack of UV radiation as a photolytic source
of vitamin D. This would have been unethical practice in knowingly subjecting a test
group to conditions with heightened risk of stress fracture. Over the six month duration of
the study, the respective daily values of supplemental vitamin D were administered at
monthly, bi-monthly, and one single large dose to study participants.5 This method of
testing was administered to three different test groups having the administration of the
doses of vitamin D as the variable changed and recorded. The results of this study found
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that the single large initial dose of vitamin D had a greater effect than the monthly and bi-
monthly supplementations.
Though the study’s focus was on the effect of dietary supplementation of vitamin
D on combating vitamin D deficiency, UV radiation was observed as a means of inducing
or controlling hypovitaminosis D. Through UV deprivation, all participants in the study
experienced hypovitaminosis D. Lack of UV radiation as a source of sufficient vitamin D
supports the importance of UV radiation as a major contributor to production of vitamin
D in the body and maintenance of homeostatic bone density.
In a related study on UV indexing by Scott Montain et al., geographic effect on
bone health was observed in order to determine the degree to which hypovitaminosis
occurred in areas of low UV index as opposed to areas of high UV index. Quantitative
data of the study was collected by dividing up the “48 contiguous states and Alaska into
144 cells” and recording the average UV radiation indexes for the 200 major cities within
each cell.6 Female populations in the military going through basic combat training (BCT)
and female collegiate athletes were observed.6 This study hypothesized that “darker
complexions” would make UV absorption more difficult and thereby limit the amount of
vitamin D producible with comparable sunlight exposure for people with lighter skin
pigmentations. Comparatively, female U.S. navy recruits with 25-hydroxyvitamin D
levels less than 20ng/mL were found to have a higher occurrence of stress fracture than
recruits with 25-hydroxyvitamin D levels greater than 40 ng/mL. As the study progressed
to compare the relative stress fracture rates based on the pigmentation of the participant’s
skin, it was found that white females with high 25-hydroxyvitamin D plasma levels had a
lower risk of stress fracture than those with low 25-hydroxyvitamin D plasma levels. The
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same paradigm was not observed in other ethnicities. African, Asian, Hispanic, and
Native American women did not express the expected result of consistently lower rates of
stress fracture than white females due to their skin pigmentation acting as an obstacle to
UV radiation absorbtion.6
The postulation by this study that UV radiation levels, as affected by skin
complexion, do not have an effect on bone density or stress fracture rate was supported
by the lack of statistically relevant difference between females in the military with darker
skin compared to white females. Among the 2% of surveyed members of the military
who report stress fractures, women in general were shown to have between 2 and 10
times higher rates of fracture than men. The data of the study, however, showed that
“black men and women have had lower incidences of stress fractures than white men and
women performing the same military training.”6 Statistically, “10% and 5% of white and
black females developed stress fractures, respectively, during nine weeks of Navy basic
training,” and “3% and 1.4% of white and black trainees, respectively, were removed
from [basic combat training] to recover from stress fractures developed during training.”6
Both these findings suggest a difference in rate of stress fracture as a function of ethnicity
and, accordingly, UV radiation’s impact on vitamin D production. It was shown that
recruits coming from areas of low annual average sunlight HOR, (homes of residence),
did not exhibit a higher predisposition to experiencing stress fractures. Per 1000 recruits,
the stress fractures for “low, moderate and high UV index regions” were 26, 31.3 and
31.1 respectively.6 It was also shown that “non-blacks were more likely than blacks to
develop lower limb fractures…”6 UV radiation’s role in vitamin D production is
diminished as available sunlight for absorption decreases. Skin pigmentation limits the
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amount of UV radiation able to be taken in by the body and used for natural production
of vitamin D.3 Though it was hypothesized that people with darker completions would be
more likely to experience stress fracturing, the results refuted conclusive evidence
supporting darker skin pigmentation as an obstacle to UV radiation absorption.
The conclusion of the study was that low UV levels did not contribute
significantly to an increase in stress fracture rate. Instead, the study suggested
“individuals entering military service from areas with a low annualized UV index were
actually less likely to suffer a stress fracture than those entering from a high UV intensity
area.”6 Though this finding may seem to refute the hypothesis that there is a direct
correlation between higher levels of UV radiation in a given area and bone density and
stress fracture rate, it actually acts to support the theory. The surveyed subjects were all
tested at locations on military and navy bases. Using this fact as a control, these fixed
locations were themselves located in their own geographic UV index cell. The major
army and navy bases in the United States fall mostly within what the study defined as low
or moderate UV index regions. Individuals coming from low UV index regions may have
been able to more efficiently use vitamin D than individuals with previous exposure to
high UV index regions.
Vitamin D and Collegiate Athletes:
A study by Tanya M. Halliday et al. examined NCAA DI athletes and observed
the relationship between 25-Dihydroxyvitamin D blood plasma concentration and overall
vitamin D dietary intake, UV radiation exposure, and body compsition. It also
secondarily “evaluated whether 25-Dihydroxyvitamin D concentration is linked to bone
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density, development of overuse or inflammatory injuries, and/or incidence of frequent
illness”9 Individuals tested were male and female NCAA DI athletes over the age of 18
from the University of Wyoming. All athletes started without preexisting injuries and
were then split into indoor or outdoor athletes. Athletes who participated in football,
soccer, cross-country or track and field were considered outdoor athletes.9 Athletes in
wrestling, swimming, and basketball were considered outdoor athletes.9 Bone density and
PTH blood plasma concentrations were taken at seasonal intervals and any bone related
injuries that occurred over the course of the study were recorded.6 The results of the
survey, were as follows: overall, 9.8% of the athletes in the fall were found to be vitamin
D deficient. In the winter, 60.6 % of athletes were found to be vitamin D deficient. In the
spring, 4% of athletes were found to be vitamin D deficient. When comparing outdoor to
indoor athletes, 53.1% vs 31.9% of fall athletes, 31.9% to 10.2% of winter athletes, and
44.6% to 33.1% of spring athletes showed higher vitamin D blood plasma levels.9 The
report noted that, though a difference in UV radiation exposure contributed to higher
levels of vitamin D in blood plasma, no difference in concentration of 25-
Dihydroxyvitamin D was found between genders. The study suggested “that athletes who
[practiced] indoors [were] at risk for vitamin D insufficiency and deficiency…”ix and the
athletes experienced an expected decrease in 25-Dihydroxyvitamin D blood plasma
concentration levels in the winter as compared to the spring and fall when sunlight is
seasonally more intense and consistently available. It was also found that there was a
“lack of a relation between vitamin D status” and consumption of vitamin D via dietary
supplementation.
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Dietary supplementation as a primary source of vitamin D though was shown not
sufficient or as effective as that of UV radiation. 25-Dihydroxyvitamin D blood plasma
levels and PTH blood plasma levels are known to regulate the release or suppression of
osteoclast cells in the body causing an increase or decrease in bone density. Halliday et
al.’s focus upon the impact of sources of vitamin D on 25-Dihydroxyvitamin D
concentration in the body depending on relative seasonal sunlight, (UV index), and
dietary supplementation strongly support a correlation between receiving enough natural
UV radiation over a prolonged period of time and a lowered risk for stress fracturing. The
target test group included college female athletes ages 18 and up who fit the description
of people at high risk for stress fracture based on their consistent and sustained intense
physical activity. The study found that limiting the availability and consumption of
vitamin D rich foods, dietary supplementation of vitamin D made a negligible impact on
the test group. The observable changes then, were attributed to the changes in the
geography or climate the athlete trained in. Based on the change in environment, whether
it was between indoor and outdoor (less sunlight to more sunlight exposure) or what
season the athlete’s participated in their respective sports, a direct correlation between
more UV radiation and more 25-Dihydroxyvitamin D concentration was supported. As it
has already been established that 25-Dihydroxyvitamin D’s interaction with VDR also
has a direct correlation with stress fracture rate via PTH and bone density regulation, it
follows that the study also supports a relationship between UV radiation and stress
fracture rate.
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Summarizing factors of stress fracture:
Physical activity itself “has been associated with improvements in bone health, as
such, physical training regimens may provide an important opportunity for athletes or
populations engaged in physically demanding activities to maximize bone strength such
that future bone injuries may be avoided.”x A study by James McClung explained the
primary factors affecting stress fracture risk, were age, vitamin D concentration in blood
plasma, gender, whether or not a person smokes, amenorrhea, and polymorphisms in
VDR.10 With respect to gender, he found that 21% of females experienced stress
fracturing compared to just 5% in men among the general military population.10 A study
involving comparison of twins suggested that VDR polymorphisms or genotypic
differences play a role in determining risk of stress fracture. The study suggested that “up
to 75% of the variation in peak bone mass” could be due to VDR variation and “up to
80% of the variability in [bone mass density] may be explained by genetic factors.”10
This would suggest that the other factors such as sunlight exposure and dietary
consumption of vitamin D may only show measurable difference in individuals where a
genetic predisposition to poor uptake or inefficient activity of VDR and 25-
Dihydroxyvitamin D has not already taken precedence as the primary cause of
hypovitaminosis D.
Treatment strategies:
Treatment of hypovitaminosis D and treatment of stress fractures involve both pre
and post habilitation solutions. Preventative measures for vitamin D deficiency,
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excluding VDR polymorphisms as the cause, involve a diet where vitamin D rich foods
are consumed in secondary support of exposure to UV radiation in order to stimulate
natural vitamin D production in the body. Preventative exercises such as stretching and
lighter intensity workouts, also known as prehabilitation, do not have as well defined
parameters. Physical activity is known to improve bone health to a degree, yet stress
fracturing itself is caused by an excess of physical activity in the form of overuse and
overtraining. Because of this, finding a balance between rest to avoid muscular fatigue
and training is the best solution to avoid stress fracturing. Female athletes already
experiencing hypovitaminosis D can be treated through similar approaches to
prehabilitation measures with increases in 25-Dihydroxyvitamin D supplementation or, in
the case of the amenorrhetic component of the female athlete triad, hormone therapy, or a
prolonged break from or diminished intensity of workouts. This can restore homeostatic
regulation of PTH and calcitonin in the body, making better use of 25-Dihydroxyvitamin
D and dampening the effects of low vitamin D blood plasma levels. Though these
measures are not as efficient or preferable to naturally produced vitamin D, they do help
to lessen the risk of stress fracture and do help promote bone health. Rehabilitation for
stress fractures mainly involves time as the cause of fracture stems from bone trauma
happening at a greater rate then the body is able to rebuild bone.
Conclusions:
Female athletes who train in areas of high annual UV radiation have the
advantage of a readily available and constant source of vitamin D production over female
athletes in areas of low annual UV radiation. As suggested by Scott J Montain et al,
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preconditioning to UV radiation may play a larger role in ability to efficiently absorb
vitamin D and therefore UV radiation in itself may not be directly responsible for bone
health or stress fracture rate.6 As was previously mentioned in the study by McClung on
vitamin D and stress fracture, the contribution of vitamin D receptor gene polymorphisms
also suggest that UV radiation’s varied affect on bone density may be due more to
genetic factors than other mitigating variables.10 Both of these studies, though strongly
supported, also concluded that many environmental factors had to be ignored in order to
create observable control groups. Scientific evidence backing a correlation between UV
radiation and stress fracture rate has been difficult to prove or test given the range of
factors contributing to vitamin D production, activity between vitamin D and VDR and
PTH, and bone density in general. Despite the lack of clinical evidence to support a
connection between UV radiation and stress fracturing, there is strong biochemical
mechanistic evidence backing the claim that female athletes in areas of high annual UV
radiation are at lesser risk for stress fracturing than female athletes in areas of low annual
UV radiation.
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References:
i Leidig-Bruckner, H. Roth, Bruckner T,
Lorenz A, Raue F, Frank-Raue K. Osteoporos. Int. 22, 231–240.
ii Barker, Tyler; Schneider, Erik D;
Dixon, Brian M; Henriksen, Vanessa T; Weaver, Lindell K. Nutr. Rev. 68, 365–9.
iii Wentz, Laurel; Liu, Pei-yang; Hay, Emily; Ilich, Jasminka Z 176, 420–431.
iv Rosenblom, Christine. Nutrition Today. 48, 81-87
v Iuliano-Burns, S; Ayton,J; Hillam, S; Jones,G; King, K; Macleod, S; Seeman, E. Osterooros. Int. 23,
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D Enette. Med. Sci. SportsExerc. 43, 335–43.
ix Ducher, Gaele; Turner, Anne I; Kukuljan, Sonja; Pantano,Kathleen J; Carlson, Jennifer L; Williams,
Nancy I; Souza, Mary Jane De. 41, 587–608.
x McClung, James P; Karl, J Philip. Nutr. Rev. 68, 365–9.