2023-05-22 00:49:13
The increase in life expectancy has led to an increase in vitamin D deficiency in postmenopausal women and, with it, an increase in osteoporotic fractures in this group. Therefore, studying new sources of this vitamin in the long term is key to the health of women over 50 years of age, a population group with a high risk of bone loss.
«Women who have sufficient stores of vitamin D can totally prevent the onset of osteoporosis»
doctor esteban fuck
“Vitamin D plays an important role in bone health and probably also in multiple acute and chronic extraskeletal diseases,” says Dr. Esteban Jodarhead of the department of Endocrinology and Nutrition of the university hospitals Quirónsalud Madrid y Ruber Juan Bravo.
From the Spanish Society of Endocrinology and Nutrition (SEEN) remember that vitamin D is Fundamental for bone mineralization at all ages and calcium absorption. In addition, it regulates calcium levels in the blood, is responsible for stimulating the absorption of calcium at the intestinal level and favors the reabsorption of calcium at the renal level.
When the sun is not enough
The SEEN warns that in our country low concentrations of this vitamin have been described in more than 80% of individuals over the age of 65, and in 40% of the population under 65 years of age. Something surprising considering the number of hours of sunshine, a great source of vitamin D, that the Iberian Peninsula enjoys throughout the year. But the increasing sedentary lifestyle has reduced sun exposurewithout the scheduled administration of vitamin D supplements having been implemented, as occurs in other neighboring countries.
The Quirónsalud specialist highlights that, in humans, the greatest contribution comes from the skin transformation of ‘7-dehydrocholesterol’ into cholecalciferol by the action of ultraviolet rays from the sun, that is, our greatest source of vitamin D is the sun . It can also be obtained from food, in 10%, both of animal origin (cholecalciferol) and of plant origin (ergocalciferol). Although most have low amounts of this vitamin, Dr. Jódar points out fish and shellfish, dairy products, eggs, mushrooms or fortified cereals, among others, as the richest in vitamin D.
Why during menopause?
This practitioner stresses that osteoporosis and menopause often go hand in hand, so that the loss of bone density that occurs at menopause contributes to increasing the rates of osteoporosis and fractures in this group. In fact, it highlights that “osteoporosis causes more than 80% of menopausal fractures over 50 years of age.”
During menopause there is a decrease in estrogen, which in turn causes activation of osteoclasts, with the consequent destruction of bone without associated renewal. “Postmenopausal women are characterized by loss of bone mass, which progresses over the years, and can end in osteoporosis, especially among women who are more prone to it. If they have sufficient reserves of vitamin D, it is a process that can be totally prevented”, remarks the specialist.
long-term treatment
Although calcifediol supplementation, a metabolite of vitamin D, has shown efficacy and safety in short-term clinical trials to prevent this type of situation, until now its long-term effects were unknown.
To evaluate it, a group of 18 experts carried out a phase III-IV, double-blind, randomized, controlled, and parallel superiority clinical trial in ten centers in Spain and Italy between March 2018 and October 2020, to evaluate the Efficacy and safety of monthly calcifediol 0.266 milligrams, versus cholecalciferol 25,000 IU (0.625 mg), in postmenopausal women with vitamin D deficiency.
safe and effective
“The study concludes that long-term treatment with monthly calcifediol in patients with vitamin D deficiency is effective and safe, that withdrawal of treatment leads to a pronounced decrease in vitamin D levels, that calcifediol presented an onset of action faster compared to monthly cholecalciferol and that long-term treatment produces stable and sustained concentrations of vitamin D without associated safety concerns”, explains Jódar.
Specifically, for the study, the patients were randomized into three groups according to drug administration: calcifediol 0.266 mg/month for 12 months (Group A1); calcifediol 0.266 mg/month for 4 months: followed by placebo for 8 months (Group A2) and cholecalciferol 25,000 IU/month (0.625 mg/month) for 12 months (Group B).
For the fourth month, stable levels of vitamin D were documented for all groups: 26.8 (Group A1), 28.5 (Group A2) and 23.1 (Group B). At 12 months, the levels were 23.9 (Group A1) and 22.4 (Group B).
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