IN POST- MENOPAUSAL WOMEN
INTRODUCTION
The purpose of the study is to analyze the relationship between vitamin D intake in the post menopausal women in the age group of 55-60 years and osteoporosis. The elderly women have higher chances of losing vitamin D and thus suffer from multiple fractures and falls.
Vitamin D is a fat soluble vitamin that is stored in the fat cells of the body. It helps in the absorption of calcium by the body. Calcium and other minerals like phosphates are required for maintaining bone health. Deficiency of Vitamin D leads to rickets in the young age and osteoporosis in the elderly. Vitamin D can be synthesized by the body itself through exposure to sunlight. Thus the vitamin is also called as “sunshine” vitamin. Very few variety of foods naturally contain vitamin D, some of these are fat rich foods, beef liver, cheese, egg yolk and mushrooms. It is important to note that milk does contain vitamin D, but products made out of milk do not contain any amount of vitamin D. it is difficult to obtain the minimum requirement of vitamin D by the food sources only. Therefore, taking vitamin D supplements may be required. Vitamin D supplements can be taken in two forms: Ergocalciferol (Vitamin D2) and cholecalciferol (Vitamin D3). Daily requirement of vitamin D can be met by daily exposure to sunlight for 10 to 15 minutes without applying sunscreen. The exposure should be direct on the face, arms, back and legs. To determine the blood levels of vitamin D tests are done. The form of vitamin D which can be tested in the blood is 25- hydroxyvitamin D. levels below 30nmol/L and above 125nmol/L are considered abnormal. Level above 50nmol/L is considered to be good enough for a normal individual. The recommended daily allowance or RDA of vitamin D for different age groups is as follows:
Infants (adequate intake of vitamin D)
0 - 6 months: 400 IU (10 micrograms (mcg) per day)
7 - 12 months: 400 IU (10 mcg/day)
Children
1 - 3 years: 600 IU (15 mcg/day)
4 - 8 years: 600 IU (15 mcg/day)
Older children and adults
9 - 70 years: 600 IU (15 mcg/day)
Adults over 70 years: 800 IU (20 mcg/day)
Pregnancy and breast-feeding: 600 IU (15 mcg/day)
People of age higher than 50 years require more vitamin D than the younger people. Vitamin D toxicity is not that common, in case it occurs, it is always due to overdosing of Vitamin D supplements (Medline Plus).
In the skin, metabolism of vitamin D takes place in the presence of the ultraviolet rays of the sun. 7- dehydrocholesterol is converted into previtamin D3 in the presence of sunlight, which is then converted to cholecalciferol or vitamin D3. After being bound to vitamin D bindng protein in the serum, the cholecalciferol is transported to the liver. In the liver the vitamin D3 is hydoxylated to 25(OH) D3. In the kidneys, this form is converted to 1-α, 25- dihydroxyvitamin D3, this is the biologically active form of vitamin D.
Vitamin D deficiency is a common finding in the elderly women, mainly in the post menopausal age. Aging leads to decrease in the muscle mass and muscle strength (Janssen, Samson and Verhaar). The incidences of falls and fractures are so common in this age group that a thorough study needs to be conducted and a proper plan of treatment must be chalked out to prevent the complications.
For conducting a detailed study in this regard, a sample population will be taken. The patients attending outpatient department of a hospital will be taken into consideration. Women of the age group between 55 and 60 having joint pains will be tested for blood levels of 25-hydroxyvitamin D. On subsequent visit to the hospital after giving the vitamin D supplements, they will be followed up. Their subjective symptoms will be noted down and 25- hydroxyvitamin D levels will be rechecked again. Another test that can help in assessing the bone health is the bone mineral density test. The results should show positive changes in the blood levels of 25- hydroxyvitamin D and an increased bone mineral density.
LITERATURE REVIEW
A research was conducted by Sanders et al. in which they tried to study the effect of vitamin D administration in the elderly age group. They wanted to test whether administering a massive dose of vitamin D annually will lead to reduction in the number of fractures and falls in the elderly. They took a sample size of 2256 women aged above 70 years. This study was done by double blind method. Vitamin D supplements and placebos were given to these women on a randomly basis. They were observed for the next three to five years. The results were however not favorable. They observed that the incidences of falls and hip fractures increased after administration of vitamin D supplements (Sanders et al.).
The results are contradictory in this case, but the cause for this contradiction could be something that has not been brought about or studied in the experiment. It could also be due to the massive administration of the dosage. Probably if the same dose was given in divided form then it might have proved to be beneficial for the patients instead of being more harmful.
In an attempt to ascertain whether calcium along with vitamin D supplementation can reduce the incidences of osteoporotic fractures, a study was carried out on a randomized trial. The study showed 12% reduction in the incidences of fractures after providing calcium and vitamin D supplements. The recommended levels of calcium and vitamin D supplements required to reduce osteoporotic fractures are 1200mg and 800 IU respectively (Tang et al.).
This test states that a daily intake of the mentioned amount of calcium and vitamin D supplements can reduce the occurrence of osteoporotic fractures. The results obtained are satisfactory and convincing enough to be believed to be valid and reasonable. The same principle is also supported by many other similar researchers.
A study conducted on the North American post menopausal women who were being treated for osteoporosis showed very contradictory results. Although they have been receiving treatment for osteoporosis, still they had a below normal 25- hydroxyvitamin D levels. This puts a greater emphasis on the lack of knowledge among the people regarding the importance of Vitamin D. It calls for improvement in public education about the significance of vitamin D (Holick et al.).
In this study, they emphasized on the lack of knowledge of the patients regarding the relation between vitamin D and calcium. If the patients are not aware enough themselves then they can never take active part in treatment of the disease. it is thus very important to educate the patients about the link between the two and how they have to take care of both the things in their body.
All these studies have some relevance to the utilization of vitamin D and osteoporotic conditions in the elderly females, however some were contradictory. According to Sanders et al., administration of massive doses of vitamin D supplements annually, proved to be derogatory for the bone health of the post menopausal women. On the other hand, Tang et al., showed that giving a daily dose of 1200mg of calcium along with 800 IU of vitamin D supplementation can remarkably reduce the incidences of osteoporotic fractures. In another study, Holick et al., proved that giving calcium supplements for the treatment of osteoporosis alone is not sufficient. Calcium has to be given in combination with vitamin D supplementations for obtaining better results. Otherwise, giving calcium alone will not serve the purpose of treating osteoporotic condition in the elderly women, especially who are mostly staying under the comfort of their homes and have negligible exposure to the sunlight.
In yet another research study by LIPS et al, they concluded that women with osteoporosis had a lower level of 25-hydroxyvitamin D in their serum. They took a sample of 2606 postmenopausal women to conduct the research and all of them were tested for 25- hydroxyvitamin D levels. The results were as expected, majority of the osteoporotic women demonstrated lower levels of 25- hydroxyvitamin D. this research thus strengthens the point that administering vitamin D samples can help in treatment of osteoporosis (LIPS et al, 2006).
METHODOLOGY
Now we will conduct a research on the relationship between vitamin D intake and osteoporosis in the post menopausal women of the age group 55 to 60. The research will be based on correlational research. We will hypothesize that intake of vitamin D will have a positive result on the bone mineral density of the elderly women and hence the incidences of fractures will reduce. The subjects will be chosen from a community health center where women visit regularly with their health problems. The population to be selected will be a sample of around 1500 women, registered over a period of two years, in the age group of 55 and 60 years, suffering from recurrent joint pains, osteoarthritis, and other osteoporotic manifestations. These patients will be enquired verbally about their subjective symptoms, records of their previous medical history will be collected from the health centers, they will be made to undergo Bone mineral density test, Radiological examination of the femur, serum 25- hydroxyvitamin D levels and a routine urine examination. The selection of the sample should be free from any bias. Any patient having the history of femoral fracture before the age of 30 due to any accident should not be taken into consideration. The reason for this exclusion is that a female who has a fracture of the femur due to any reason other than vitamin D or calcium deficiency, has a chance of having another fracture at the same sight. The reason may not be the vitamin D or calcium deficiency again. It could be a mere trauma to the previously injured site. This will give a false result which will affect the outcomes of the research. Also any patient with a history of lung TB should be avoided, a person who had lung TB has a high risk of developing bone TB too, thus the fracture occurring in these patients could be a result of bone TB rather than osteoporosis. The dependent variables in the experiment are the levels of vitamin D in the serum. Independent variable being the number of fractures that the patient may have to suffer from. All these 1500 women won’t be given vitamin D supplementation. Randomly selected 800 of them will receive vitamin D supplements daily, they will be the treatment group. 300 women will receive nothing, and will be called as the control group. The rest 400 will receive placebos, and would be known as the placebo group. Correct selection of patients, bias free attitude and proper examinations will be required. Measuring the bone mineral density, and 25- hydroxyvitamin D levels in the body before and after administering vitamin D supplements and the resultant difference in the values thus obtained will make the data more reliable and valid. All these women will be examined in a timely manner, they will have to undergo all the tests repeatedly that they underwent during the initiation of the research. These data will be studied, observations regarding incidences of falls and fractures will be noted down, difference in the bone mineral density will be recorded, serum calcium levels will be monitored to determine the mineral losses from the bones. There is no limitation as such, except if the patients being in such a vulnerable age group tend to ignore the daily dose of vitamin D supplements due to any cause like emotional reasons, familial tension etc. This may interfere with the results of the experiment and the outcome may be affected badly. The elderly women will be required to be encouraged constantly about taking the supplementations in a timely manner. The selected age group is an age group which is emotionally vulnerable. Great care needs to be taken while dealing with them. IRB approval will not be required for this research work as it is limited to normal regular checkups and certain investigations only. The administered drug is only a supplementation of Vitamin D, which is also prescribed by the physicians and available as an Over the counter drug too. The expected results will be a significant reduction in the number of falls and simultaneous increase in the 25-hydroxyvitamin D levels in the blood.
References
Holick, Michael F. et al. 'Prevalence Of Vitamin D Inadequacy Among Postmenopausal North American Women Receiving Osteoporosis Therapy'. The Journal of Clinical Endocrinology & Metabolism 90.6 (2005): 3215-3224. Web. 19 Apr. 2015.
Janssen, Hennie CJP, Monique M Samson, and Harald JJ Verhaar. 'Vitamin D Deficiency, Muscle Function, And Falls In Elderly People1,2'. The American Journal of Clinical Nutrition 75.4 (2002): 611-615. Web. 19 Apr. 2015.
LIPS, P. et al. 'The Prevalence Of Vitamin D Inadequacy Amongst Women With Osteoporosis: An International Epidemiological Investigation'. J Intern Med 260.3 (2006): 245-254. Web. 20 Apr. 2015.
Medline Plus,. 'Vitamin D: Medlineplus Medical Encyclopedia'. N.p., 2015. Web. 19 Apr. 2015.
Sanders, Kerrie M. et al. 'Annual High-Dose Oral Vitamin D And Falls And Fractures In Older Women'. JAMA 303.18 (2010): 1815. Web. 19 Apr. 2015.
Tang, Benjamin MP et al. 'Use Of Calcium Or Calcium In Combination With Vitamin D Supplementation To Prevent Fractures And Bone Loss In People Aged 50 Years And Older: A Meta-Analysis'. The Lancet 370.9588 (2007): 657-666. Web. 19 Apr. 2015.
