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Vitamin D
Vitamin D deficiency is common among community-dwelling elderly, among institutionalised elderly, and patients with hip fractures.
Vitamin D deficiency is an established risk factor for osteoporosis, falls and fractures.
Clinical trials have demonstrated that 800 IU per day of Vitamin D supplementation alongside adequate calcium intake reduces the risk of falls and fractures. Supplementation with Vitamin D, commonly as a combination tablet with calcium, is associated with a reduced rate of falling for housebound older people.
Calcium supplementation is only required in diets that are deficient in calcium.
The University of Edinburgh’s calcium calculator is a useful tool in helping patients/clinicians to calculate whether a diet has sufficient calcium intake:
- Vitamin D helps the absorption of calcium from foods. Most of our vitamin D is made by the action of sunlight on the skin.
- Sun exposure is the main source of vitamin D, but excessive sun exposure is the main cause of skin cancer, including melanoma, the fastest rising type of cancer in the UK. Enjoying the sun safely, while taking care not to burn, can help to provide the benefits of vitamin D without unduly raising the risk of skin cancer. It is impractical to offer a ‘one-size-fits-all’ recommendation for the amount of sun exposure that people need to make sufficient vitamin D, as this varies according to a number of environmental, physical and personal factors. The time required to make sufficient vitamin D is typically short and less than the amount of time needed for skin to redden and burn. Regularly going outside for a matter of minutes around the middle of the day without sunscreen should be enough. When it comes to sun exposure, little and often is best, and the more skin that is exposed, the greater the chance of making sufficient vitamin D before burning. However, people should get to know their own skin to understand how long they can spend outside before risking sunburn under different conditions.
- All adults and children over the age of one should consider taking a daily supplement containing 10µg vitamin D, especially during autumn and winter.
- A daily supplement is recommended all year round for those who are at risk of low vitamin D including: all pregnant and breastfeeding women, babies and young children, people aged 65 years and over and people with darker skin or who are not exposed to much sun.
- Foods rich in vitamin D include oily fish, eggs and fortified breakfast cereals/spreads but you cannot get enough vitamin D from food alone. You may need to take a supplement if you do not get enough (safe) sun exposure or if you are over 65 years old.
Bone Health
The Institute of medicine suggested that “most people with a serum 25OHD between 30 and 50 nmol/L have adequate calciumabsorption.”
National Osteoporosis Society – Full Guidelines Vitamin D & Bone Health
Department of Health Guidance (Taken from the full guidance referenced 1)
Adult groups at risk of vitamin D deficiency:
- Older people, aged 65 years and over
- People who have low or no exposure to the sun, for example those who cover their skin for cultural reasons, who are housebound or who are confined indoors for long periods
- People who have darker skin, for example people of African, African-Caribbean or South Asian origin, because their bodies are not able to make as much vitamin D.
Recommendations:
- People aged 65 years and over and people who are not exposed to much sun should also take a daily supplement containing 10 μg (400 IU) of vitamin D.
- Vitamin D should be purchased over the counter unless specific prescribing criteria are met.
- Primary Care Vitamin D Prescribing Guidance (gloshospitals.nhs.uk)
- NHS Gloucestershire detailed and basic PIL’s for Vitamin D can be found here:
- Detailed: English-Vitamin-D-detailed-leaflet.pdf (nhsglos.nhs.uk)
- Easy read: https://www.nhsglos.nhs.uk/wp-content/uploads/2024/02/English-Vitamin-D-Leaflet-easy-read.pdf
- British Dietetic Association Food Facts https://www.bda.uk.com/foodfacts/calcium
Nutrition for bones
Eating and drinking the right things can help support your bone health at every stage of your life.
Calcium and vitamin D are two well-known nutrients to be important for bones. But there are many other vitamins, minerals and nutrients that are vital to help your bones stay healthy and strong.
Try not to become too concerned with getting all these in your diet. If you enjoy a healthy, balanced diet, you’re getting everything you need.
A healthy, balanced diet
This is all about eating meals that have foods from the four main food groups:
- Fruit and vegetables
- Carbohydrates, like bread, potatoes, pasta and cereals
- Dairy and alternatives
- Proteins, like beans, eggs, fish and meat
For more information about these food groups and how much of each you need, we recommend you take a look at The Eatwell Guide, developed by the NHS.