A lack of Vitamin D can be due to many factors including limitation of sun exposure, hormonal issues or even the process of ageing. Without sufficient Vitamin D, the ability of calcium to be adequately metabolised and absorbed can be compromised.
Rickets and osteomalacia are worldwide skeletal diseases, however, in developed countries they are rarely as result of dietary deficiency. The research shows that these conditions are a result in some derangement of vitamin D absorption or metabolism, or in calcium or phosphorus homeostasis.
Almost all healthcare providers know the importance of testing their patients’ vitamin D levels. When vitamin D levels are low, supplementation is recommended or the dosage is often increased. More and more we see how research demonstrates intricate interrelationships with other nutrients. In regards to vitamin D, it is important to maintain optimal levels of this vitamin, as well as all the fat soluble vitamins, but one cannot forget about magnesium.
According to a review published this month in The Journal of the American Osteopathic Association, researchers identified that vitamin D cannot be metabolised without sufficient magnesium levels. Interestingly, magnesium is one of the most common nutrients deficiencies, similar to vitamin D. If an individual is deficient in magnesium, vitamin D will remain stored and inactive.
Vitamin D facilitates calcium absorption in the small intestine by stimulating the synthesis of calcium binding proteins, as well as being involved in bone turnover. Vitamin D deficiency is common, and a myriad of newly identified downstream effects have been elucidated as the importance of this nutrient has come to the forefront in functional medicine. Contributing factors to vitamin D insufficiency include avoidance of sun exposure, use of medications which bind fat and/or reduce cholesterol synthesis and absorption (anticonvulsants, steroid drugs, laxatives, bile acid sequestrants), and women with low hormone levels, as estrogen and progesterone deficiencies impair formation of the active form of vitamin D.
Vitamin D status declines with age, due to reduced dietary intake, diminished absorption from food, and decreased capacity of the liver and kidneys to hydroxylate and activate vitamin D. Additionally, aging skin has a reduced capacity for vitamin D synthesis via ultraviolet light exposure. A substantial proportion of patients with hip fractures present with osteomalacia, due to vitamin D deficiency.3 Vitamin D deficiency may also be associated with reduced muscular function, which may increase risk for falling and injury in older populations.4 Age is not the only factor that may increase need for bone-supporting nutrients. Younger women experiencing the “female athlete triad” may benefit from a bone-building formula, due to insufficient caloric intake, reduced estrogen levels and increased wear-and-tear on the bones.