Vitamin D Prevents Hip Fracture and Breast Cancer
by Jeffrey Dach MD
Hip Fractures Prevented
In a recent medical study by Cauley in the August 2008 Annals of Internal Medicine, low Vitamin D was found to be associated with increased rate of hip fracture.
Left Image Hip Fracture Courtesy of Wikimedia
The study measured vitamin D levels in 400 patients with incident hip fracture and 400 post - menopausal women followed over 7 years.
Not only did the fracture group have an average lower vitamin D level, a lower vitamin D level was associated with 70% increased fracture risk.
Dr. Cauley and her co-authors reported potential conflicts of interest with Novartis, Eli Lilly, Merck, Roche Diagnostics, Johnson & Johnson, Procter & Gamble, Amgen, GlaxoSmithKline, Zelos, sanofi-aventis, General Electric, Pfizer, MicroMRI, and Abbott.
Breast Cancer Prevented
Another recent study by Dr. Nancy Davidson from Johns Hopkins University presented at a medical meeting and not yet published showed that low vitamin D levels was associated with increased rate of breast cancer recurrence after surgical treatment.
Left Image Surgical procedure 1922 courtesy of wikimedia
Low Vitamin D Associated with Increased Mortality
A recent study by Melamed published in the August Archives of Internal Medicine showed that low vitamin D (below 17.8 ng/nl) was associated with a 26% increase in mortality from any cause.
These are only three of the many medical studies showing the importance of vitamin in preventing many diseases. Low vitamin D is associated with increased risk for multiple sclerosis, cancer, hypertension, diabetes, and heart disease.
Excellent 2008 Review Article
For an excellent 2008 review article, see Diagnosis and Treatment of Vitamin D Deficiency, by JJ Cannell, BW Hollis, M Zasloff & RP Heaney. Expert Opin. Pharmacother. (2008) 9(1):1-12
See my previous article on the topic: Vitamin D Deficiency by Jeffrey Dach MD
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Links and References
http://www.annals.org/cgi/content/abstract/149/4/242
Serum 25-Hydroxyvitamin D Concentrations and Risk for Hip Fractures
Jane A. Cauley, DrPH; Andrea Z. LaCroix, PhD; LieLing Wu, MS; Mara Horwitz, MD; Michelle E. Danielson, PhD; Doug C. Bauer, MD; Jennifer S. Lee, MD; Rebecca D. Jackson, MD; John A. Robbins, MD; Chunyuan Wu, MS; Frank Z. Stanczyk, PhD; Meryl S. LeBoff, MD; Jean Wactawski-Wende, PhD; Gloria Sarto, MD; Judith Ockene, PhD; and Steven R. Cummings, MD
Annals Internal Medicine 19 August 2008 | Volume 149 Issue 4 | Pages 242-250
Background: The relationship between serum 25-hydroxyvitamin D [25(OH) vitamin D] concentration and hip fractures is unclear.
Objective: To see whether low serum 25(OH) vitamin D concentrations are associated with hip fractures in community-dwelling women.
Design: Nested case–control study.
Setting: 40 clinical centers in the United States.
Participants: 400 case-patients with incident hip fracture and 400 control participants matched on the basis of age, race or ethnicity, and date of blood draw. Both groups were selected from 39 795 postmenopausal women who were not using estrogens or other bone-active therapies and who had not had a previous hip fracture.
Measurements: Serum 25(OH) vitamin D was measured and patients were followed for a median of 7.1 years (range, 0.7 to 9.3 years) to assess fractures.
Results: Mean serum 25(OH) vitamin D concentrations were lower in case-patients than in control participants (55.95 nmol/L [SD, 20.28] vs. 59.60 nmol/L [SD, 18.05]; P = 0.007), and lower serum 25(OH) vitamin D concentrations increased hip fracture risk (adjusted odds ratio for each 25-nmol/L decrease, 1.33 [95% CI, 1.06 to 1.68]).
Women with the lowest 25(OH) vitamin D concentrations (47.5 nmol/L) had a higher fracture risk than did those with the highest concentrations (70.7 nmol/L) (adjusted odds ratio, 1.71 [CI, 1.05 to 2.79]), and the risk increased statistically significantly across quartiles of serum 25(OH) vitamin D concentration (P for trend = 0.016). This association was independent of number of falls, physical function, frailty, renal function, and sex-steroid hormone levels and seemed to be partially mediated by bone resorption.
Conclusion: Low serum 25(OH) vitamin D concentrations are associated with a higher risk for hip fracture.
http://www.washingtonpost.com/wp-dyn/content/article/2008/05/16/AR2008051601472.html
Low Levels of Vitamin D Spell Trouble for Breast Cancer Patients
http://www.usatoday.com/news/health/2008-05-15-vitaminD-cancer_N.htm?csp=34
Low Vitamin D linked to breast cancer
http://www.msnbc.msn.com/id/24654464/
Vitamin D may benefit breast cancer patients
Those with lower levels more likely to die of the disease, study found
Only 24 percent of women in the study had sufficient blood levels of D at the time they were first diagnosed with breast cancer. Those who were deficient were nearly twice as likely to have their cancer recur or spread over the next 10 years, and 73 percent more likely to die of the disease.
Dr. Nancy Davidson, a Johns Hopkins University cancer specialist who is president of the oncology society, said those tests are growing in popularity, even in ordinary medical care.
http://archinte.ama-assn.org/cgi/content/short/168/15/1629
25-Hydroxyvitamin D Levels and the Risk of Mortality in the General Population
Michal L. Melamed, MD, MHS; Erin D. Michos, MD, MHS; Wendy Post, MD, MS; Brad Astor, PhD. Arch Intern Med. 2008;168(15):1629-1637
Results In cross-sectional multivariate analyses, increasing age, female sex, nonwhite race/ethnicity, diabetes, current smoking, and higher body mass index were all independently associated with higher odds of 25(OH)D deficiency (lowest quartile of 25(OH)D level, <17.8 ng/mL [to convert to nanomoles per liter, multiply by 2.496]), while greater physical activity, vitamin D supplementation, and nonwinter season were inversely associated. During a median 8.7 years of follow-up, there were 1806 deaths, including 777 from CVD. In multivariate models (adjusted for baseline demographics, season, and traditional and novel CVD risk factors), compared with the highest quartile, being in the lowest quartile (25[OH]D levels <17.8 ng/mL) was associated with a 26% increased rate of all-cause mortality (mortality rate ratio, 1.26; 95% CI, 1.08-1.46) and a population attributable risk of 3.1%. The adjusted models of CVD and cancer mortality revealed a higher risk, which was not statistically significant.
Conclusion The lowest quartile of 25(OH)D level (<17.8 ng/mL) is independently associated with all-cause mortality in the general population.
http://www.vitamindcouncil.org/PDFs/diagnosis-vitdd.pdf
Diagnosis and Treatment of Vitamin D Deficiency
JJ Cannell, BW Hollis, M Zasloff & RP Heaney. Expert Opin.
Pharmacother. (2008) 9(1):1-12
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Dear Jeff:
Another great newsletter. Here are some bits of a manuscript on vitamin D, that I sent to JAP&S (journal of the american college of physicians and surgeons)
— the breast cancer findings:
"Cancer Prevention
The National Cancer Institute study mentioned in the Introduction section was reported by most media in a manner that indicated that vitamin D as a supplement did not prevent cancer; therefore, this was how I, too, interpreted the news.
The actual title of the study report:
Prospective Study of Serum Vitamin D and Cancer Mortality in the United States
was missing a key word — 25-hydroxy, which is what was actually measured in serum by radioimmunoassay. A total of 16,818 participants in a national health survey had their sera assayed for 25-hydroxyvitamin D3 levels, then were followed for a median of 8.9 years to find 536 cancer deaths. Potential confounders were assessed and only age, sex, race/ethnicity and smoking were used to adjust the RR of several types of cancer at various levels, which were not quintiles, but arbitrary levels related to recommended intakes.
No intake levels were associated with cancer overall, p=0.65.
But the RR of colorectal cancer, set to 1.0 at <20 ng/mL, dropped to RR=0.44 at 20-<32 ng/mL, and to 0.28 at ≥32 ng/mL of 25-hydroxyvitamin D3, both significant.
For breast cancer, the RR was set to 1.0 at <25 ng/mL, and dropped to 0.28 at ≥25 ng/mL. This was dismissed because a linear trend was not found; but why was one expected, since the results for lung cancer were grossly non-linear? [24]
Appearing simultaneously, the first RCT claimed to be the first to provide sufficient supplemental vitamin D3 to raise 25-hydroxyvitamin D3 levels to >32 ng/mL as well as report a cancer outcome.
This was a double-blind, randomized, placebo-controlled trial on 1179 women aged >55 years from rural Nebraska, and followed for 4.3 years. Interventions were 1500 mg/d of calcium as the citrate or carbonate or the same plus 1100 IU/d of vitamin D3, the odd amount being determined by actual assay of each batch of supplement labeled as containing 1000 IU.
Leaving out the first-year results, for all non-skin cancer, 6.3% of the placebo group were so diagnosed; the calcium-only group, 3.8% (RR=0.60); and the Ca + D group, 1.6% (RR=0.25, p = <0.005).
For breast cancer with Ca + D, RR=0.57.
For colon cancer Ca + D, there were 2 in the placebo group and none in the treatment group.
The only other trial the authors were aware of with a cancer outcome achieved ≈200 IU/d of vitamin D because of poor compliance, under 1/5 the dose in this study. This was the Women’s Health Initiative Study mentioned above in the Osteoporosis section. For cancer outcome, Ca had half the benefit of Ca + D; but a D-only group would have been welcome. [25]
Sincerely, --Joel
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Thanks very much Joel. regards, jeffrey dach md
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