Bone and Mineral Metabolism Metabolic Bone Disease

Abstract

The prevalence of osteoporosis at any anatomic site in a random sample of postmenopausal women (n=150) in a semi-urban area by cluster sampling technique was found to be 50% and the prevalence of vitamin D insufficiency or deficiency to be 50%. On considering the number of women in this age group in India, the magnitude of the problem appears to be substantial. Simple interventions such as adequate calcium intake and vitamin D supplementation combined with mass education may significantly reduce morbidity and mortality associated with osteoporotic fractures in this population. In particular, we need to ensure that the calcium intake and vitamin D status are optimized before initiation of other therapeutic measures, such as bisphosphonates, for osteoporosis. Although sensible exposure to sunlight is a good means of generating vitamin D, high ambient temperatures in Vellore (gt40°C in summer) discourage this practice in India. Fortification with vitamin D of milk products or community level supplementation of vitamin D orally or parenterally may have to be considered as important preventive interventions. Buttermilk and lassi, which are good natural sources of calcium, are readily available, relatively inexpensive, and acceptable to large sections of the Indian society. They have the additional advantage of low fat content, which makes them more suitable for the elderly population in whom cardiovascular disease is a concern. They are better tolerated than milk, and it may be possible to fortify these products with vitamin D because these products are consumed as such, cooking-related losses would be minimal. Ideally, they should be promoted in the electronic media instead of unhealthy carbonated drinks, which are widely promoted currently. To summarize, the vitamin D deficiency has emerged as an important problem in ambulatory women who had attained menopause, postmenopausal women who had sustained hip fracture and in HIV infected men who were on HAART therapy. A significant proportion of them also had decreased BMD. newline