Vitamin D is a fat-soluble hormone that is synthesized in your body when sunlight interacts with your skin. It is one of the most common deficient nutrients.
It serves as the key to unlock the gut, and calcium gets into your bloodstream. If you don’t have enough of this hormone, your bones are unable to absorb the calcium that they require to maintain their density and strength. If you live in a sunny state such as Texas, you may still be in danger. Millions of people spend their days indoors and may suffer from a hidden epidemic of low vitamin D and bone loss.
Vitamin D deficiency can cause a number of problems, including rickets in children and osteoporosis in adults. Secondary hyperparathyroidism, increased bone turnover, bone loss, and defects in mineralization may result from vitamin D deficiency and can cause fractures.
The only way to defend yourself is to understand exactly how this nutrient works and what you can do to prevent bone loss and save yourself from a fracture.
How Vitamin D Builds and Protects Your Bones
Your skeleton is also living tissue, continuously replacing old, damaged bone with new, strong bone. This process is based on the delicate balance between two types of cells: osteoclasts (which break down old bone) and osteoblasts (which lay down new bone).
Here is how Vitamin D protection works in this system:
- It enhances the absorption: Calcium from food does not get absorbed into the blood without Vitamin D. Vitamin D allows the small intestine to absorb calcium by up to 30-40%.
- It regulates mineralization: Once calcium and phosphorus are in the blood, vitamin D ensures they are deposited directly into the bone matrix, rather than building up in your arteries or kidneys.
- It promotes muscle strength and balance: This is a very underrated advantage. Your skeletal muscles have receptors to which vitamin D binds. It is the fast-twitch muscle fibers that catch you if you trip. Vitamin D directly helps to keep muscles strong and helps to prevent falls, which are the leading cause of fractures.
When you have a vitamin D deficiency, this entire system fails. This means that the osteoblasts are unable to keep up with the rate of bone destruction by the osteoclasts, causing direct bone loss.
What Do Your Numbers Actually Mean?
The best way to measure your vitamin D levels is through a blood test called 25-hydroxyvitamin D (25-OH vitamin D). But it is in the interpretation of the results that most individuals go wrong with standard medicine.
Deficient (Below 12 ng/mL): Vitamin D deficiency is defined as having a level below 12 ng/mL. A 25-hydroxyvitamin D blood level of 12 to 30 ng/mL is considered “insufficiency. At this stage, there is a high risk of secondary hyperparathyroidism, bone loss, osteomalacia, muscle weakness, and fractures. The need for supplementation is urgent and necessary at this stage.
Insufficiency (<20 ng/mL): This means that your body is in crisis. It is not getting enough calcium from your foods, and is actively removing it from your bones. At this point, vitamin D deficiency bone loss is occurring at a quick pace, and you are at a high risk of fractures.
Low normal (20 to 29 ng/mL): In this range, many people are considered sufficient according to the most conservative assessment. However, according to functional medicine and many endocrinologists, higher levels are needed for optimum skeletal and muscular health. Do not consider this level to be the best. Insufficient means that your bones are receiving enough calcium to sustain your life, but not enough to promote the maintenance of bone density. It’s a quiet loss of bone that happens over time.
Optimal (40-60 ng/mL): This is the functional medicine target range. This is where your body is getting an adequate amount of the hormone to develop new bone, fight off infections, and properly absorb everything you consume.
If you have never had 25-OH vitamin D testing, or if it was over 12 months ago and your situation has changed, the only way to know your actual level is to get a test.
How Men and Women Experience This Differently
Hormones play a significant role in both males and females, with the major difference being how their bodies react to bone loss.
For Women
The risk is much greater and occurs much more quickly. During perimenopause and menopause, when women reach their 40s and 50s, the production of estrogen suddenly decreases. Estrogen naturally protects bones by slowing down the osteoclasts (the cells that dissolve bone).
As estrogen decreases, the breakdown of bone increases rapidly. If a woman also suffers from a vitamin D deficiency during this exact time, the damage is doubled. That’s why women are four times more likely to develop osteoporosis than men are.
Vitamin D supplementation is warranted in women at midlife with levels less than 20 ng/mL. For perimenopausal women or other groups of people with higher fracture risk, a level of at least 30 ng/mL is warranted.
Additionally, post menopausal women need more calcium and Vitamin D than before. Women between the ages of 51 and 70 require at least 1200mg of calcium a day and 600–800IU of vitamin D. Many functional health recommendations, however, call for 1,500 – 2,000 IU of vitamin D3 per day, depending on blood levels.
Women who have celiac disease, inflammatory bowel disease, or have had gastric bypass surgery are at especially high risk for vitamin D deficiency.
For Men
Men do not experience the sudden hormonal changes that women do. They are losing bone at a slower, more consistent rate. Testosterone actually converts into a form of estrogen in men’s bones, which offers continuous protection.
Vitamin D should be tested and a bone density evaluation should be considered in men who: have a history of fracture from minor trauma, have low physical activity, use proton pump inhibitors or corticosteroids for long periods, have chronic kidney or liver disease, smoke, drink high amounts of alcohol, have low testosterone levels, or are older than 50 years.
The minimum vitamin D requirement for adults is 600–800 IU per day, and 800-1000 IU per day after age 70. But these are not optimal requirements. Men with a deficiency must take 2,000–5,000 IU daily under medical supervision to restore and maintain healthy levels.
Foods, Sunshine, and Why They Are Not Enough
To prevent vitamin D deficiency, you need a multi-step approach.
- Sunlight: Living in Texas has its advantages, but it’s not a sure bet. Vitamin D only forms in your body when the sun is high. If you are outside early in the morning or late in the afternoon, or if you are wearing sunscreen, you are not making enough. Exposing yourself several times a week, 10 to 15 minutes with bare arms and legs in the middle of the day is best.
- Food: This hormone is found in very few foods naturally. You can get it from fatty fish like salmon, mackerel, and sardines, as well as egg yolks and cheese. You will also find it in fortified milk and orange juice.. But one has to consume gallons of milk daily to get to optimal levels. If you have a severe deficiency, this cannot be corrected with food alone.
- Vitamin D3 Supplementation: If you are not getting benefits from your food and sunlight exposure, you must take a good Vitamin D3 supplement. This helps resolve the issue and prevent further bone loss from Vitamin D deficiency.
Who Is at Highest Risk for Vitamin D Deficiency and Bone Loss?
The following group of people is at higher risk of vitamin D deficiency nd bone loss:
- Older adults. The skin’s ability to produce vitamin D through exposure to sunlight can drop by up to 75% after the age of 20. At the same time, the kidneys lose their capacity to activate vitamin D to its hormonal form.
- Dark-skinned individuals. Melanin is the pigment that imparts color to the skin and decreases the amount of UVB radiation that penetrates the skin, which lowers vitamin D levels. The amount of vitamin D needed is 3-5 times greater in a dark-skinned individual than in a lighter skin type.
- Those who spend much of their time indoors. This is the typical situation for most people working today, in all climates.
- People with obesity. Even though dietary and supplemental vitamin D is adequate, higher body weight is associated with lower serum vitamin D. Obesity patients may need much higher supplemental doses to obtain and maintain adequate blood levels.
- People with malabsorption conditions. Celiac disease, Crohn’s disease, ulcerative colitis, chronic pancreatitis, and post-bariatric surgery can all affect the gut’s ability to absorb fat-soluble vitamins.
Steps to Protect Your Skeleton Today
Do not wait for a fracture to take your skeletal health seriously. This is exactly what you need to do:
- Get the Right Test: First, request a blood test to check your 25-OH vitamin D level from your provider. The blood test is easy to get, and if performed during an annual wellness exam or when someone has a medical condition that makes it important, most insurance companies cover it.
- Take Vitamin D3 with Vitamin K2: If you are taking a Vitamin D supplement, it has to be combined with Vitamin K2 and Magnesium. Vitamin D increases the amount of calcium in your blood. Vitamin K2 serves as the traffic cop and ensures the calcium goes directly to your bones, but not to your arteries. Magnesium is required to actually convert the supplement into its active form in your bloodstream.
- Strengthen bones through Resistance Training. Walking is also good exercise for the heart, but doesn’t have a significant effect on bone density. Weight-bearing exercises are required. When you work out using weights, resistance bands, or body weight squats and lunges, your bones are under mechanical stress, and your osteoblasts respond by creating thicker, stronger bone.
- Eat a Mineral-Rich Diet: Give your body the raw materials it needs. Consume foods rich in calcium and magnesium, such as leafy greens (kale, spinach), high-quality protein foods, and foods high in omega-3 fatty acids to decrease systemic inflammation, which can injure joints and bones.
Add magnesium. Magnesium is needed to activate vitamin D. Vitamin D is less effective when people do not have enough magnesium in their diet. The high doses of vitamin D can actually lead to more magnesium depletion. Get 300-400 mg per day of magnesium from food and supplements. Good food sources include leafy greens, nuts, seeds, legumes, and dark chocolate.
Bottom Line
Vitamin D deficiency bone loss is one of the most preventable causes of fractures and disability, and loss of independence in older people. It is one of the most missed in routine care. It can be present for years without causing symptoms until it becomes apparent as a hip fracture or as a catastrophic DEXA scan.
At Kairos Integrative Care, Lola, one of our integrative health practitioners, will look at your advanced lab work, like your 25-hydroxy vitamin D test, and create a personalized, easy-to-follow plan to rebuild your bone density.
We see patients in Houston, Sugar Land, and nearby areas (77046 and 77478) and accept most major insurance plans, including Aetna, Cigna, BCBS, UnitedHealthcare, Tricare, and more.
Book your appointment today!
