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Vitamin D question
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mountainmom48 posted:
Hello, I am newly dx'd with osteopenia. I've upped my calcium, vit D. I have a question about getting vit D naturally via sunshine. Recently I read an article which stated we get 20,000 iu of vit D in just 15 minutes of no-sunscreen sun exposure. I use sunscreen. My question is, does sunscreen prevent vit D absorption or production or however it is we get the vitamin? Do we get enough through skin no covered with sunscreen such as my head or body covered in clothing? I only use sunscreen on exposed skin and do not wear clothing with SPF.

I was going to post this on the skin community page, but it doesn't seem to have an expert weighing in and is mostly about rashes. Hoping this community can help.

Thanks!
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bonebabe responded:
Hi.

Several things. First, osteopenia is not a diagnosis. It is a condition or symptom. Osteoporosis is a diagnosed illness. A very important distinction is you're getting life insurance or giving a medical history.

Now about the Vitamin D. Yes, it is called the sunshine vitamin because our bodies make it from the sun. Not everybody gets the same amount every day. In fact, if you live above an imaginary line between Columbia, SC and Los Angeles, you won't get enough from the sun and will need to supplement. People who live nearer the equator can get plenty from the sun, provided they do not wear sunscreen over every part of their body that is exposed. The sunscreen does block the vit D.

Unfortunately, too, after age 50 or so, our bodies begin to slow down the process by which they make Vit D and it becomes necessary to supplement.

Your best bet for Vit D if you are over 50, wear sunscreen and live in a "northern" climate, is to take a calcium supplement with D. You need 1200 mg of calcium/day and roughly 1000 IU Vit D/day.
 
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mountainmom48 replied to bonebabe's response:
Thanks on the tip regarding response on insurance applications. I understand osteopenia for the most part, but wondered specifically if sunscreen completely blocks it, which apparently it does. I'm in a southern climate so I do get outdoors. I also supplement with 1800mg of calcium and 2000iu of vit D.

Does our body, and if so, how long does our body store vit D absorbed from sunshine? Just wondering if anything we get from sun lasts through the winter at all? I guess not since it is necessary to supplement.

My osteopenia is likely a symptom of hashimoto hypothyroidism, so I wonder if as it (hypo) progresses, will that speed osteopenia?

Can you address BCP or other HRT as a treatment? I am near menopause, just have about two periods per year the past couple of years. I will be going to my gyn soon to discuss this. Additionally, I may not be as near to menopause as it seems because irregular periods is also a symptom of hashi. I'm wondering if even a couple of years on estrogen might be a good idea.

If it matters in how you formulate a reply, I am 48, always had very regular periods until the past two years. I only took BCP for about four years in my early 20s. I've had four pregancies and breastfed my kids for a total of four years. I'm a slim framed, caucasion woman. Never smoked. Need to exercise more regularly, but am busy, active. No family history of osteoporosis.

Thank you very much. Your input here is quite valuable.
 
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bonebabe replied to mountainmom48's response:
Vit D is a fat soluble vitamin and is stored primarily in the liver. It is released as the body needs it. It will stay in the body a few months unless the need is great, i.e., if you have a condition that requires Vit D and you're deficient.

At age 48 with sporadic periods you are likely perimenopausal. This is the 5 year period leading into and through menopause. You can lose up to 20% of your bone density during this time. If your bone density is already low, it would be wise to talk with your doctor about steps you can take to keep it from decreasing even more.

Birth control pills, or any estrogen for that matter, protect the bones. Estrogen replacement is not for everybody ( I personally use it) and should be considered with your physician's input.

Breastfeeding quickly depletes the body of calcium. If you were not supplementing during those years, that could be one reason you're seeing low bone density now.

You do not need 1800 mg of calcium a day. You only need 1200mg in diet and supplementation. In fact, because the body only absorbs 500-600 mg at a time, truly getting 1800 mg into the body is quite a task.

Even though you live in a southern climate, your use of sunscreen does block your Vit D absorption. You're also getting to an age where the body won't process the sunlight into Vit D as it did during your bone forming years. You are right to take a supplement, but I think 2000 IU is excessive.

When you go to the doctor, ask about having a Vit D level check. It's a simple lab draw. Anything below 30 is looked at as below optimum. Your doctor can then advise you as to what you should be doing.
 
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mountainmom48 replied to bonebabe's response:
Thank you again. For now, the calcium and vit D levels are at the dose recommended by my internist. I just started this about three weeks ago. I take supplements three times a day in addition to milk, yogurt and cheese every day. I have had labs that show low levels. I have the report, but not in front of me at this moment. I will get that and add it to this thread. I have lab work every three months right now as we adjust the the thyroid med. I did not take any supplements during breastfeeding years, dang, wish I had known! How often do you have your vit D level checked? How quickly can one get levels back up to optimum level?

As far as estrogen, I have an appointment with my gyn in about three weeks to get her input. I'll have some blood work to see where I am in the peri/meno-pausal stage. I know it isn't as accurate if one is peri, but we'll see. For now, I have mammograms every six months because my breast tissue shows some changes. I've had a biopsy recently showing nothing remarkable thankfully. I don't have a family history at all for breast cancer, but still. I guess we'll have to weigh that out: raise risk for breast cancer slightly or take measures that slows bone loss. Thoughts?

Thank you so much, oh wise one!
 
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bonebabe replied to mountainmom48's response:
Glad I can help you sort through this.

Estrogen might not be the best choice for you with any type of breast issues. Evista would be something to consider. It's a synthetic hormone that helps the bones but has no effect on the breast tissue.

If your D levels are low, usually the doctor will give you a booster shot of 50,000 IU of Vitamin D, then you continue with a daily supplement. Your D levels can be checked at your annual exam unless there's reason to suspect something is amiss.

It sounds to me like you're getting plenty of calcium and may not even need a supplement. Go to www.nof.org and print out their calcium handout so that you can track how much you're actually getting from foods on a daily basis. Remember too that if you see a % on a food label, for instance 30% daily requirement of calcium, to remove the % and add a 0 for the amount of calcium. 30% would = 300 mg. Take into consideration that the max your body can use at one time is 600mg and go from there to see how much you're getting.

Since you have children, bear in mind that during their bone forming years, they need plenty of sunshine, exercise and calcium too. Used to be we reached our peak bone mass at about age 35, now it's around age 21!
 
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mountainmom48 replied to bonebabe's response:
I wrote down Evista and will discuss with my doc.

I'd love to have had a shot of vit D and then maintenance. I think I will recheck levels at six months then annually if my doctor agrees to this.

I perused the site you suggested. Awesome link! I understand the limit on what the body absorbs. I pretty much eat or take calcium/vit D about every three hours all day long.

Thank you for the reminder regarding my kids. One of my kids is outside all day long. He is an avid cyclist, hiker, hunter, and more. Two need to boost their weight bearing activities and sun exposure. One of my kids has a disability and has since childhood, had osteopenia. She is on a low dose of estrogen (BCP) and supplements in addition to appropriate foods. Its been awhile since DEXA and never had labs, so I am going to revisit this. I appreciate the prodding.

I can't believe peak bone mass is reached so young! Why is that? Thirty five to 21 is a drastic reduction in time!

Thank you again, I just can't say that enough. Your input is invaluable.
 
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bonebabe replied to mountainmom48's response:
You're quite welcome. I wish all our patients were as invested in their and their kids' bone health.

The reason the peak bone mass age has been lowered is because of environmental and lifestyle changes. Kids are smoking at a young age, they are indoors with computers and video gaming, they are getting soft drinks in school instead of milk and their PE requirements are less than they were a generation ago. Also girls are more focused on being skinny and anorexia/bulimia is not unheard of anymore. We're seeing the results of this show up as stress fractures and low bone density when they have a DXA because of the fracture.

Pass the word to all you know who have children under age 21.
 
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mountainmom48 replied to bonebabe's response:
THANKS!
 
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An_251897 responded:
The answer to your question is that sunscreen does appear to inhibit the absorption of vitamin D3. There is a really good article detailing the research and clinical trials at the Vitamin D3 Blog: http://vitamind3blog.com/2011/01/vitamin-d3-deficiency-linked-to-sunscreen/


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