Parathyroid hormone and ionised calcium should be measured as an adjunct to 25-hydroxyvitamin D. Virtually all commercial assays now measure 25-hydroxyvitamin D 2 as well as 25-hydroxyvitamin D 3. This assay should also be used to monitor therapy. severe vitamin D deficiency While there is debate as to ideal concentrations, the following could be used to guide a clinical approach: Vitamin D deficiency can be detected using the 25-hydroxyvitamin D radioimmunoassay. 2 Also, virtually all of the currently approved osteoporosis treatments have been evaluated in the presence of adequate vitamin D concentrations so these should be achieved as part of the approach to osteoporosis treatment. While there is debate about the benefit of vitamin D supplementation in preventing osteoporotic fractures, there is evidence that it may reduce falls risk. It is often seen in older people with osteoporosis.
Vitamin D deficiency is usually asymptomatic, but signs and symptoms can include muscle aches and particularly weakness (proximal limb girdle). 5 On the other hand, people with darker skin can require 3–4 times more sun to achieve the same vitamin D synthesis. People who are at the highest risk of skin cancers, such as those who are immunosuppressed, should take even more stringent precautions in the sun. Important caveats include some knowledge by the public of the ultraviolet index * – concentrations above 3 require sun protection. Many factors need to be considered including geographical location such as latitude, season, time of day, skin colour, age and particularly clothing.ĭermatologists have expressed concern about relaxation of sun protection messages, which have played a large role in the media campaigns to reduce the incidence of skin cancers. Guidelines on exposure to sunshine need to be tailored to the individual − one size does not fit all. 1 Certainly, avoidance of the most dangerous ultraviolet exposure in the middle of the day is appropriate, especially in summer, with responsible use of ultraviolet blocking agents. Recommended exposure of 5–15 minutes of sunlight 4–6 times a week outside the hours of 10 am–2 pm seems prudent ( Table 1 ).
It is a subject where there has often been a lack of consensus among medical specialists themselves and this problem is further compounded in transferring this message to the public. Much controversy has surrounded the topic of how much sunshine is enough and how much is too much.
Guidelines on sun exposure must be tempered by the high prevalence of skin cancers in this country.
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