by Melanie Reid
Doctors say that food fortified with vitamin D should be on sale in Scotland to help prevent the thousands of crippling hip injuries every year.
Studies carried out in Glasgow show that 98 per cent of people with hip fractures suffer from a serious shortage of the vitamin, which is vital for allowing calcium to strengthen the bones. Most people meet their vitamin D needs through exposure to sunlight, but it is also found in oily fish such as salmon and tuna, and egg yolks.
Stephen Gallacher, a consultant physician who is head of South Glasgow’s fracture liaison service, said yesterday that levels of the vitamin in Scotland were “frighteningly low”.
“Vitamin D seems to play a key role in many systems in the body, not just bones, but diseases like diabetes and certain cancers,” he said. “A serious shortage of vitamin D leads to a condition called osteomalacia, where your bone fails to mineralise.”
Vitamin D deficiency, he added, was linked to poor bone density and osteoporosis, and could occur in younger patients. Dr Gallacher said that among the hip fracture patients aged between 50 and 70 referred to him, most tended already to have very low bone density.
As people get older, their bodies become less adept at converting vitamin D from sunshine through their skin. To add to the problem, the diet in Scotland is traditionally low in vitamin D.
Dr Gallacher said: “In the United States, milk which is fortified with vitamin D can be purchased alongside ordinary milk and I think there’s an argument that it would be quite useful to do the same here. It makes logical sense to give people the choice.”
He welcomed the Scottish government’s recent move to raise awareness among pregnant women and young mothers about the importance of vitamin D.
Scotland now leads the world in following up cases of broken bones to trace their underlying cause and try to prevent further breaks. A fracture liaison service was pioneered in Glasgow in 1999. Now accessible to three quarters of the population of Scotland, the service means that anyone over 50 who suffers a fracture is automatically referred to have their bone density measured and, if low, their vitamin D level taken.
Those who have poor density, and are at risk of osteoporosis and further fractures, are treated with calcium and vitamin D supplements and other anti-osteoporosis therapies.
“We would like to have Scotland as the first country in the world with a comprehensive fracture liaison service,” said Dr Gallacher. “We’re 75 per cent of the way there and just need the financial investment to complete the loop. It would make Scotland a beacon for the rest of the world.”
Over ten years the service has proved cost-effective by averting further fractures through treatment. “Taking a supplement can make a difference quite quickly,” said Dr Gallacher. “Bone density can increase by 20 per cent in a few months with enough vitamin D,” he said.
“We have found we can reduce fractures by something like 30 to 50 per cent. It is our belief that we can significantly reduce the risk of fractures in the population by giving people anti-osteoporosis therapy and vitamin D supplements.”
Dr Gallacher’s research in Glasgow found near universal vitamin D inadequacy among more than 500 elderly patients with broken hips. The report also pointed out that in Iceland, where there is intensive dietary and lifestyle education, there is a much lower incidence of hip fractures.
The study would seem to demonstrate that “ vitamin D inadequacy represents a significant correctable risk factor for fragility fracture in our elderly population, and that the observed prevalence of inadequacy is substantially higher than in many other parts of the world”.
The current spate of bad weather has brought more cases to light. Dr Gallacher, who is based at the Southern General Hospital, said: “Falls are bad news, particularly for elderly patients.”
“Clearly the most serious of all is the hip fracture. Some elderly people will lose their independence as a result of hip fracture, and some, sadly, will not survive. A significant proportion of people with less serious fractures would also end up in hospital. “An old person who breaks her wrist may not be able to go home and look after herself and my end up in in-patients for a number of days.”.
He said his workload would increase over the next six weeks as people who had fractured bones in recent falls were referred to the fracture liaison service.
