Exposure to more sunlight to ensure sufficient absorption of vitamin D, and providing information about the benefit of this little known vitamin will reduce the number of the osteoporosis patients in the future, doctors say.

Living in a sunny country like Thailand doesn't mean everyone gets enough nutrients from the sun. On the contrary, Thais tend to be at risk of vitamin D deficiency because of the value they place on having pale skins.

Yet just a couple of months of inadequate absorption weakens the bones and leads to osteoporosis, especially in older people.

An example of the link between vitamin D deficiency and bone disease can be found by looking at the iguana.

"These creatures live in the forest and like to spend time sunbathing. When people buy them as pets, within six months their skin goes pale and the bones start to fracture. They aren't able to walk properly and eventually die," explains Assoc Prof Sompongse Suwanwalaikorn, an endocrinologist at King Chulalongkorn Memorial Hospital.

Most of us associate calcium with keeping the bones healthy and strong. But on its own, this mineral is not enough. Vitamin D is just as important as the body needs it to absorb calcium.

A lack of vitamin D leads to too little calcium in the bones causing bone fragility, the major symptom of osteoporosis.

Osteoporosis is a disease in which the density and quality of bone are reduced, leading to weakness of the skeleton and increased risk of fracture, particularly of the spine, wrist, hip, pelvis and upper arm. Osteoporosis and associated fractures are an important cause of mortality and morbidity.

It is a major health problem in Thailand because most of the patients don't know if their bones are strong or not until they either break a hip, or find themselves suffering from severe backache.

"Ten per cent of osteoporosis patients are receiving treatment. The rest don't even know about the disease and are certainly not taking any preventive measures against it," says Sompongse, adding that almost half the population, especially those aged over 60, are likely to be diagnosed with osteoporosis.

A recent global study funded by international pharmaceutical company MSD showed that 47 per cent of Thai women with osteoporosis out of 100 studied cases lacked education about vitamin D.

"This demonstrates that we must do more to educate our patients about the critical role the vitamin plays in maintaining bone health. We also need to find better ways to ensure that women with osteoporosis receive adequate doses of vitamin D," says Sompongse, one of the Thai investigators who participated in the global study.

Vitamin D's major source is sunlight, which makes it affordable to all. Salmon, tuna and fatty fish are also good sources. But fatty foods can raise cholesterol levels and those with a potential problem should take care not to increase their intake of fat.

Thais should not be afraid of skin cancer from over-exposure to the sun.

According to Sompongse, when Thai people take in too many rays, their bodies create coloured melanin that may turn the skin darker but protects by blocking the sunlight.

"Young and healthy people can get enough vitamin D by spending 10 to 15 minutes three or four times a week in the sun," advises the doctor.

The sun takes longer to work its magic on older people and the elderly, as well as those confined indoors for any length of time who should take a vitamin D supplement.

Those who avoid exposure to sunshine may also require a supplement, along with postmenopausal and pregnant women, who are at high risk of deficiency. But, while taking a supplement is useful, the dose should be moderate as taking too much can create unwanted side effects. It's probably best to go to your doctor for advice.

"A four hundred unit-dose of vitamin D per day is the recommended supplement. It is enough to benefit the body. Taking too much creates high calcium levels, which will make the patient want to urinate more often, and feel fatigued," Sompongse warns.  

Tips to prevent  osteoporosis 

-  Expose parts of your body, such as arms and legs, to the sunlight for 10 to 15 minutes at least three or four times a week

-  Balance your diet by taking various nutrients from a variety of foods

- Get regular exercise

- Avoid smoking

Juthamas Cholthavornpong

The Nation