Sunday, August 31, 2003

Vitamin D Deficiency Plagues Teens

Overlooked problem causes weak bones in adolescents

- 2003/08/31

Doctor's say it’s an often overlooked problem that may affect millions of U.S. adolescents. Often undetected and untreated, vitamin D deficiency puts them at risk for stunted growth and debilitating osteoporosis later in life. There’s even evidence that chronic deficiency may be linked with some cancers, diabetes and high blood pressure, said Dr. Michael Holick, a Boston University vitamin D specialist. Youngsters in northern cities with less intense year-round sunlight are especially prone to vitamin D deficiency, as are blacks and other dark-skinned ethnic groups whose pigmented skin doesn’t absorb sunlight as easily as whites. Ironically, so are kids who follow the advice of moms and doctors to slather on sunscreen to avoid skin cancer, because it can block the absorption of ultraviolet rays. But while too much sunlight is bad, ultraviolet rays also interact with chemicals in the skin to produce vitamin D. Holick recommends kids spend about 10 minutes a few times a week in the sun without sunscreen. “We get into lively debates with dermatologists because they say we should all have sunscreen on all the time,” said Dr. Catherine Gordon, a Boston pediatric endocrinologist who has many patients with vitamin D deficiency. Her recent research suggests as many as 20 percent of healthy children in Boston may be vitamin D deficient. UP TO 30 PERCENT AFFECTED? Holick, who has done research on youngsters in Maine and elsewhere, estimates that as many as 30 percent of adolescents nationwide may be affected, and percentages among blacks are probably even higher. “It’s really an unrecognized epidemic,” he said. And with today’s youngsters often favoring indoor activities from Web-surfing to television, and many shunning vitamin D-fortified milk in favor of soda, specialists say it’s no wonder. One problem is that the simple blood test that detects the deficiency is rarely done unless a problem is suspected. Unfortunately, youngsters suffering from it often don’t have symptoms until it has advanced to the point of causing fractures or rickets, a bone-weakening disease that doctors think may be on the rise. Doctors suspect that many otherwise healthy youngsters may have undetected deficiency. Those most likely to be diagnosed often have underlying chronic diseases requiring medication that can cause bone problems that bring them to the attention of specialists. That’s what happened with Leon Jordan. Currently in remission from leukemia, he had aching bones and was referred a year ago to Dr. Craig Langman, a specialist in treating pediatric bone problems at Children’s Memorial Hospital in Chicago. Leukemia treatment may be linked to the thinning bones, but Langman suspected a vitamin D deficiency was contributing; a blood test confirmed his suspicions. LIFESTYLE CONTRIBUTES TO PROBLEM Langman says about half the youngsters referred to him turn out to be deficient in vitamin D, and in about a quarter of those cases, lifestyle habits contribute. Jordan said he had no idea his habits put him at risk. Now he takes vitamin D supplements and a bone- building drug. If the deficiency is detected early enough, before bones stop growing, such treatments can help prevent permanent damage, Holick said. Adolescence is a particularly vulnerable time because youngsters are undergoing such rapid growth, said Dr. Susan Coupey, chief of adolescent medicine at Montefiore Medical Center’s children’s hospital in New York. Their bones require large amounts of calcium, and vitamin D is needed to help the body absorb it. Thus adequate vitamin D intake is crucial from ages 10 through 18, she said. “It’s as important as the first two years of life because the growth rate increases,” Coupey said. ‘WHAT, ME WORRY?’ According to Gordon, “If someone is vitamin D deficient, it causes the cells that break down bone to go into overdrive. Advertisement “A mild form of vitamin D deficiency can be commonly unrecognized,” she said, “but there may be ongoing damage to their skeleton.” Gordon is among specialists leaning toward urging routine testing for the deficiency. In new guidelines issued earlier this year, the American Academy of Pediatrics recommends multivitamin supplements containing 200 international units of vitamin D for babies who are breast-fed only and for at-risk children and adolescents. At-risk means those who don’t drink at least 17 ounces daily of fortified milk, who don’t get regular sunlight exposure or who don’t already take multiple vitamins with at least 200 IUs of vitamin D. “Now is the time to do something about it,” Langman said. “The typical adolescent response is, ’What, me worry?”’

SOURCE: Associated Press