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• W1870823981 abstract "I read with interest the article “Premenopausal women and low bone density” by Aliya Khan.1 Many of us believe that management of low bone density in adults begins by maximizing bone accretion during childhood and adolescence. With current inadequate intakes of calcium and vitamin D in Canada and the poor exercise habits of many of our youth, this is an uphill battle!There were 2 statements in Dr Khan’s article that could be adjusted. The first relates to screening for celiac disease. The author refers to a “celiac panel.” This might be a local laboratory test, but it is not uniform across the country. The antigliadin antibody test has, in general, gone out of use, as it has very poor specificity. The antitransglutaminase antibody test is far more specific. A recent review in the Canadian Journal of Gastroenterology2 notes, from the National Institutes of Health Consensus Conference on Celiac Disease, that “all diagnostic tests need to be performed while the patient is on a gluten-containing diet” and that antitransglutaminase and antiendomysial antibody tests are equally effective. It goes on to note that “small-bowel biopsy [is] indicated in any individual with a positive celiac disease antibody test.” In summary, make sure the patient is eating gluten daily; do an antitransglutaminase test; if test results are positive, arrange for a small-bowel biopsy.My second point relates to the sentence, “It is important to ensure adequate calcium and vitamin D intake.” “Adequate” is one of those wonderfully stretchy words. What is adequate vitamin D intake? Health Canada still proposes 200 IU daily for everyone from extreme youth to older middle age. Our studies in children (3 to 16 years of age) in Edmonton, Alta, show that 200 IU daily is not even adequate for maintaining levels now considered mildly to moderately deficient (40 nmol/L), let alone optimum (<80 nmol/L).3 Rucker et al in Calgary4 and Vieth et al in Toronto5 have identified substantial deficiency in populations of healthy adults in Canada. From these and other studies across Canada we can extrapolate that Canadians in general have moderate to severe vitamin D deficiency. This deficiency will be exacerbated in those who do not drink fluid milk; do not take daily vitamin supplements; and do not get sun exposure on bare skin without sunscreen for at least 10 minutes during the middle of the day (about 11am to 4pm) at least twice weekly.Adequate vitamin D intake is that which will ensure a circulating blood level of 25-hydroxycholecalciferol (25[OH]D3) of 35 to 50 ng/mL or 80 to 200 nmol/L. In general, this intake will be at least 1000 IU daily, plus normal dietary vitamin D, but might be as much as 4000 IU daily.An excellent review can be found in “Benefits and requirements of vitamin D for optimal health.”6 Bone density for any individual relates to many factors, such as genetics, health issues, prior bone accretion in childhood and adolescence, and sex. It can, however, be improved for every individual through weight-bearing exercise and “adequate calcium and vitamin D intake.”" @default.
• W1870823981 created "2016-06-24" @default.
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• W1870823981 date "2006-09-10" @default.
• W1870823981 modified "2023-09-26" @default.
• W1870823981 title "What is adequate" @default.
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