Vitamin D in Rheumatology: Cause and Effect Unclear

Vitamin D plays a role in bone health and the possible development of osteoporosis and other bone conditions.
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The controversy over vitamin D is hearty enough to confuse even seasoned rheumatologists, says Nathan Wei, MD, The Arthritis Treatment Center, Frederick, Md.

“It’s like what you hear with coffee. One week, [a study finds] coffee is … good for you; the next week, there’s a study saying it’s bad for you,” he says.

Vitamin D appears to be in the same conundrum right now in rheumatology. Although there’s the general thought that optimal levels can be beneficial for patients, it’s not always clear how much is needed, how much vitamin D contributes to disease development, and whether D has any protective factor against rheumatic disease.

What’s certain is testing for vitamin D levels is popular right now, says Stuart D. Kaplan, MD, chief of rheumatology at South Nassau Communities Hospital in Oceanside, N.Y. When he started to practice rheumatology in 1989, he says checking vitamin D levels was not even on the radar screen.

As the specialty’s knowledge of rheumatic disease has increased, there’s a general thought that vitamin D may help combat osteoporosis and reduce the risk for falls, says Linda A. Russell, MD, assistant attending physician, Hospital for Special Surgery, New York.

The current enthusiasm for Vitamin D stems, in part, from the public’s interest in finding more “natural” ways to prevent and treat disease that do not involve conventional medications, says Sharon L. Kolasinski, MD, Division of Rheumatology, University of Pennsylvania, Philadelphia.

What We Know about Vitamin D

There’s a multitude of ongoing research related to vitamin D right now, and while some questions remain unanswered, what’s clear is that a deficiency is a risk factor for many diseases, including heart disease and cancer, says Amber Toyer, community outreach manager at the nonprofit Vitamin D Council in San Luis Obispo, Calif. “Researchers are discovering that vitamin D deficiency can make some diseases more severe. Researchers are also discovering that vitamin D can be an important piece in the treatment of some illnesses and diseases,” she says. There’s a substantial amount of evidence that shows the importance of vitamin D in preventing breast, colorectal and prostate cancer, and there’s also a good deal of research showing a relationship between vitamin D and multiple sclerosis, Ms. Toyer adds.

Within rheumatology, it’s clear from the research that vitamin D plays a role in bone health and the possible development of osteoporosis and other bone conditions, Ms. Toyer says.