What is Deficiency or Inadequency of 25-Hydroxyvitamin D? - How does it Harm Healthy Individuals Physically and Mentally?


Austin J Musculoskelet Disord. 2017; 4(1): 1042.

What is Deficiency or Inadequency of 25-Hydroxyvitamin D? - How does it Harm Healthy Individuals Physically and Mentally?

Okuyama K1*, Miyakoshi N², Sasaki H¹, Tajimi K¹, Kawamura Y³ and Shimada Y²

¹Department of Orthopedic Surgery, Akita Rosai Hospital, Japan

²Department of Orthopaedic Surgery, Akita University School of Medicine, Japan

³Department of Clinical Laboratory, Akita Rosai Hospital, Japan

*Corresponding author: Okuyama K, Editorial Board of Austin Journal of Musculoskeletal Disorders, Department of Orthopedic Surgery, Akita Rosai Hospital, Karuizawa Aza Shimotai 30, Odate, Japan

Received: February 02, 2017; Accepted: February 07, 2017; Published: February 09, 2017


25-Hydroxyvitamin D; Employed Worker; Latitude 40° North Area; Health Status; Depression


25[OH]D: 25-hydroxyvitamin D; PTH: Parathyroid Hormone; NIH: National Institute of Health; SF-36Ver 2®: Medical Outcome Study Short-Form 36-Health SurveyVersion 2; GH: General Health; MC: Mental Component; VDR: Vitamin D Nuclear Receptor

A Letter to Dr. Mark R

Vitamin D or cholecalciferol is a collective structurally related to metabolites obtained from dietary foods, supplements and sunlight. The importance of vitamin D is well recognized in the skeleton. It regulates calcium and phosphorus level in the blood by promoting their absorption from the intestine, and also stimulates bone formation and mineralization. The article titled “Vitamin D and Cartilage: Does Vitamin D Influence Cartilage Integrity?” by Dr. Marks R is very timely and insightful [1]. Detailed mechanism between the articular cartilage of the joint and vitamin D was discussed in his article. As I’ m actually engaged in a lot of operations for degenerative disorders of the joint and the spine as an orthopedic surgeon, the potential links, proposed by Dr. Marks R, between the impact of vitamin D insufficiency and osteoarthritis sounds very intriguing [1].

The potential links are following.

Need for the further research of vitamin D function in the human body is mentioned in his discussion. I also guess that there are lots of unknown aspects of vitamin D in the human body. Especially, relationship with falls, muscle dysfunction, neurological impairment, depression, poor health status, the incidence of colo-rectal and breast cancer, the exacerbation of asthma or chronic obstructive pulmonary disease, and so forth should be disclosed in the near future. Now a days, these are being hot topics of researches in the whole world for the last decade.

25[OH]D is a stable form of vitamin D metabolized in the liver. Therefore, serum 25[OH]D concentrations currently becomes a hot interest in light of the bone and muscle metabolism as an indicator of vitamin D in human body.In the field of orthopedics, the threshold of insufficient serum 25[OH]D concentrations is determined by PTH reflection point of the relationship between serum PTH and 25(OH)D concentrations, and clinically identified as one of the risk factors which related to osteopenia and/or sarcopenia. Osteopenia and/or sarcopenia secondarily lead to hip and spinal vertebral fracture caused even by minor falls, and they finally result in disused syndrome or mortality in the elderly generations [2]. Vitamin D may play a key role to prevent from falls directly or indirectly in the elderly generations although the mechanism is still controversial [3]. In 2008, Suzuki et al. proposed that the serum 25[OH]D concentrations below 20ng/mL was a threshold of falls in the Japanese elderly generations (≧65yrs). As a positive study which supports vitamin D is associated with prevention from falls, in vitro, our colleagues, Miyakoshi and Sasaki have demonstrated that a vitamin D analog, alfacalcidol had an effect of strengthening muscle tonus in the rats [4].

The proportion of elderly people has been increasing in our globe. Out of all the advanced countries, Japan, in terms of the aging society phenomenon, is at the center of this problem. As of 2014, the rate of people over 65 years and 75 years is 25.7% and 12.5%, respectively in Japan. Moreover, the rate of people over 65 years is rapidly increasing and estimated to rise to 33.4% by 2034. This is unsurprising data, and one we must confront. Undoubtedly, the current situation of Japan is bound to develop in other countries in the near future [5].

In the western developed countries, especially in the United States, influence of 25[OH]D deficiency, insufficiency and Inadequency on the individual health is very concerned. What is deficiency, insufficiency and Inadequency of vitamin D?NIH, World Health Organization, Institute of Medicine, Centre for Disease Control and other organizations has suggested risks caused by lack of 25[OH]D. In particular, NIH has clearly proposed a guideline for the serum 25[OH]D concentrations (Table 1) [7]. On contrary to the United States there is no objective proposal of the normal or healthy range of the serum 25[OH]D concentrations from the medical associations in Japan. Dawson-Hughes B et al. have reported that 90% of Japanese and Korean population have serum 25[OH]D concentrations below 30ng/mL of which level is defined as a threshold off alls [6]. The guideline proposed by NIH is really available for Asian including Japanese? There may exist an ethnic difference of serum 25[OH]D concentrations in the healthy individuals.