MAJ. GEN. R K MARWAHA(Retd) CONSULTANT ENDOCRINOLOGIST & SCIENTIFIC ADVISOR INTERNATIONAL LIFE SCIENCES INSTITUTE(ILSI), INDIA FORMER ADDL. DIRECTOR AND HEAD DEPT. OF ENDOCRINOLOGY AND THYROID RESEARCH CENTRE INMAS, DRDO, DELHI 1 Introduction  Vitamin D is an important hormone necessary not only for maintaining calcium balance and safeguarding skeletal integrity but also essential for overall health and well being.  It is primarily acquired by exposure to sunlight and food articles commonly consumed by Indians do not provide adequate vitamin D.  No food articles are adequately fortified in India.  Nutritional rickets and vitamin D deficiency continues to exist as a major health problem in India. 2 Cont..  The most sensitive index in assessing vitamin D status is 25(OH)D (Hollis BW Calcif Tissue Int; 1996; 58; 4-5).  Age, sex, pubertal status, latitude, season, race, pollution and ethnicity influence 25(OH)D levels.  Approximately 40-50% of total skeletal mass at maturity is accumulated during childhood and adolescence. (Mora et al, 1999; Cadogan et al, 1998)  Life style determinants - exercise, body composition, nutrition, calcium and Vitamin D intake affect bone development.  Peak bone density is attained by 3rd decade. 3 Role of Vitamin-D in our health  It maintains blood calcium level in normal range which is vital for normal functioning of nervous system, bone growth and achieving peak bone density.  It is a potent immune system modulator and prevents development of respiratory infections like infuenza virus and autoimmune disorders.  It inhibits uncontrolled proliferation and stimulates differentiation of cells thereby preventing common cancers.  Plays a role in insulin secretion under conditions of increased insulin demand. Whiting J S and Calvo S M American Society of Nutritional Sciences, 2005 4 Why Sound Bone Health?  Poor bone health is responsible for causation of 8.9 million Fractures annually worldwide.  Life time risk for hip, vertebral and wrist fracture is 30- 40%.  High morbidity and mortality associated with osteoporotic fractures. Projected Number of 0 5 2 3 Projected to reach Osteoporotic Hip Fractures 3.250 million in Asia by 2050 Worldwide 8 2 6 4 6 7 Total number of 0 9 0 2 4 hip fractures: 8 6 7 3 0 0 1950 = 1.66 million 6 2050 = 6.26 million 1950 2050 1950 2050 0 1950 2050 0 1 1950 2050 Estimated number of hip fractures: (1000s) Adapted from C. Cooper et al, Osteoporos Int. 1992; 2:285-9 All Fractures are Associated with Morbidity Unable to carry out at least one independent activity of daily living 80% Unable to walk independently Permanent 40% disability Death within one year 30% 20% Cooper C., Am J Med. 1997; 103(2A):12s-19s 8