October Discussion Summary

October Summary

Vitamin D has been the subject of many studies over the last few years, and due to strong evidence for its role in preventing osteomalacia and fractures, the upper limit for vitamin D had been increased. Therefore, there have been additional studies looking into other effects that vitamin D might have in our bodies. Some observational studies have shown associations between severe vitamin D deficiencies and joint disorders, but a new large-scale randomized, placebo-controlled clinical trial did not see any benefits between vitamin D supplements and improvement of joint disorder symptoms.

Q1: Joint pain and swelling can be a big issue for someone trying to exercise. How would you council them on the importance of exercise in general and with arthritis? What are some ways they can exercise without being in too much pain?

Sarah and Courtney both would mention that exercise can help prevent other diseases and Carly and Erin would also point out that exercise is good for mental health as well. Alyssa brought up a great point about getting cleared for exercise by the doctor and seek out a physical therapist. Carly also made a good point about getting training on the equipment since proper technique can prevent further injuries. Lynetta would work with her patients to set realistic goals and have them journal the activities that led to pain, while Courtney would really work with her patients to learn what activities they like best and modify them. Additionally, Beth would mention the fact that post-menopausal women are more at risk for developing osteoporosis and Kaitlin would be sure to focus on the right exercises for the client depending on where their joint pain is located. Aria would remind her patients that a body in motion stays in motion, and you need to use your body to keep it healthy.

Most everyone agrees that low impact exercises are good for joint pain, especially water aerobic, swimming, walking, and yoga.

Q2: Osteoporosis and fractures frequently occur in the older population. How would you council someone at risk for this disease and injury for prevention? How would you council an older woman for treatment after a hip fracture?

Sarah would recommend vitamin D and calcium supplements and encourage them to partake in weight-bearing and stretching exercises. She would also recommend using walking assistants and stair railings to prevent falling. Erin also recommends taking extra precautions and not to push themselves too hard. Beth would focus on building bones through supplements and weight bearing activities as well to reach earlier ADLs. Lynetta, Aria, and Carly would focus on food sources for vitamin D and calcium and would recommend higher calorie and protein intake post-fracture for healing. Courtney would mention that the protein would also help prevent muscle loss. Carly further suggests trying Ensures to reach optimal nutrition needs, and Alyssa would recommend meeting with a physical therapist. Kaitlin would talk with her client and encourage the activity that is best for the client’s lifestyle and Aria made a good point to gauge the motivation of the client since many deaths occur within a year of a hip fracture.

Q3: The DRI For vitamin D has recently increased to 600 IU/day for adults 70 years and younger and 800 IU/day for adults 71 years and older. How would you advise someone to increase his or her vitamin D stores? How could you explain to them the importance of increasing their vitamin D intake?

Most would suggest the specific reasons why vitamin D is important noting bone health. Carly also suggested its importance for hyperparathyroidism, fall prevention, and bone loss during kidney failure, and Sarah mentioned colorectal cancer. Everyone agrees that sun exposure is important, and Erin and Aria went further to say that sun exposure would also help with mood. Lynetta and Courtney gave some great specific examples of food products with vitamin D and most suggested a supplement to increase D levels, especially for winter months and those who live in the northern hemisphere.  Courtney also made a great point about the decreased production of vitamin D as we age, and Aria suggests higher supplement doses since the current recommended levels may still be too low.