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Vitamin D and adult bone health in Australia and New Zealand: a position statement

Med J Aust 2005; 182 (6): 281-285.

Summary

  • A significant number of Australians are deficient in vitamin D — it is a fallacy that Australians receive adequate vitamin D from casual exposure to sunlight.

  • People at high risk of vitamin D deficiency include elderly people (particularly those in residential care), people with skin conditions where avoidance of sunlight is advised, those with dark skin (particularly if veiled), and those with malabsorption.

  • Exposure of hands, face and arms to one-third of a minimal erythemal dose (MED) of sunlight (the amount that produces a faint redness of skin) most days is recommended for adequate endogenous vitamin D synthesis. However, deliberate sun exposure between 10:00 and 14:00 in summer (11:00–15:00 daylight saving time) is not advised.

  • If this sun exposure is not possible, then a vitamin D supplement of at least 400 IU (10 μg) per day is recommended.

  • In vitamin D deficiency, supplementation with 3000–5000 IU ergocalciferol per day (Ostelin [Boots]; 3–5 capsules per day) for 6–12 weeks is recommended.

  • Larger-dose preparations of ergocalciferol or cholecalciferol are available in New Zealand, Asia and the United States and would be useful in Australia to treat moderate to severe vitamin D deficiency states in the elderly and those with poor absorption; one or two annual intramuscular doses of 300 000 IU of cholecalciferol have been shown to reverse vitamin D deficiency states.

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  • Terrence H Diamond1
  • John A Eisman2
  • Rebecca S Mason3
  • Caryl A Nowson4
  • Julie A Pasco5
  • Philip N Sambrook6
  • John D Wark7

  • 1 Members of the Working Group were:
  • 2 University of New South Wales, Sydney, NSW.
  • 3 Garvan Institute of Medical Research, St Vincent’s Hospital and University of New South Wales, Sydney, NSW.
  • 4 University of Sydney, NSW.
  • 5 Deakin University, Melbourne, VIC.
  • 6 The University of Melbourne, Geelong, VIC.
  • 7 University of Sydney and Royal North Shore Hospital, NSW.
  • 8 The University of Melbourne and Royal Melbourne Hospital, VIC.

Correspondence: 

Acknowledgements: 

We thank the many members of the Australian and New Zealand Bone and Mineral Society (ANZBMS), Osteoporosis Australia (OA), the Endocrine Society of Australia (ESA) and the Cancer Councils of Australia for their suggestions and critical comments; the Australian Radiation Protection and Nuclear Safety Agency for calculating the data and providing information on sun exposure times; and Dr Richard McKenzie (National Institute of Water and Atmospheric Research) for providing the New Zealand data. We also thank Professor BEC Nordin for critical appraisal of the final draft of the position statement and Professor GC Nicholson (Chair, Medical and Scientific Affairs Committee, ANZBMS) for commissioning the project on behalf of ANZBMS.

Consensus process: This position statement was developed by a working group commissioned by the ANZBMS and OA. The first draft was developed by the seven members of the working group with expertise in bone health and osteoporosis. Drafts were circulated to other experts in the area and also to the Cancer Council of Victoria for advice on sun exposure recommendations. The subsequent draft was posted on the ANZBMS website for widespread comment and feedback. Suggested revisions were incorporated with consensus from each member of the working party. Further advice about sun exposure was provided by the Australian Radiation Protection and Nuclear Safety Agency. The final manuscript was reviewed by Councils of the ANZBMS, ESA and OA scientific affairs committees.

Competing interests:

None identified.

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