D Deficiency in Teens Called Epidemic
by Lindsey Tanner, Associated Press, September 1, 2003
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In some ways, Leon Jordan is a pretty typical teenager -- he
doesn't get much outdoor exercise, prefers movies and video
games, and won't drink milk.
Those habits contributed to a vitamin D deficiency that has
helped weaken the 18-year-old's bones and left him prone to
Doctors say it's an often overlooked problem that may affect
millions of U.S. adolescents. Often undetected and untreated,
vitamin D deficiency puts them at risk for stunted growth and
debilitating osteoporosis later in life.
There's even evidence that chronic deficiency may be linked with
some cancers, diabetes and high blood pressure, said Dr. Michael
Holick, a Boston University vitamin D specialist.
Youngsters in northern cities with less intense year-round
sunlight are especially prone to vitamin D deficiency, as are
blacks and other dark-skinned ethnic groups whose pigmented skin
doesn't absorb sunlight as easily as whites.
Ironically, so are kids who follow the advice of moms and
doctors to slather on sunscreen to avoid skin cancer, because it
can block the absorption of ultraviolet rays.
But while too much sunlight is bad, ultraviolet rays also
interact with chemicals in the skin to produce vitamin D. Holick
recommends kids spend about 10 minutes a few times a week in the
sun without sunscreen.
"We get into lively debates with dermatologists because they say
we should all have sunscreen on all the time," said Dr.
Catherine Gordon, a Boston pediatric endocrinologist who has
many patients with vitamin D deficiency.
Her recent research suggests as many as 20 percent of healthy
children in Boston may be vitamin D deficient.
Holick, who has done research on youngsters in Maine and
elsewhere, estimates that as many as 30 percent of adolescents
nationwide may be affected, and percentages among blacks are
probably even higher.
"It's really an unrecognized epidemic," he said.
And with today's youngsters often favoring indoor activities
from Web-surfing to television, and many shunning vitamin
D-fortified milk in favor of soda, specialists say it's no
One problem is that the simple blood test that detects the
deficiency is rarely done unless a problem is suspected.
Unfortunately, youngsters suffering from it often don't have
symptoms until it has advanced to the point of causing fractures
or rickets, a bone-weakening disease that doctors think may be
on the rise.
Doctors suspect that many otherwise healthy youngsters may have
undetected deficiency. Those most likely to be diagnosed often
have underlying chronic diseases requiring medication that can
cause bone problems that bring them to the attention of
That's what happened with Leon Jordan.
Currently in remission from leukemia, he had aching bones and
was referred a year ago to Dr. Craig Langman, a specialist in
treating pediatric bone problems at Children's Memorial Hospital
Leukemia treatment may be linked to the thinning bones, but
Langman suspected a vitamin D deficiency was contributing; a
blood test confirmed his suspicions.
Langman says about half the youngsters referred to him turn out
to be deficient in vitamin D, and in about a quarter of those
cases, lifestyle habits contribute.
Jordan said he had no idea his habits put him at risk. Now he
takes vitamin D supplements and a bone-building drug.
If the deficiency is detected early enough, before bones stop
growing, such treatments can help prevent permanent damage,
Adolescence is a particularly vulnerable time because youngsters
are undergoing such rapid growth, said Dr. Susan Coupey, chief
of adolescent medicine at Montefiore Medical Center's children's
hospital in New York.
Their bones require large amounts of calcium, and vitamin D is
needed to help the body absorb it. Thus adequate vitamin D
intake is crucial from ages 10 through 18, she said.
"It's as important as the first two years of life because the
growth rate increases," Coupey said.
According to Gordon, "If someone is vitamin D deficient, it
causes the cells that break down bone to go into overdrive.
"A mild form of vitamin D deficiency can be commonly
unrecognized," she said, "but there may be ongoing damage to
Gordon is among specialists leaning toward urging routine
testing for the deficiency.
In new guidelines issued earlier this year, the American Academy
of Pediatrics recommends multivitamin supplements containing 200
international units of vitamin D for babies who are breast-fed
only and for at-risk children and adolescents. At-risk means
those who don't drink at least 17 ounces daily of fortified
milk, who don't get regular sunlight exposure or who don't
already take multiple vitamins with at least 200 IUs of vitamin
"Now is the time to do something about it," Langman said. "The
typical adolescent response is, 'What, me worry?"'
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