About 1% of Americans are on glucocorticoids, usually for asthma or autoimmune diseases. These steroids lower inflammation, much like vitamin D, but do so at a cost in that people on glucocorticoids are more susceptible to a host of diseases, including infection and osteoporosis. So looking at vitamin D levels in people on glucocorticoids is important. We have some data from small studies that indicate patients on glucocorticoids have low vitamin D levels but no big population studies exist.
Dr. Amy Skversky and colleagues from the Albert Einstein School of Medicine changed that when she studied 22,000 people to find 181 individuals taking glucocorticoids. Those 181 people were twice as likely to have severe vitamin D deficiency, levels less than 10 ng/ml.
Skversky AL, Kumar J, Abramowitz MK, Kaskel FJ, Melamed ML. Association of Glucocorticoid Use and Low 25-Hydroxyvitamin D Levels: Results from the National Health and Nutrition Examination Survey (NHANES): 2001-2006. J Clin Endocrinol Metab. 2011 Sep 28.
Patients on steroids often come repeatedly to their doctor with chronic pain and get prescribed powerful and addicting pain medications. If the doctor would only push his knuckle on their sternum or tibia, he would elicit severe pain, which is a sign of adult rickets or osteomalacia.
About 3 million Americans are on glucocorticoids, so we can infer from this study that about 300,000 of them have vitamin D levels less than 10 ng/ml (11%). I worry about these people because osteomalacia usually accompanies such levels. Besides their asthma or autoimmune disorders, doctors often diagnose them with fibromyalgia, or even as “crocks,” a deriding term doctors use when they cannot find the source of someone’s complaint. All they need is some vitamin D.
The authors also pinned down the reason people of glucocorticoids have low vitamin D levels. The enzyme increases expression of the 24-hydroxylase (the enzyme that destroys vitamin D), and 24-hydroxylase lowers vitamin D levels very quickly. People on glucocorticoids should take at least 5,000 IU/day and sometimes 10,000 IU per day to keep their 25(OH)D level around 50 ng/ml. Children on glucocorticoids need 2,000 IU per every 25 pounds of body weight.
I would be very interested to hear any reports from patients on glucocorticoids who take vitamin D. Were you able to get off the glucocorticoids? Do the higher vitamin D levels help the symptoms of asthma, rheumatoid arthritis, Crohn’s disease, or lupus? I know of three case reports where parents of asthmatic children reported that their child’s asthma slowly became better on vitamin D. I wonder if anyone else has such a report?