what-when-how
In Depth Tutorials and Information
for adults aged 19-50 years. Low-fat dairy foods con-
tain the same amount of calcium as full fat dairy, but
kcalories are lower. Other dietary sources of calcium
include broccoli, bok choy, kale, some nuts and dried
beans, and fortified dairy substitutes such as soy or
rice beverages. Increasingly, common foods such as
orange juice, cereals and breads are fortified with
calcium. There is no evidence suggesting that tak-
ing in more calcium than the AI results in improved
bone health; however, bisphosphonate therapy, often
used for persons with OI, requires adequate calcium
(and vitamin D, discussed below) to promote bone
formation.
1
On the other hand, persons with certain medical
conditions, such as a history of kidney stones, may
require less calcium than the AI. There is also a school
of thought that suggests that persons with small stature
may require less calcium and/or vitamin D than the AI
for adults.
20
Such individuals are recommended to con-
sult with their physician and/or RD for individualized
calcium recommendations.
In a review of current management and treatment
of OI, Monti et al.
16
recommend an adequate intake of
vitamin D, suggesting between 400 and 800 interna-
tional units/day.
Although the optimal amount of vitamin D for indi-
viduals with OI is not clear at this time, the recommen-
dations all support the need for adequate intake, equal
to or greater than the AI established for the general
population.
There is concern for potential negative health con-
sequences associated with excess intake of vitamin D,
a fat soluble vitamin that is stored for long periods in
the fatty tissues of the body. Excessive vitamin D intake
may lead to hypercalcemia and hypercalcuria. For this
reason the IOM has set an upper limit (UL) of 2000 IU
per day.
22
Before taking supplements providing more
that the UL, individuals should consult a physician.
Other Micronutrients
Vitamin K is involved in promoting bone mineral-
ization and maturation. Some studies show a correla-
tion between low serum vitamin K and increased risk
of fractures; however, there are no studies that examine
the role of vitamin K and fractures due to OI.
Vitamin A appears to play a role in bone remodel-
ing. A lack of vitamin A causes bones to weaken and
thicken. Again, there is no research on the role of vita-
min A in relation to OI.
Vitamin C assists in the formation of collagen and in
the healing of wounds and fractures. Although vitamin C
cannot reverse the collagen defects of OI, adequate
vitamin C is recommended to encourage healing.
Vitamin D and Bone Health (see Chapter 56)
Vitamin D is necessary to promote absorption of cal-
cium and mineralization of the bone. It also mediates
the release of calcium and phosphorus from bone to
maintain circulating levels of these minerals. Vitamin D
deficiency is associated with an increase in bone remod-
eling leading to increased porosity in the bone matrix.
Severe vitamin D deficiency results in rickets in chil-
dren and osteomalacia in adults.
21
Vitamin D is available through dietary intake and
through skin synthesis in response to exposure to UV
light. Food sources of vitamin D include fatty fish such
as salmon, egg yolks and foods fortified with vitamin D,
such as milk, margarine and soy beverages. Because
dietary sources are limited, many individuals do not
meet a significant portion of their vitamin D needs
through diet.
22
Exposure to UV sunlight may assist with adequate
vitamin D status; however, factors such as little sun
exposure, latitude above 42°N, use of sunscreen and
darker skin tone may inhibit vitamin D formation.
A higher prevalence of vitamin D deficiency, or its
milder form, vitamin D insufficiency, has been noted in
persons who meet the above characteristics.
The IOM has set adequate intake levels of vitamin D
for healthy people based on age (
Table 40.2
).
22
Dr. Jay Shapiro has conducted research specifically
on vitamin D needs in persons with OI, and has created
a set of intakes based on bodyweight for individuals
with OI (
Table 40.3
).
23
The full text of the proposal can
be found at
http://www.osteogenesisimperfecta.org/
under the heading “OI News.”
TABLE 40.2
Adequate Intake for Vitamin d
Adequate Intake
(micrograms/day)
Age
Infants, children, and adolescents
5
Adults up to 50 years of age
5
Pregnancy and lactation
5
Adults ages 51-70 years
10
Adults age 70 and older
15
TABLE 40.3
suggested Vitamin d
3
Intake for People with OI
23
Bodyweight
International Units (IU) per day
50 lb (20 kg)
600-800
90 lb (40 kg)
1100-1600
110 lb (50 kg)
1200-2000
150 lb (70 kg) and above
2000-2800
