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Under a Creative Commons license Open access Highlights• Vitamin D deficiency is common in patients with bone tumours. •Potential association between pre-diagnostic vitamin D status and tumour malignancy in patients with bone tumours. 25(OH)D status should routinely be assessed and monitored in patients with bone tumours. AbstractVitamin D deficiency is a global health concern that is estimated to afflict over one billion people globally. The major role of vitamin D is that of a regulator of calcium and phosphate metabolism, thus, being essential for proper bone mineralisation. Concomitantly, vitamin D is known to exert numerous extra-skeletal actions. For example, it has become evident that vitamin D has direct anti-proliferative, pro-differentiation and pro-apoptotic actions on cancer cells. Hence, vitamin D deficiency has been associated with increased cancer risk and worse prognosis in several malignancies. We have recently demonstrated that vitamin D deficiency promotes secondary cancer growth in bone. These findings were partly attributable to an increase in bone remodelling but also through direct effects of vitamin D on cancer cells. To date, very little is known about vitamin D status of patients with bone tumours in general. Thus, the objective of this study was to assess vitamin D status of patients with diverse bone tumours. Moreover, the aim was to elucidate whether or not there is an association between pre-diagnostic vitamin D status and tumour malignancy in patients with bone tumours. In a multi-center analysis, 25(OH)D, PTH and calcium levels of 225 patients that presented with various bone tumours between 2017 and 2018 were assessed. Collectively, 76% of all patients had insufficient vitamin D levels with a total mean 25(OH)D level of 21.43 ng/ml (53.58 nmol/L). In particular, 52% (117/225) of patients were identified as vitamin D deficient and further 24% of patients (55/225) were vitamin D insufficient. Notably, patients diagnosed with malignant bone tumours had significantly lower 25(OH)D levels than patients diagnosed with benign bone tumours [19.3 vs. 22.75 ng/ml (48.25 vs. 56.86 nmol/L); p = 0.04). In conclusion, we found a widespread and distressing rate of vitamin D deficiency and insufficiency in patients with bone tumours. However, especially for patients with bone tumours sufficient vitamin D levels seem to be of great importance. Thus, we believe that 25(OH)D status should routinely be monitored in these patients. Collectively, there should be an increased awareness for physicians to assess and if necessary correct vitamin D status of patients with bone tumours in general or of those at great risk of developing bone tumours.
KeywordsBone tumour Vitamin D Hypovitaminosis D Vitamin D deficiency Malignancy Tumour malignancy Cited by (0)© 2020 The Authors. Published by Elsevier GmbH. It’s likely you’ve heard that vitamin D is essential for building and maintaining healthy bones. But did you also know that Vitamin D is being researched extensively to understand its role in preventing some types of cancer, or reducing the likelihood of recurrence? Find out more about what the research is showing and what Dr. Hyun Sue Kim, one of our oncologists located at the Colorado Springs cancer center, tells patients about Vitamin D. What is Vitamin D?Vitamin D is the name given to a group of fat-soluble prohormones (substances that can turn into hormones) which aid the body in absorbing calcium and phosphorus— two minerals your body must have for strong teeth and bones. There are two major forms of vitamin D that are important to humans: vitamin D2, which is made naturally by plants, and vitamin D3, which is made naturally by the body when skin is exposed to ultraviolet (UV) radiation in sunlight. Most people are unlikely to have high vitamin D intakes— but that doesn’t mean you should worry about not getting enough. Instead, keep in mind that excessive intake of any nutrient, including vitamin D, can cause toxic effects. Too much vitamin D can be harmful because it increases calcium levels, which can lead to calcinosis (the deposit of calcium salts in soft tissues, such as the kidneys, heart, or lungs) and hypercalcemia (high blood levels of calcium). With that said, some groups — particularly people who are obese, who have dark skin, and who are older than age 65 — may have lower levels of vitamin D due to factors such as their diets or limited sun exposure. If you have any concerns about vitamin D deficiency, talk with your doctor who can check the levels of this vitamin in your blood with a simple blood test. The Connection Between Vitamin D and Cancer Remains an Ongoing Part of ResearchAt this time, the medical community hasn’t reached a collective agreement regarding the correlation between vitamin D and cancer. While some studies have found a link between vitamin D deficiency and increased risk for breast cancer as well as colon cancer and even non-Hodgkin’s lymphoma, others have found no connection at all. Recently, researchers published findings in the journal Endocrinology linking vitamin D deficiency with increased risk that breast cancer will spread outside the breast (metastasize). Research is ongoing, although it is difficult to pinpoint a link between low vitamin D and the development of cancer, in part because levels of the vitamin change in the body and because dietary studies can’t quantify how much vitamin D people get from sunshine. But Rocky Mountain Cancer Centers’ oncologist Hyun Sue Kim, MD, isn’t waiting for a definitive decision; she’s making sure her Colorado Springs breast cancer patients get plenty of the essential vitamin D, and of calcium. “I’ve always been very aggressive about maintaining patients’ bone health,” Kim says. She carefully monitors vitamin D levels, because the association between low vitamin D and greater breast cancer risk is fairly well established. “We wish we knew the mechanism – we don’t yet – but studies have shown people with good bone health have less breast cancer and have fewer recurrences of breast cancer,” Kim says. She initially began checking vitamin D levels in her patients because the body needs it to deliver calcium to the bones. Her findings weren’t what she expected: Most patients’ calcium levels met recommended goals, but vitamin D deficiency was common. “We are closer to the sun because of our high altitude, so I was surprised when I checked vitamin D – only a few women were at recommended levels without supplements.” The Institute of Medicine recommends 600 “international units” (also called IUs) per day of vitamin D up to age 70, and 800 units after age 70. Most supplements come in doses measured by international units. “It’s not hard to surmise why so many women are deficient in vitamin D, which we primarily obtain from sun exposure,” Kim says. “We are mostly indoors now. Few of us work outside. And even if we are outdoors, we put on so much sunscreen, we aren’t getting vitamin D.” Kim isn’t advising people to run out and bake themselves in the sun. There are plenty of other sources, such as fatty fish, fish oil, and milk and other dairy products that have been fortified with vitamin D. And, she recommends supplements. “I tell people to take 2000 to 5000 international units a day,” she says. While the link is still being researched, vitamin D might just be another weapon in the fight against cancer. How to Get Vitamin D if You Need ItAs mentioned earlier, most vitamin D can be obtained through sun exposure. However, too much sun exposure can put you at risk for skin cancer (so don’t plan on ditching the sunscreen anytime soon). Instead, consider these other tips that can help you maintain an adequate level of vitamin D:
Remember, not everyone needs to worry about their vitamin D intake levels. Therefore, taking high-dose supplements or getting your levels checked might not be needed. However, if you are concerned about your levels of vitamin D, check with your healthcare provider. If you are a cancer patient, talk to your oncologist about your calcium and Vitamin D levels and what you should do to keep them in the optimal range. What cancers cause low vitamin D levels?A vitamin D deficiency has also been documented in patients with prostate cancer, ovarian cancer, as well as multiple myeloma. Larger randomized clinical trials should be undertaken in humans to establish the role of vitamin D supplementation in the prevention of these cancers.
Is vitamin D associated with cancer?Vitamin D may decrease tumor invasiveness and propensity to metastasize, leading to reduced cancer mortality. Higher serum 25-hydroxyvitamin D (25[OH]D) levels at diagnosis have been linked to longer survival in cancer patients.
What underlying conditions can cause vitamin D deficiency?Medical conditions that can cause vitamin D deficiency include: Cystic fibrosis, Crohn's disease and celiac disease: These conditions can prevent your intestines from adequately absorbing enough vitamin D through supplements, especially if the condition is untreated.
Is low vitamin Da sign of bone cancer?In bone oncology, it has recently been demonstrated that vitamin D deficiency enhances secondary cancer growth in bone. These findings were partly explained through indirect effects of vitamin D deficiency as a result of increased bone remodelling.
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Can low vitamin d be a sign of cancer
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