Today, Dr. Joy Wu of Stanford’s multidisciplinary sarcoidosis program is here to answer questions about sarcoidosis, Vitamin D and Calcium. Many patients have questions about the complex relationship between sarcoidosis and calcium metabolism- we are here to help.
Let’s start off with the basics- what is the relationship between calcium and Vitamin D in normal circumstances, or someone without sarcoidosis?
Calcium is a mineral that is important for keeping your bones strong, while vitamin D promotes efficient absorption of calcium from your GI tract.
How does sarcoidosis affect calcium and vitamin D levels?
Vitamin D is made in the skin and eventually converted to its active form, calcitriol. People with sarcoidosis may convert more vitamin D to calcitriol than normal, and this in turn can lead to high calcium levels in the blood or urine. High calcium levels in the blood can cause a variety of symptoms including weakness, fatigue, confusion, and constipation, while high calcium levels in the urine can damage the kidneys.
Generally speaking, should people with sarcoidosis take calcium and Vitamin D supplements?
This is a tricky question. On the one hand calcium and vitamin D are usually recommended for optimal bone health, and people with sarcoidosis are at risk for bone loss and fractures. But on the other hand, people with sarcoidosis can be at risk for developing high calcium levels when taking calcium or vitamin D supplements. So calcium and vitamin D supplements should only be taken after discussing the risks and benefits with your doctor, and after lab tests to make sure that levels of calcium, vitamin D (measured as 25-hydroxyvitamin D) and calcitriol are not already elevated. If calcium and vitamin D supplements are started, then calcium levels in the blood and urine should be carefully monitored.
What about sarcoidosis patients on prednisone? Lots of doctors who don’t specialize in sarcoidosis recommend people who take prednisone take calcium and Vitamin D as well.
Prednisone can be very effective for treating sarcoidosis, but it can also lead to bone loss and increased risk of fractures. While people taking prednisone are often advised to take calcium and vitamin D to protect their bones, this decision is more complicated in people with sarcoidosis as discussed above.
How can people with sarcoidosis keep their calcium and Vitamin D levels within goal/normal range?
The normal range for vitamin D in people with sarcoidosis has not been well-defined. People with sarcoidosis should have their calcium levels checked in blood and urine. Options for lowering calcium levels include adjusting dietary intake, or various medications if needed.
What can sarcoidosis patients do to protect their bone health?
Besides discussing the risks and benefits of calcium and vitamin D with your doctor, everyone should engage in regular exercise for at least 30 minutes a day. Weight or resistance training 2-3 times a week will also help to strengthen bones. If you are over 65, are on or have taken high doses of prednisone, or if you have had fractures as an adult that occurred with minimal trauma, you should have a bone density scan to evaluate your risk of fracture. If you have osteoporosis or high fracture risk, you should discuss with your doctor whether medication is needed to lower your risk of fracture.
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