Dr. Sharoff Lokesh Mohan
Orthopedician and Traumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
My mother is 91 years old. First, she has spinal and SI joint arthritis and is about 30 lbs overweight. She recently had a blood panel where her vitamin D - 25 hydroxyvitamin D was 65 nmol/L range is supposed to be 75 to 250. She was already taking daily a liquid, animal-derived supplement, vitamin D3 - 1500 IU drops, taken in the morning with daily tea. She often complained about a sour stomach, and I did not associate it with it. The family doctor told me to double it up - approximately 3000 IU. She got even more often a sour stomach. Again she took it more for energy gain and tiredness than bone strength. She did have a recent bone scan which was okay. I switched her to a plant-based vitamin D and gave her 1000 IU daily, but it appeared to give her constipation. So currently on it bidaily. She also suffers from rosacea, so she is trying to see if there is a cause and effect. Other than spinal and SI arthritis- she also has atrial fibrillation and takes intermittent antibiotics for bladder UTI. So any practical tips to safely increase her vitamin D not to create more problems?
Second, it relates to me; I have had three arthroscopies on my right knee, two in my teenage years, and the last one was nine years ago when I was 39. I had a small coin-size loose piece of cartilage that was catching, and sometimes my knee would lock. It was removed successfully. I started taking four glucosamine chondroitin and MSM tablets daily - each component 500 mg, and 400 mg, respectively. I took four tablets for the first two years, and now only two a day for the last seven years. A knee X-ray a year ago showed no significant knee arthritis - knees in good shape. I do have a bursitis sac in the left knee, which flares once in a while. My mother has two total knee replacements; my sister, 58, will also need knee replacements in the next few years. I pop these supplements daily like a robot, But is there any true merit in taking them? What is the proper dosage now and long term? Please help.
Hi,
Welcome to icliniq.com.
I understand your concern.
1. Yes, It would be best to continue 1000 IU Of vitamin D and have it with any juice in the evening rather than morning (not with milk or tea); her vitamin D levels are acceptable, and the bone scan is good (the attachments are removed to protect the patient's identity) so there is nothing to worry about - repeat her vitamin D levels after three months now, (if she gets constipation, her calcium dosage needs to be reduced rather than relating it to vitamin D), And also increase her fibrous fruits intake, which will reduce constipation. The probable diagnosis is vitamin D dosage.
2. To reduce the risk of arthritis which seems mechanical in your case - you need to control your body weight by managing a diet plan which has to be made by your dietician. The probable diagnosis is arthritis. Yes, twice a day is the correct dose if you take it long-term, but if you have had it for two years. Now, I think it is best to stop it as I do not see any merit in continuing it. Further, It would help if you were careful in trying to avoid any further injuries to your knee (you can wear a knee cap for little extra support); I would like to see your X-rays (because there are many treatment modalities available nowadays for bursitis too, so let me see the X-rays first).
Regards.
Patient's Query
Hi doctor,
My mother's calcium intake is through her diet. Our weather is cold, and people spend more time indoors, so vitamin D is less created. But, again, her vitamin D is essential for energy, etc. So are you inferring that glucosamine chondroitin, MSM, as a pure preventative supplement has no merit? I have taken it now for nine years. I might taper it off then to once a day. As it appears, there is conflicting information out there for its benefit.
Hi,
Welcome back to icliniq.com.
It is good that calcium is in her diet. It is best to give her vitamin D with fruit juices and make her eat fibrous fruits and vegetables, which will prevent constipation. Again, her dose of vitamin D is acceptable. Let her continue one dosage for three months, then do her blood tests (and if levels are reducing, then we can increase it. But if we keep fluctuating the doses, we will never know what is the proper dosage for her, so continue with the same dosage till the following blood tests).
For you,
I would not suggest Glucosamine if you have no knee pain or as a pure preventive supplement for osteoarthritis at the age of 30 or your age, (but if you have knee pain and the doctor feels that it can be cartilage related, then two years is enough time to take it at your age, and I never give it for more than that). According to reports, it is considered safe only for two years, so I never exceed that and switch to other supplements, (if you still have knee pain, then do X-rays and MRI (magnetic resonance imaging) scan to find out the reason and treat according to it).
Prevention of arthritis should be through muscle strengthening exercises (low impact exercises of lower limbs) and weight reduction by diet.
I hope you find it helpful.
Regards.
Patient's Query
Hi doctor,
So I asked you earlier about vitamin D for my mother. This is not related to bone strength but to energy levels. I think there is a correlation between higher levels and her being less tired. But the consequence does not have daily. There is some factor with magnesium and not calcium which she has only through diet.
Hi,
Welcome back to icliniq.com.
Yes, magnesium is a micro-nutrient that works in combination with calcium and other micro-nutrients for the enzymatic activity of bone which helps in preventing osteoporosis. Magnesium is available through diet as well tablets along with calcium. Vitamin K2 is also a vitamin that helps in preventing osteoporosis and works with calcium.
I hope you find it helpful.
Regards.
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Orthopedician and Traumatology
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