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Denise Smith flinched in agony as she heard her wrist bone snap — her third break  in two years. 
‘All I’d done was hit a toy punchbag my husband had bought me as a joke. 
‘I couldn’t believe I’d broken a bone again so soon,’ says Denise, 39, an assistant accountant who lives in Molash, Kent.
Two years before, Denise had broken her foot after landing awkwardly while jumping for the ball in a netball match. 

Denise Smith, 39, was diagnosed with osteoporosis, a condition that causes the honeycomb structure of the bones to become porous and prone to fractures
‘The other girls on the team heard the crack and I blacked out with the pain,’ she says.
‘I was a bit surprised to have broken a bone because it wasn’t a high-impact fall — I’d had far worse knocks than that. I’d always been active and had fallen off horses and crashed my car in motor racing competitions, but I’d never broken anything before. 
‘Then, just over a year later, I slipped on an icy pavement and snapped my wrist. When I broke my wrist again nine months later hitting the punchbag, I was mortified.’
But Denise’s spate of fractures was not simply due to bad luck. Tests revealed her bones were perilously thin — and resembled those of someone much older. 
She was diagnosed with osteoporosis, a condition that causes the honeycomb structure of the bones to become porous and prone to fractures.
Yet nothing in Denise’s lifestyle seemed to place her at risk of the disease: she hadn’t smoked, she didn’t have a bad diet and she had never suffered from the eating disorder anorexia. Indeed, there wasn’t even a history of brittle bones in her family.
The only explanation that the doctors could give was that it might have been prompted by the fact that, due to her fair complexion, Denise had spent a lifetime avoiding the sun — causing her to be deficient in vitamin D. 
‘When I was a child, my mum had plastered me in high-protection sun cream because she was so worried I would burn. 
'I was only allowed to play in the garden under a makeshift tent she set up, consisting of a sheet draped over a washing line. And I always had to wear a hat.
Vitamin D is equally vital for young children
‘When I got older, I carried on applying high factor sun cream and never got a tan. I’m mainly office-based, but I’d put on factor 50 if I knew I’d be outside during the day.
‘At the time, I thought I was doing what was healthy — certainly, it was the standard health advice — but I’m beginning to worry if it was the right thing.’
Indeed, it was reported recently that an increasing number of people  — up to one in three adults — are suffering from vitamin D deficiency due to a lack of sun exposure and poor diet. 
The condition increases the risk of osteoporosis and fractures by up to 60 per cent. 
According to the All-Party Parliamentary Osteoporosis Group that produced the ten-year study, the number of British men admitted to hospital with a hip fracture has risen by 77 per cent over the past decade, with worrying rises in women as well. 
Increased life expectancy is thought to be largely to blame, but it is possible that a lack of vitamin D may be linked.
Furthermore, a lack of vitamin D has been linked to an increased risk of colds and flu, heart disease, diabetes, multiple sclerosis and cancer. 
Around 90 per cent of our vitamin D is made in the skin with the help of sunlight. 
Ultraviolet rays from the sun convert cholesterol into vitamin D, says Dr William Marshall, consultant clinical biochemist and clinical director of pathology at The London Clinic. We can also get a small amount from a healthy diet.
‘Vitamin D is important for general good health, growth, strong bones, muscle function and a healthy immune system,’ he says.
‘It also helps the body to use the calcium and phosphorus obtained from your food and regulates normal cellular differentiation, thus helping to prevent cancer.
‘A deficiency can eventually lead to osteomalacia — a disease that causes the bones to become weak and painful, or rickets in children.’
But how do you strike a balance between getting enough sun without increasing your risk of skin cancer?
And who is at risk of vitamin D deficiency and how much should you take? We asked leading experts for their advice...
Those who are housebound are at risk of vitamin D deficiency because the main way we produce it is by exposure to sunlight.
‘Elderly people in care homes really suffer as they tend to spend most of their time inside,’ says Dr Kassim Javaid, lecturer in metabolic bone disease at the University of Oxford. 
‘They are also less efficient at producing the vitamin when their skin is exposed.’
The recommended amount of sun exposure to produce adequate vitamin D levels is ten to 15 minutes on the face and hands three times a week, covering up if the skin starts to turn pink. 
‘But it can be difficult for some elderly people to get outside,’ says Dr Javaid.
‘That’s why supplements are important for this group. 
A study of 3,000 people revealed  that the middle-aged and elderly with low levels of vitamin D in their blood had a higher risk of heart disease and diabetes.

Research shows that overweight people are less likely to expose their skin to the sun because they feel self-conscious
Vitamin D is fat-soluble, so if you are obese (with a BMI of 30-plus) it simply gets absorbed in the fat stores rather than being metabolised and used by the body, says independent dietitian Dr Carrie Ruxton of the Health Supplements Information Service. 
‘This means vitamin D isn’t manufactured as well.’
Research also shows that overweight people are less likely to expose their skin to the sun because they feel self-conscious, says Dr Javaid. 

Once you get into the post-menopausal years, you consistently lose bone mineral density, which will have peaked in your 20s, says Dr Ruxton. 
‘You want to try to keep what you have for as long as possible, and a bone health supplement, such as calcium and vitamin D together, will help that.’ 
But what about the studies linking vitamin D and calcium with heart attacks and strokes?
‘The evidence is conflicting,’ says Dr Javaid. ‘Some scientists say they might increase the risk, while others say they don’t. 
‘At the moment, I would follow your doctor’s recommendations.’
Hip fractures are a huge problem in Britain — there are 87,000 each year, says Dr Javaid. And after a hip fracture, as many as one-third of patients die within a year.
‘There’s a myth that men don’t get osteoporosis — they do,’ he says. ‘Men tend not to be checked for this after their first fracture, so they can go on to have another one. 
‘It’s also likely, particularly if you’ve suffered a hip fracture, that you may be deficient in vitamin D.
‘That’s because falls over the age of 65 are generally caused by the muscles gradually getting weaker — and vitamin D is vital for maintaining muscle function, as well as bone health,’ says Dr Javaid. 

‘It’s vital that pregnant women in high-risk groups — those who are obese or who don’t get much sun — take 400 IU (10mcg) of vitamin D a day, according to the NICE guidelines,’ says Dr Javaid. 
‘I can’t stress enough how important this is because the baby needs vitamin D to grow properly. 
‘The body never forgets what happens in the womb. If you are deficient before birth, you may carry the effects of that all your life. 
‘Research shows that a lack of vitamin D can cause bones to grow to the wrong shape and density. And it could possibly increase the risk of mental illness later in life.’

Vitamin D is equally vital for young children. The Department of Health recommends that all children from six months to five years have extra vitamin D to ensure they have strong bones. 
Teenagers are also likely to be lacking in vitamin D because fewer of them are drinking milk or eating oily fish — both good sources of the vitamin — and a growing number of them are obese.
‘It’s estimated that 40 per cent of adolescents have deficient levels of vitamin D, largely because so many of them have appalling diets,’ says Dr Ruxton.

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