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PRACTICE REVIEW

Safe sunlight and its role in bone health

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Clear, consistent messages around safe sunlight exposure are a good starting point to ensure people get the vitamin D they need for strong bones

There has been some confusion for the public and health professionals about going out in the sun and whether it is healthy or dangerous. Messages in the media have, in the past, stressed the importance of going out in the sun to get adequate vitamin D to maintain bone health but have raised fears of increased risks of skin cancer as a direct consequence of sun exposure.

Getting the balance right is difficult, especially where evidence is scant and expert views contradict each other. However, in 2010, a joint working group brought together experts from the British Association of Dermatologists, Cancer Research UK, Diabetes UK, Multiple Sclerosis Society, National Heart Forum, National Osteoporosis Society and the Primary Care Dermatology Society and they launched a joint statement to tackle these issues. The consensus statement is still relevant and useful (British Association of Dermatologists et al, 2010). In addition, each summer the National Osteoporosis Society’s (2014) subsequent Sunlight Campaign has continued to promote the agreed messages.

Sunlight Campaign messages

Sunlight is the best natural source of vitamin D. Exposure to sunlight outdoors every day between May and September will produce enough vitamin D to help keep bones healthy and help avoid conditions such as rickets and osteoporosis.

You should advise patients to:

  • Try to get 10 minutes of sun exposure to bare skin, once or twice a day, without sunscreen;
  • Always take care not to burn, especially during the strong sunshine in the middle of the day.

There are concerns some groups of people are still getting inadequate vitamin D, and worrying reports of the return of rickets in children.

There is ongoing debate about:

  • The definition of “sufficiency”, as there is no agreement about the absolute level that needs to be achieved;
  • Which patients need a blood test to determine serum levels of the vitamin;
  • When supplements are required;
  • The recommended dose.

There is also discussion about whether vitamin D has potential broader health benefits beyond that of healthy bones; however, the evidence is far from conclusive and more research is needed (Theodoratou et al, 2014).

Resources

The National Osteoporosis Society has produced a guidance document reflecting expert views on the clinical management of vitamin D deficiency (National Osteoporosis Society, 2013). A comprehensive patient education leaflet has also been produced by the charity explaining the elements of healthy living for strong bones, including how to get sufficient vitamin D from sunlight. In addition, the Scientific Advisory Committee on Nutrition is re-examining the evidence in relation to vitamin D and bone health and its report is awaited with interest - it will have particular relevance for future public health messages.

Box 1. Useful links

  • National Osteoporosis Society

Healthy Bones for Strong Living, leaflet available at www.nos.org.uk

  • Nursingtimes.net

A summary of National Osteoporosis Society’s vitamin D guideline: tinyurl.com/NOS-vit-D-guide Activate your subscription to view this article

Sarah Leyland is senior osteoporosis nurse at the National Osteoporosis Society.

  • Click here for a print-friendly PDF of this article
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