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Tanning is associated with optimal vitamin D status (serum 25-hydroxyvitamin D concentration) and higher bone mineral density -- Tangpricha et al. 80 (6): 1645 -- American Journal of Clinical Nutrition

Tanning is associated with optimal vitamin D status (serum 25-hydroxyvitamin D concentration) and higher bone mineral density -- Tangpricha et al. 80 (6): 1645 -- American Journal of Clinical Nutrition

ABSTRACT
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ABSTRACT
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION
REFERENCES


Background: Vitamin D is made in the skin on exposure to solar radiation, and it is necessary to optimal skeletal health. Subjects who use a tanning bed that emits ultraviolet B radiation (290–315 nm) are likely to have higher 25-hydroxyvitamin D [25(OH)D] concentrations than do subjects who do not regularly use a tanning bed.

Objective: The first objective of this study was to ascertain whether subjects who regularly use a tanning bed have higher 25(OH)D concentrations than do subjects who do not use a tanning bed. The second objective was to ascertain whether higher 25(OH)D concentrations correlated positively with bone mineral density.

Design: This cross-sectional analysis examined 50 subjects who used a tanning bed at least once a week and 106 control subjects. Each subject gave a blood specimen for measurement of serum 25(OH)D and parathyroid hormone concentrations. Each subject underwent bone mineral density testing of the hip and spine.

Results: Subjects who used a tanning bed had serum 25(OH)D concentrations 90% higher than those of control subjects (115.5 ± 8.0 and 60.3 ± 3.0 nmol/L, respectively; P < 0.001). Subjects who used a tanning bed had parathyroid hormone concentrations 18% lower than those of control subjects (21.4 ± 1.0 and 25.3 ± 0.8 pg/mL, respectively; P = 0.01). Tanners had significantly higher BMD and z scores at the total hip than did nontanners. Conclusion: The regular use of a tanning bed that emits vitamin D–producing ultraviolet radiation is associated with higher 25(OH)D concentrations and thus may have a benefit for the skeleton. Key Words: Vitamin D deficiency • secondary hyperparathyroidism • vitamin D • bone mineral density • bone mineral content • tanning

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Adults who used a tanning bed had 90% higher serum 25(OH)D and 18% lower PTH concentrations than did adults who did not use a tanning bed. The prevalence of vitamin D deficiency [25(OH)D 50 nmol/L] was significantly lower in the tanners (8%) than in the nontanners (41.5%) at the end of the winter. Tanners also had significantly higher BMD at the hip than did the nontanners, which confirms the findings of Bischoff et al (8). There was a small but nonsignificant positive relation between serum 25(OH)D concentrations and BMD at the hip and spine. These findings have important clinical implications. The increased public awareness of the negative effect of sunlight in causing skin cancer has resulted in the fact that many adults and children always wear sun protection or completely avoid sunlight exposure. A lack of sunlight exposure can result in vitamin D deficiency. Humans produce most of the vitamin D found in the circulation in the skin through exposure to sunlight (2, 3), and adults who spend most of their time indoors are at risk of vitamin D deficiency (15–18, 20, 21, 23–26). Nursing home residents, medical inpatients, institutionalized persons, and blacks are at highest risk of vitamin D deficiency (18, 23–28). Subjects living in northern latitudes have low production of vitamin D in the skin because even the zenith of the angle of the sun's rays does not allow for cutaneous vitamin D3 production (2, 3, 15, 17, 28). In addition, increased pigmentation (27–29) or the wearing of clothing that largely covers the body (30–32) impairs the production of vitamin D3 in the skin. The regular use of sunscreens can also result in vitamin D deficiency (33): sunscreen with an SPF > 8 can reduce the production of vitamin D in the skin by as much as 95% (2, 14).

Young adults are also at risk of vitamin D deficiency because of inadequate sunlight exposure that results from greater pursuit of indoor activities, greater use of sunscreen because of fear of skin cancer (34, 35), and less consumption of vitamin D–fortified milk (15, 36, 37) than were seen in previous generations. A recent survey of young adults living in Boston found that 36% of young adults were vitamin D deficient, even though many took a multivitamin and drank a glass of milk daily (15). African American adolescents and white preteen girls are also at risk for vitamin D deficiency (37, 38).

Vitamin D is important to bone mineralization because of its role in the maintenance of adequate serum calcium and phosphorus concentrations (2, 3). Vitamin D deficiency results in osteomalacia in adults and is a frequent source of occult muscle and bone pain (39–41). There is increasing evidence that vitamin D can protect against the development of many chronic diseases, including type 1 diabetes mellitus, hypertension, cardiovascular disease, common cancers, multiple sclerosis, and rheumatoid arthritis (2, 3).

The use of tanning beds has been promoted to the public for the cosmetic purpose of tanning, but this study shows that a moderate use of tanning beds may also provide some medical benefit. Higher concentrations of 25(OH)D throughout the year may have a significant effect in enhancing intestinal calcium absorption and improving bone health (7, 8, 42). Blood concentrations of 25(OH)D in tanners are > 75 nmol/L, which is considered to be necessary for maximum intestinal calcium transport (23, 42). This may explain why higher serum 25(OH)D concentrations are associated with higher bone density. There is mounting evidence that a healthy concentration of 25(OH)D (ie, >75 nmol/L) may reduce the risk of colon, breast, and prostate cancers, hypertension, and autoimmune diseases (2, 3, 39–42).

In conclusion, the regular use of a tanning bed results in higher 25(OH)D concentrations and prevents increased seasonal prevalence of vitamin D deficiency during the winter. The subjects who had used tanning beds for a mean of 5 y had higher BMD at the hip than did the nontanners (control subjects). Larger studies should be conducted to investigate the potential positive effect of chronic use of tanning beds on vitamin D status and bone health.

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