Wednesday, January 9, 2013

Vertigo, Vitamin D and Osteoporosis

If you have ever felt the world spinning around you with a loss of balance and possibly nausea and vomiting, you were having an episode of vertigo. Not something that anyone needs, most especially if you have a weakened bone structure that is vulnerable to breaking if you fall. Vertigo and the fragile bones of osteoporosis simply do not mix; combined, they are a sure recipe for disaster.

The causes of vertigo span a broad range...from an inflammation of inner-ear nerves, to medications, to tumors--so it is extremely important to have your doctor determine its exact origin.

The most common cause, and one that I see fairly regularly in my office, is benign paroxysmal positional vertigo (BPPV)--a condition linked to free floating calcium crystals in the inner ear.

   - Deep within the fluid-filled inner ear, part way between the semicircular canals and the cochlea, microscopic hair cells with attached calcium crystals wave gracefully back and forth similar to sea grass and attached barnacles in the ocean's currents. Any tilting, bouncing or turning of the head causes the crystals and hair cells to move, stimulating nerve fibers and sending messages of motion to the brain. It is through this mechanism that we are able to sense motion and maintain balance.

   - In BPPV, calcium crystals have broken away from their hair cell moorings and float into the fluid-filled tubular semicircular canals where they do not belong. Here, these crystals activate neurons haphazardly sending confusing neurological messages about body position to the brain. Simply tilting your head or rolling over in bed can set off a severe episode of vertigo.

Calcium crystals might be dislodged due to a head trauma or inner ear infection which can damage the hair cells. A third predisposing risk factor for BPPV is a disturbance in calcium metabolism, such as that seen in osteoporosis.
 
A new study reported by Jeong et al. in the Journal of Neurology demonstrates an association between BPPV and low blood levels of vitamin D. The researchers measured serum levels of vitamin D in 100 patients with BPPV and when compared to controls, found the group with BPPV to have lower vitamin D levels. They concluded that decreased vitamin D may be a risk factor for BPPV.

If you are experiencing episodes of vertigo, it is extremely important to work with your doctor to identify the cause. If the condition is identified as BPPV, have a blood test to determine vitamin D levels and, if you haven't had a recent bone density examination, it's time to get one.

BPPV is not considered to be intrinsically life-threatening. However, it can be tremendously disruptive to a person's work and social life, as well as pose a health hazard due to an increased risk of falls associated with dizziness and imbalance. Unfortunately, BPPV and osteoporosis travel together.


Jeong S.H. et al., 2012. Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol Oct 25 [Epub ahead of print].
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