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The US Preventive Services Task Force (USPSTF) has recently published recommendations on vitamin D and calcium supplements for preventing bone fractures in adults.
The Role of Vitamin D and Calcium in Bone Health
Calcium is an essential mineral for many body functions, including building and maintaining healthy bones. Human bodies do not make calcium; they get it from food or supplements. Because bones are constantly being broken down and rebuilt, calcium is needed throughout life. Vitamin D also is essential for bone health, mostly because it helps ingested calcium be absorbed from the intestine. Most vitamin D in the body is made by the skin in response to sunlight, but it can also be absorbed from food and supplements.
Bone Density and Fracture Risk
As people age, the rate of bone breakdown starts to overtake the rate of bone building. In women, a major reason is a decrease in estrogen levels during menopause. Over time, this can lead to low bone density (weak bones). Eventually, it can cause osteoporosis (porous bones). People with osteoporosis are more likely to have bone fractures, especially after trauma such as a fall. Getting enough vitamin D and calcium through food earlier in life can decrease the risk of developing osteoporosis later in life. However, the role of taking vitamin D and calcium supplements is less clear.
What Is the Population Under Consideration for Taking Vitamin D and Calcium Supplements to Prevent Fractures?
This recommendation applies to adults with no known osteoporosis or vitamin D deficiency, no history of osteoporotic bone fractures, and no increased risk of falls and who live in the community (not in a nursing home or other institutional care setting).
What Are the Potential Benefits and Harms of Taking Vitamin D and Calcium Supplements to Prevent Fractures?
The possible benefit of taking vitamin D and calcium supplements is that it helps prevent osteoporosis, thereby decreasing bone fractures. However, there is currently not enough evidence to say that this is the case for most older adults. Evidence does show that taking lower doses of vitamin D and calcium (≤400 IU of vitamin D and ≤1000 mg of calcium daily) does not prevent fractures in postmenopausal women. Potential harms of taking combined vitamin D and calcium supplements include a small increased risk of kidney stones. The possible link between vitamin D and calcium supplementation and cardiovascular disease outcomes is controversial, but no studies have shown a direct link between them.
How Strong Is the Recommendation to Take Vitamin D and Calcium Supplements to Prevent Fractures?
For men and women who have not gone through menopause, there is not enough evidence to weigh the benefits and harms of taking vitamin D and calcium supplements for preventing fractures. For postmenopausal women, there is not enough evidence to weigh the benefits and harms of taking >400 IU of vitamin D and >1000 mg of calcium daily, but there is some evidence that taking ≤400 IU of vitamin D and ≤1000 mg of calcium daily has no net benefit for preventing fractures.
Bottom Line: Current Recommendation for Taking Vitamin D and Calcium Supplements to Prevent Fractures
The USPSTF concludes that for community-dwelling men and premenopausal women, there is insufficient evidence to assess the balance of benefits and harms of vitamin D and calcium supplementation, alone or combined, for the prevention of fractures (“I” statement). For postmenopausal women, the USPSTF recommends against taking ≤400 IU of vitamin D and ≤1000 mg of calcium daily for preventing fractures (“D” statement). For postmenopausal women, there is insufficient evidence for taking >400 IU of vitamin D and >1000 mg of calcium daily for preventing fractures (“I” statement).
Source: US Preventive Services Task Force. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults [published online April 17, 2018]. JAMA. doi:10.1001/jama.2018.3185
Topic: Preventive Medicine
Jin J. Vitamin D and Calcium Supplements for Preventing Fractures. JAMA. 2018;319(15):1630. doi:10.1001/jama.2018.3892
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