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July 2018

New Prevention Guidelines for Falls and Fractures—Looking Beyond the Letters

Author Affiliations
  • 1Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles
JAMA Intern Med. 2018;178(7):892-893. doi:10.1001/jamainternmed.2018.1809

In this week’s issue of JAMA are the updated US Preventive Services Task Force (USPSTF) recommendations on vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults1 and for falls prevention in community-dwelling adults,2 as well as accompanying evidence reports.3,4 Overall, the summary recommendations have not changed much compared with previous recommendations released in 2013 and 2012. The major change is the downgrade of the vitamin D supplementation recommendation for preventing falls from being a B grade (recommended based on high certainty of moderate benefit or on moderate certainty of moderate to substantial benefit) to a D grade (recommended against based on moderate or high certainty of no benefit or that harms outweigh the benefit). For falls prevention, exercise remains a B grade recommendation, and multifactorial interventions remains a C grade (selectively offer) recommendation. Both falls prevention recommendations are consistent with a 2017 meta-analysis of falls prevention interventions.5 Recommendations for fracture prevention have not changed, including insufficient evidence to make recommendations on calcium and vitamin D to prevent fractures in men and premenopausal and postmenopausal women. Although it is unclear whether supplementation with more than 400 IU of vitamin D and more than 1000 mg of calcium in postmenopausal women is beneficial for preventing fractures, the USPSTF recommends against (D grade) supplementing postmenopausal women with doses of 400 IU or less of vitamin D and 1000 mg or less of calcium. Of note, the USPSTF supplementation recommendations do not apply to those with previous osteoporotic fracture, with osteoporosis, or who are at risk of falls.

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