What Now on Calcium and Vitamin D Pills?


After years of touting calcium and vitamin D supplements for your bones, lately it seems the medical establishment has taken a U-turn-leaving many people who are concerned about osteoporosis confused. The US Preventive Services Task Force (USPSTF) recently made headlines by weighing in against low-dose supplements for the prevention of fractures in postmeno-pausal women-and to say the evidence is lacking to endorse higher doses. The task force is an independent expert panel that works to improve Americans health by making evidence-based recommenda-tions about preventive medicine.

But Bess Dawson-Hughes, MD, direc-tor of Tufts HNRCA Bone Metabolism Laboratory, says to stick with previous expert recommendations. For calcium, that means meeting the RDA (see box) set by the Institute of Medicine (IOM), to the greatest extent possible from food sources, using supplements only as needed to fill the gap.

As for vitamin D, Dr. Dawson-Hughes says, The USPSTF is the outlier in data synthesis and interpretation on this issue. Other expert groups and individuals, including the IOM, Endocrine Society, the National and International Osteopo-rosis Foundations and many others, have reviewed the same evidence that the USP-STF had access to-no more and no less-and reached the conclusion that vitamin D lowers fracture risk. There is some lack of consensus about the dose and blood lev-els that are optimal, but no disagreement about whether D lowers fracture risk.

TASK FORCE CONCLUSIONS:What exactly did the task force conclude? The USP-STFs final recommendations were:

  • Daily supplements of less than 400 IU of vitamin D and less than 1,000 mg of calcium for postmenopausal women are not recommended, because of a lack of evidence of benefit against fractures and a slight increase in risk of kidney stones.
  • The current evidence is insufficient to make a recommendation on daily supple-ments in higher doses for the prevention of fractures in postmenopausal women.
  • The current evidence is also insuf-ficient to make a recommendation on vitamin D and calcium supplements to prevent fractures in men and premeno-pausal women.

Vitamin D and calcium are known to play an important role in maintaining health, including bone health. However, despite the large number of studies done there are few conclusive answers about the ability of vitamin D and calcium supplements to prevent fractures, stated task force chair Virginia Moyer, MD.

WHAT YOU SHOULD DO: The recommen-dations, published in Annals of Internal Medicine, do not apply to patients already diagnosed with osteoporosis, who have a history of fractures, or who reside in an assisted-living community. In 2012, the task force recommended that older adults with a history of falls who suffer from vitamin D deficiency take supplements to strengthen muscles and improve balance.

That earlier advice is at odds with the latest report, notes Dr. Dawson-Hughes, since falls and fractures are of course related. She adds, Personally, I agree that 400 IU is an ineffective dose, but disagree that there is no evidence that higher doses of vitamin D (700-1,000 IU per day) lower fracture risk.

As for calcium, while meeting the RDA mostly through your diet, Dr. Daw-son-Hughes cautions, Id avoid exceeding the RDA. There is no known benefit to exceeding it and there may be increased risk of adverse events, however small.


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