Toss the Vitamin D and Calcium?

Vitamin D and calcium supplements do not reduce fracture risk in those at low fall risk

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Preventing the risk of fractures as you grow older is important. Previously, vitamin D and calcium supplements were thought to help reduce that risk – but recommendations have changed.

The US Preventive Services Task Force reviewed the evidence on vitamin D and calcium supplements.

The Task Force found that there is not enough evidence to recommend daily vitamin D or calcium in men or women to prevent first-time bone fractures.

The Task Force actually recommends against vitamin D in daily doses of 400 IU or less and calcium in daily doses of 1000 mg or less because it can increase the risk of kidney stones. At those doses, supplements do not prevent fractures in younger men and women.

However, the Task Force continues to recommend vitamin D supplements to prevent falls in adults 65 and older who are at higher risk for falls.

"Ask a pharmacist about vitamins and supplements."

The clinical guidelines report, authored by Virginia A. Moyer, MD, MPH, chair of the US Preventive Services Task Force, relied on two systematic evidence reviews and a meta-analysis on taking vitamin D supplements both with and without calcium.

Systematic evidence reviews are research projects that review all the available evidence on a particular question and assess the quality of the findings and conclusions.

A meta-analysis is a study that combines the results of all the studies together and looks at the evidence as a whole.

The Task Force found that daily supplements of vitamin D at 400 IU or less and calcium at 1000 mg or less do not help prevent first-time fractures in older women (post-menopause).

At these lower doses, the Task Force found there was a higher likelihood that people taking the supplements might develop kidney stones.

The Task Force also reviewed the evidence for taking higher doses of vitamin D and calcium. However, there wasn't enough evidence to determine if higher doses could benefit post-menopausal women or cause possible harms.

When the Task Force looked at vitamin D and calcium supplements in men and in younger women (before menopause), they again did not find enough evidence to make a recommendation for or against the supplements.

These recommendations refer only to adults who live on their own (not in a nursing home or similar care facility), do not have symptoms of fractures and are not at risk for falling down.

Basically, right now, there isn't enough evidence to know what the positive and negative effects of taking daily vitamin D and calcium are for people who are not at risk for falls.

The Task Force continues to recommend that women age 65 and older get screened for osteoporosis. Younger women who have a higher risk for fractures should also be screened for osteoporosis.

Osteoporosis is a disease that causes bones to become brittle and easily break, even from simple stresses like coughing or bending over.

The Task Force also continues to recommend that adults aged 65 and older who are at higher risk for falls should take vitamin D supplements to prevent falls.

"Vitamin D does many things we didn't know it could do," said Dr. Moyer. "It actually appears to be related to balance, so what happens is you're less likely to fall with the vitamin D."

The Task Force noted in their report that the Institute of Medicine and the World Health Organization both have recommended standards for adults to get enough daily calcium and vitamin D for general health. Neither of these organizations has looked at these supplements for preventing fractures.

Donnie Calhoun, the president and a pharmacist at Golden Springs Pharmacy in Anniston, Alabama, and a dailyRx expert, said he agrees that patients at risk for falls should take appropriate doses of calcium and vitamin D, though recognizing that vitamin D in low doses can increase the risk of kidney stones in those prone to them.

"I would say however, that the majority of Americans who don't have a healthy diet, need to take multiple vitamins which usually have the minimum daily recommended doses of these two nutrients," Dr. Calhoun said.

"It is very important that proper nutrition is available through diet and supplementation," he said. "Each individuals should consult with their doctor or pharmacist for help with their personal nutrition needs."

The clinical guidelines were published by the US Preventive Services Task Force in the February 26 issue of the Annals of Internal Medicine. The US Preventive Services Task Force is a volunteer service, and the only support comes from the Agency for Healthcare Research and Quality through the US Congress. The authors declared no conflicts of interest.

Reviewed by: 
Review Date: 
February 22, 2013
Last Updated:
March 4, 2013