Importance: Because of the aging population, osteoporotic fractures are an increasingly important cause of morbidity and mortality in the United States. Approximately 2 million osteoporotic fractures occurred in the United States in 2005, and annual incidence is projected to increase to more than 3 million fractures by 2025. Within 1 year of experiencing a hip fracture, many patients are unable to walk independently, more than half require assistance with activities of daily living, and 20% to 30% of patients will die.
Objective: To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on vitamin D supplementation, with or without calcium, to prevent fractures.
Evidence Review: The USPSTF reviewed the evidence on vitamin D, calcium, and combined supplementation for the primary prevention of fractures in community-dwelling adults (defined as not living in a nursing home or other institutional care setting). The review excluded studies conducted in populations with a known disorder related to bone metabolism (eg, osteoporosis or vitamin D deficiency), taking medications known to be associated with osteoporosis (eg, long-term steroids), or with a previous fracture.
Findings: The USPSTF found inadequate evidence to estimate the benefits of vitamin D, calcium, or combined supplementation to prevent fractures in community-dwelling men and premenopausal women. The USPSTF found adequate evidence that daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium has no benefit for the primary prevention of fractures in community-dwelling, postmenopausal women. The USPSTF found inadequate evidence to estimate the benefits of doses greater than 400 IU of vitamin D or greater than 1000 mg of calcium to prevent fractures in community-dwelling postmenopausal women. The USPSTF found adequate evidence that supplementation with vitamin D and calcium increases the incidence of kidney stones.
Conclusions and Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of vitamin D and calcium supplementation, alone or combined, for the primary prevention of fractures in community-dwelling, asymptomatic men and premenopausal women. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of daily supplementation with doses greater than 400 IU of vitamin D and greater than 1000 mg of calcium for the primary prevention of fractures in community-dwelling, postmenopausal women. (I statement) The USPSTF recommends against daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium for the primary prevention of fractures in community-dwelling, postmenopausal women. (D recommendation) These recommendations do not apply to persons with a history of osteoporotic fractures, increased risk for falls, or a diagnosis of osteoporosis or vitamin D deficiency.
Very controversial and goes against the common conception in general practice of routinely recommending vitamin D and calcium in the general population (and not the at-risk groups).
This does not address its use in osteopenia.
Hedging on "those with low Vit D levels" unfortunately is not helpful, since by current standards this applies to at least 50% of adults. However, it is highly likely the current "sufficient" threshold is incorrect and should be lowered from 20 to 12.
The entire supplementation literature is hopping. Vit D was the panacea for several years and now, not so much.
Most of the patients I see are at increased risk for falls or they've had a fragility fracture, so these recommendations don't apply to the patients in my clinical practice.
‘Calcium and D supplementation for post-menopausal women; ‘In for a penny, in for a pound’. As with many expert guidelines (e.g., hypertension, diabetes, and bone health), as the fields advance, recommendations change. This well designed and executed analysis leaves more questions than it answers. Most authorities recommend at least 800IU of vitamin D3 and 1,500mg calcium for post-menopausal women, so this analysis that demonstrates that it is not beneficial to under-dose with less than 400IU and 1,000mg, respectively, is of little help. My best synthesis of the literature is to encourage meeting the requirements with dietary calcium first, if tolerated, plus at least 800IU of vitamin D. But ask me again next year.
This sets a standard for a very common problem.
The clinical information reported may not be very compelling in that it simply states that evidence is not yet sufficient to recommend calcium/vitamin D supplementation (or not). This has limited clinical usefulness.
Useful information that suggests that long-term accepted therapies often have little to no scientific data to support their use and require physicians to change the information given to their patients.
These recommendations change as new studies are completed. Risk for kidney stones again is shown.