Vitamin D and Calcium Supplementation to Prevent Fractures in Adults (US Guidelines - Feb. 2013)


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Vitamin D and Calcium Supplementation to Prevent Fractures in Adults (US Guidelines - Feb. 2013)

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Vitamin D and Calcium Supplementation to Prevent Fractures in Adults (US Guidelines - Feb. 2013)

  1. 1. Vitamin D and Calcium Supplementation to Prevent Fractures inAdults: U.S. Preventive Services Task Force RecommendationStatementThe full report is titled “VitaminD and Calcium Supplementationto Prevent Fractures in Adults:U.S. Preventive Services TaskForce RecommendationStatement.” It is in the 7 May2013 issue of Annals of InternalMedicine (volume 158, pages691-696). The authors are V.A.Moyer, for the U.S. PreventiveServices Task Force.This article was published at on 26 February 2013.Who developed these guidelines?The U.S. Preventive Services Task Force (USPSTF) is a group of experts that makesrecommendations about preventive health care.What is the problem and what is known about it so far?Vitamin D and calcium are known to be important for strong, healthy bones. Both comefrom certain foods, and vitamin D is also produced in the body after exposure to sun-light. However, many Americans have lower intake or levels of these substances thanrecommended. This is concerning because low vitamin D and calcium levels put people atrisk for osteoporosis and bone fractures. Fractures, especially hip fractures, are associatedwith pain, disability, loss of independence, and death. For that reason, many people takevitamin D and calcium supplements with the hope of preventing fractures. However,although vitamin D and calcium supplements are helpful for adults known to haveosteoporosis, whether they are helpful in adults who do not have osteoporosis is not clear.It is important to note that the risk for osteoporosis and fractures is higher in women aftermenopause than in premenopausal women. This means that the same recommendationsmight not apply to both groups of women.How did the USPSTF develop these recommendations?The USPSTF reviewed studies about the benefits and harms of vitamin D and calciumsupplementation when taken to prevent fractures in adults who do not have knownosteoporosis.What did the authors find?Appropriate intake of vitamin D and calcium are essential to overall health. However,there is not enough evidence to determine the effect of combined vitamin D and calciumsupplementation on fractures in men or premenopausal women. However, there is goodevidence that daily supplementation with 400 IU of vitamin D3 and 1000 mg of calciumhas no effect on the incidence of fractures in postmenopausal women. The benefits andharms of higher doses taken to prevent fractures in postmenopausal women who do notlive in institutions are not well-defined. Supplementation with 400 IU or less of vitaminD3 and 1000 mg or less of calcium is associated with a small risk for kidney stones.What does the USPSTF recommend that patients and doctors do?It remains unclear whether men and premenopausal women who are not known to haveosteoporosis or vitamin D deficiency should take vitamin D and calcium supplements toprevent fractures.It remains unclear whether postmenopausal women living outside of institutions, suchas nursing homes, should take daily supplements containing more than 400 IU of vitaminD3 and more than 1000 mg of calcium.Postmenopausal women who live outside of institutions, such as nursing homes,should not take daily doses of 400 IU or less of vitamin D3 and 1000 mg or less ofcalcium.What are the cautions related to these recommendations?These recommendations do not apply to adults with known osteoporosis or vitamin Ddeficiency. There may be other reasons to take these supplements aside from fractureprevention. For example, the USPSTF recommends vitamin D supplements to preventfalls in older adults.Annals of Internal Medicine Summaries for PatientsI-36 © 2013 American College of PhysiciansSummaries for Patients are a serviceprovided by Annals to help patientsbetter understand the complicatedand often mystifying language ofmodern medicine.Summaries for Patients are presented for infor-mational purposes only. These summaries arenot a substitute for advice from your ownmedical provider. If you have questions aboutthis material, or need medical advice aboutyour own health or situation, please contactyour physician. The summaries may be repro-duced for not-for-profit educational purposesonly. Any other uses must be approved by theAmerican College of Physicians.Downloaded From: on 05/11/2013