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Sorting Out Confusion Over Calcium and Vitamin D Supplements

February 28, 2013

In another controversial finding, the U.S. Preventive Services Task Force (USPSTF), sponsored by the Agency for Healthcare Research and Quality and the leading independent panel of private-sector experts in prevention and primary care, just released new recommendations for the use of the combination of vitamin D and calcium supplements to prevent bone fractures.

The task force statement, titled “Vitamin D and Calcium Supplementation to Prevent Fractures in Adults,” suggests there is not enough positive or negative evidence about how supplements affect bone fractures for men and premenopausal women to endorse them as a preventive treatment and that there is insufficient evidence to suggest that vitamin D and calcium supplements are effective at reducing bone fractures in healthy postmenopausal women. The USPSTF report doesn’t address recommendations for men or women with osteoporosis or with vitamin D deficiency.

This is undoubtedly confusing for the many women in particular who have been told by their primary care physician or ob-gyn to start supplementing these vital nutrients in an effort to prevent bone thinning, osteoporosis and bone fractures, rather than waiting for a fracture to start supplements.

The American Society for Bone and Mineral Research (ASBMR), the professional, scientific and medical society established to bring together clinical and experimental scientists involved in the study of bone and mineral metabolism, issued a response to the USPSTF report, stating it will continue to support the 2010 recommendations of the Institute of Medicine’s (IOM) findings. The IOM guidelines included an examination of the underlying biology of the impact of calcium and vitamin D, such as calcium absorption, which may affect fracture risk as people age. The USPSTF recommendations are based only on fracture outcomes.

One point that most organizations agree on—and numerous research findings support—is that calcium and vitamin D are vital to bone health and the best way to get them is naturally through food rich in these nutrients. Dairy and green leafy greens offer calcium—a one-cup serving of most dairy products contains 200-300 mg of calcium and many products are fortified with D3. Vitamin D is harder to get I naturally from food. It’s in egg yolks, for instance, but eggs are often discouraged because of their cholesterol content. On the other hand, just 10-20 minutes in the sun enables your body to create vitamin D.

“Research has shown us that healthy adults who are receiving the recommended amount of calcium and vitamin D in their diet and through sunlight exposure, need not take supplements for bone health,” says Cliff Rosen, MD, Past President of ASBMR and Director of Clinical and Translational Research and a Senior Scientist at Maine Medical Center's Research Institute in Scarborough, Maine. “But the report leaves out a crucial and large population – the elderly, especially those at high risk for fractures in assisted living and nursing home facilities. This population has less exposure to sunlight and is at high risk for hip fracture. They should be receiving supplements. The evidence generally supports benefits of calcium and vitamin D for building strong skeletons and preventing fractures and bone loss in high risk, elderly individuals.”

For the high-risk elderly, the recommended daily intake is 800 units of vitamin D3 and 1,200 milligrams of calcium; for healthy adults it’s 600 units of vitamin D3 and 1,000 milligrams of calcium. Supplements can help provide the full recommended daily amounts if you can’t reach those levels with food (or sunlight) alone.

“Further research is needed, so for now, the best advice for doctors and their patients is to discuss the best strategy for each patient, putting supplements as the last resort for healthy adults if they cannot reach recommended levels through the intake of calcium and vitamins rich foods,” Rosen says.