New Recommendations for Taking Calcium and Vitamin D
U.S. Preventive Services Task Force Releases Latest On
Supplements and Bone Fracture in Adults
American Society for Bone and Mineral Research Responds:
Supplements for healthy adults may not be necessary for bone health,
but supplements needed to protect from fracture in high risk elderly
WASHINGTON, D.C., February 25, 2013 – The U.S. Preventive Services Task Force (USPSTF), today, will release new recommendations for the use of the combination of vitamin D and calcium supplements to prevent bone fractures.
The task force statement, “Vitamin D and Calcium Supplementation to Prevent Fractures in Adults,” suggests there is not enough evidence, one way or the other, about how supplements affect bone fractures for men and premenopausal women. It also states 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 does not offer recommendations for men or women with osteoporosis or with vitamin D deficiency.
The USPSTF’s recommendations differ from the 2010 Institute of Medicine’s (IOM) findings, primarily because these recommendations are based only on fracture outcomes, while the IOM 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 ASBMR continues to support the recommendations of the IOM because they are based on a broader evaluation of the data rather than only fracture outcomes,” says Sundeep Khosla, M.D., past president of the ASBMR and a practicing endocrinologist and research scientist at the Mayo Clinic at Rochester, Minn.
The ASBMR has long supported that calcium and vitamin D are important to bone health and the best way to get them is through food that is naturally rich in these supplements. Calcium and vitamin D are the most crucial, yet simple, first steps in promoting good bone health.
“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 high risk elderly, the recommended daily intake is 800 units of vitamin D and 1,200 milligrams of calcium.
The recommended daily intake for healthy adults is 600 units of vitamin D3 and 1,000 milligrams of calcium. The best sources of calcium and vitamin D are food – milk, yogurt, cheese, and fortified foods and juices. Supplements can help provide the full recommended daily amounts when patients for one reason or another cannot reach those levels with food alone. But side effects of supplements can include kidney stones.
A one-cup serving of most dairy products contains 200-300 mg of calcium. Gender, age, health status and diet impact how much calcium and vitamin D a person needs and the available data can be confusing for patients and clinicians.
“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.
About the American Society for Bone and Mineral Research
The American Society for Bone and Mineral Research (ASBMR) is the premier professional, scientific and medical society established to promote excellence in bone and mineral research and to facilitate the translation of that research into clinical practice. The ASBMR has a membership of nearly 4,000 physicians, basic research scientists, and clinical investigators from around the world.
About the U.S. Preventive Services Task Force
The U.S. Preventive Services Task Force (USPSTF), sponsored by the Agency for Healthcare Research and Quality (AHRQ), is the leading independent panel of private-sector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the "gold standard" for clinical preventive services.