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USPSTF: Taking Vitamin D and Calcium Doesn’t Prevent Fractures in Older Women

USPSTF: Taking Vitamin D and Calcium Doesn’t Prevent Fractures in Older Women Supplementation with lower-dose vitamin D and calcium is not an effective fracture prevention strategy for healthy postmenopausal woman, according to a draft recommendation from the US Preventive Services Task Force (USPSTF). The task force recommends that healthy postmenopausal women should not take such supplements for this purpose. The recommendation is based on a USPSTF review of the evidence, which found that the data to date do not demonstrate that supplementation with lower daily doses of vitamin D (400 IU of vitamin D3 or less) and calcium (1000 mg calcium carbonate) prevent fractures in postmenopausal women who don't have other underlying health issues (http://tinyurl.com/3wuyzdm). In addition to not having the intended benefit, such supplementation also increased the risk of developing kidney stones. According to the USPSTF, 1 in 273 women who take these lower-dose vitamin D and calcium supplements for 7 years will develop kidney stones. “Kidney stones can be a problem,” explained Timothy Wilt, MD, a member of the USPSTF. “They can be painful and may lead to other problems.” The task force found insufficient evidence to determine whether lower-dose vitamin D and calcium supplementation prevents fractures in younger women or men. Questions also remain about the utility of higher doses of vitamin D. (Photo credit: Alison E. Burke/AMA) The largest and best-quality clinical trial considered by the USPSTF was the Women's Health Initiative (WHI), which included 36 282 healthy postmenopausal women and found no reduction in hip fractures or total fractures among women who used vitamin D and calcium supplements vs those who didn’t. In its review of the evidence, however, the USPSTF noted that the dose of vitamin D (400 IU of vitamin D3) would be considered low by today's clinical standards. Wilt, who is also a professor at the University of Minnesota and a staff physician at the Minneapolis VA Medical Center, said the jury is still out on the utility of higher supplement doses for preventing fractures. Although vitamin D and calcium supplementation may not be living up to clinicians' hopes, Wilt said it remains important for individuals to maintain adequate levels of these nutrients, both through their diet and by spending time in the sun to promote vitamin D synthesis by the body. “We recognize the importance of vitamin D and calcium in overall bone health,” he said. A reassuring finding came from a 2011 report by the Institute of Medicine (IOM): most US individuals get enough of these 2 nutrients through diet and sun exposure (Slomski A. JAMA. 2011;305[5]:453-456). In fact, many US individuals may be getting too much of these nutrients as a result of supplementation, the IOM has noted. In addition to kidney stones, excess calcium intake has been linked to hypercalcemia, hypercalcinuria, vascular and soft tissue calcification, unfavorable interactions involving iron and zinc, and constipation. Excess vitamin D intake has been associated with vitamin D toxicity and related hypercalcemia and hypercalcinuria. The USPSTF found insufficient evidence to determine whether vitamin D and calcium supplementation may prevent cancer in any age group of men or women. The IOM has also concluded that there are insufficient data to support increased vitamin D and calcium intake to prevent cancer or other conditions, such as cardiovascular disease, diabetes, immune dysfunction, multiple sclerosis, and preeclampsia. Both the IOM and USPSTF, however, note that some populations may benefit from vitamin D and calcium supplementation. For example, previously the USPSTF has recommended vitamin D supplementation as an effective therapy for the prevention of falls in community-dwelling individuals who are 65 years of age or older and at increased risk of falls (http://tinyurl.com/6ovdmzc). But JoAnn Manson, MD, a WHI principal investigator and chief of preventive medicine at Brigham and Women's Hospital in Boston, argued that several lines of evidence from that study do suggest calcium and vitamin D supplementation may improve bone health. For instance, a subgroup of women older than 60 years who took these supplements had a lower risk of fracture compared with those taking placebos. Women of all ages who took the supplements also had better bone density. She said some women may not get enough of these nutrients through diet alone and may need to supplement. However, she noted that some women may be taking larger doses than necessary. “Overall, the evidence was compelling that the supplements were of benefit for bone health,” she said. “But an important point is that more isn't necessarily better.” http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

USPSTF: Taking Vitamin D and Calcium Doesn’t Prevent Fractures in Older Women

JAMA , Volume 308 (3) – Jul 18, 2012

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Publisher
American Medical Association
Copyright
Copyright © 2012 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2012.7955
Publisher site
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Abstract

Supplementation with lower-dose vitamin D and calcium is not an effective fracture prevention strategy for healthy postmenopausal woman, according to a draft recommendation from the US Preventive Services Task Force (USPSTF). The task force recommends that healthy postmenopausal women should not take such supplements for this purpose. The recommendation is based on a USPSTF review of the evidence, which found that the data to date do not demonstrate that supplementation with lower daily doses of vitamin D (400 IU of vitamin D3 or less) and calcium (1000 mg calcium carbonate) prevent fractures in postmenopausal women who don't have other underlying health issues (http://tinyurl.com/3wuyzdm). In addition to not having the intended benefit, such supplementation also increased the risk of developing kidney stones. According to the USPSTF, 1 in 273 women who take these lower-dose vitamin D and calcium supplements for 7 years will develop kidney stones. “Kidney stones can be a problem,” explained Timothy Wilt, MD, a member of the USPSTF. “They can be painful and may lead to other problems.” The task force found insufficient evidence to determine whether lower-dose vitamin D and calcium supplementation prevents fractures in younger women or men. Questions also remain about the utility of higher doses of vitamin D. (Photo credit: Alison E. Burke/AMA) The largest and best-quality clinical trial considered by the USPSTF was the Women's Health Initiative (WHI), which included 36 282 healthy postmenopausal women and found no reduction in hip fractures or total fractures among women who used vitamin D and calcium supplements vs those who didn’t. In its review of the evidence, however, the USPSTF noted that the dose of vitamin D (400 IU of vitamin D3) would be considered low by today's clinical standards. Wilt, who is also a professor at the University of Minnesota and a staff physician at the Minneapolis VA Medical Center, said the jury is still out on the utility of higher supplement doses for preventing fractures. Although vitamin D and calcium supplementation may not be living up to clinicians' hopes, Wilt said it remains important for individuals to maintain adequate levels of these nutrients, both through their diet and by spending time in the sun to promote vitamin D synthesis by the body. “We recognize the importance of vitamin D and calcium in overall bone health,” he said. A reassuring finding came from a 2011 report by the Institute of Medicine (IOM): most US individuals get enough of these 2 nutrients through diet and sun exposure (Slomski A. JAMA. 2011;305[5]:453-456). In fact, many US individuals may be getting too much of these nutrients as a result of supplementation, the IOM has noted. In addition to kidney stones, excess calcium intake has been linked to hypercalcemia, hypercalcinuria, vascular and soft tissue calcification, unfavorable interactions involving iron and zinc, and constipation. Excess vitamin D intake has been associated with vitamin D toxicity and related hypercalcemia and hypercalcinuria. The USPSTF found insufficient evidence to determine whether vitamin D and calcium supplementation may prevent cancer in any age group of men or women. The IOM has also concluded that there are insufficient data to support increased vitamin D and calcium intake to prevent cancer or other conditions, such as cardiovascular disease, diabetes, immune dysfunction, multiple sclerosis, and preeclampsia. Both the IOM and USPSTF, however, note that some populations may benefit from vitamin D and calcium supplementation. For example, previously the USPSTF has recommended vitamin D supplementation as an effective therapy for the prevention of falls in community-dwelling individuals who are 65 years of age or older and at increased risk of falls (http://tinyurl.com/6ovdmzc). But JoAnn Manson, MD, a WHI principal investigator and chief of preventive medicine at Brigham and Women's Hospital in Boston, argued that several lines of evidence from that study do suggest calcium and vitamin D supplementation may improve bone health. For instance, a subgroup of women older than 60 years who took these supplements had a lower risk of fracture compared with those taking placebos. Women of all ages who took the supplements also had better bone density. She said some women may not get enough of these nutrients through diet alone and may need to supplement. However, she noted that some women may be taking larger doses than necessary. “Overall, the evidence was compelling that the supplements were of benefit for bone health,” she said. “But an important point is that more isn't necessarily better.”

Journal

JAMAAmerican Medical Association

Published: Jul 18, 2012

Keywords: calcium,fractures,vitamin d,older adult,united states preventive services task force

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