Daily vitamin D, calcium supplementation in postmenopausal women no longer recommended for prevention of fractures, USPSTF says

Daily vitamin D (≤400 IU) and calcium (1,000 mg) supplements for the primary prevention of fractures in postmenopausal women are no longer recommended as they don’t help prevent fractures and may cause harm, according to draft guidance from the US Preventive Services Task Force (USPSTF).

The task force is accepting public comments on the draft until July 10, 2012.

There are a few key points that the task force looked at, according to USPSTF member Kirsten Bibbins-Domingo, MD, PhD, associate professor of medicine at the University of California, San Francisco.

“We looked at vitamin D supplementation for the goal of preventing fractures and cancer. There’s a few pieces to that recommendation,” Dr Bibbins-Domingo told Formulary in an interview. “In postmenopausal women – what’s considered to be low-dose vitamin D at 400 IU plus 1,000 mg of calcium – is not effective at preventing fractures.”

Dr Bibbins-Domingo added that there is not enough evidence to make a firm recommendation one way or the other regarding:

• Whether or not a higher dose of vitamin D supplements plus calcium are going to prevent fractures

• Whether or not vitamin D supplements with or without calcium helps prevent cancers

• Whether or not vitamin D supplements and calcium is effective in premenopausal women or in men for the purpose of preventing fractures or cancer.

“This applies to the average healthy person making decisions about prevention. It doesn’t apply to people treating osteoporosis or those treating vitamin D deficiencies,” she said. “Earlier this year, our task force made a separate recommendation regarding how to prevent falls in elderly who are at high risk for falls, and in that recommendation we did find evidence that vitamin D recommendation does prevent falls in elderly who are at high risk for falls.”

Clearly, there is much more to osteoporosis prevention than simply calcium and/or vitamin D administration, said James M. Wooten, PharmD, associate professor, department of medicine, University of Missouri-Kansas City School of Medicine. “Evidence suggests that different patients’ types will need different therapeutic interventions. Understanding how to best assess, treat, and monitor these patients is the key,” Dr Wooten said. “This is not to say that calcium and/or vitamin D administration is unimportant for every patient but that these mainstays in osteoporosis prevention are just a small part of the treatment strategy.”

Vitamin D is an area of concern currently for many primary care clinicians, according to Megan J. Ehret, PharmD, BCPP, assistant professor, University of Connecticut, Storrs, told Formulary. “It seems that many people are having vitamin D levels drawn and clinicians don't know what to make when most people's levels are low. . . One of the challenges in research in this area is the length of time it takes to see fractures, so few long-term studies can be completed in this area.”

The USPSTF’s recommendation was in part based on evidence synthesis that was published in December in Annals of Internal Medicine.