Task Force issues vitamin D and calcium supplement recommendations

The US Preventive Services Task Force (Task Force) issued its final recommendation on vitamin D and calcium supplements for the prevention of fractures, of which there are several individual recommendations for people who do not live in assisted-living or nursing homes.

·  The Task Force recommends against daily supplements of less than 400 IU of vitamin D₃ and less than 1,000 mg of calcium for the prevention of fractures in postmenopausal women.

·  The Task Force found that the current evidence is insufficient to make a recommendation on daily supplements greater than 400 IU of vitamin D₃ and greater than 1,000 mg of calcium for the prevention of fractures in postmenopausal women. 

·  The Task Force found that the current evidence is also insufficient to make a recommendation on vitamin D and calcium supplements for the prevention of fractures for men and premenopausal women.

“It’s important to remember that this recommendation applies to people who do not have a known vitamin D deficiency or osteoporosis,” said Task Force member Jessica Herzstein, MD, MPH. “Vitamin D plays a role in a wide range of general health functions, and there appears to be minimal harms in taking vitamin D supplements. Clinicians and patients may take this into consideration when determining whether to recommend or take vitamin D for general health.”

“There is concern about too much calcium for kidney stones and possible heart disease,” Cliff Rosen, MD, past president of the American Society for Bone and Mineral Research, told Formulary. “Overtreating with vitamin D in healthy individuals is very common. Most people don’t need vitamin D supplementation. The high-risk individual should be screened for osteoporosis, and then treated judiciously; 1,000 mg calcium total is enough and in high-risk individuals, 600 to 800 IU vitamin D.”          

Task Force member and chair Virginia Moyer, MD, MPH, said: “Vitamin D and calcium are known to play an important role in maintaining health, including bone health. However, despite the large number of studies done there are few conclusive answers about the ability of vitamin D and calcium supplements to prevent fractures. The Task Force has determined the evidence is inconclusive that higher doses of vitamin D and calcium supplements are effective in preventing fractures in postmenopausal women. The evidence was also inconclusive for fracture prevention in men and premenopausal women. What we do know is that doses less than or equal to 400 IU of vitamin D [or 1,000 mg of calcium] are not effective at preventing fractures in postmenopausal women.”

The Task Force’s recommendation has been published online in the Annals of Internal Medicine, as well as on the Task Force website at: http://www.uspreventiveservicestaskforce.org. A fact sheet that explains the draft recommendation statement in plain language is also available online.

Because the Task Force recognizes that vitamin D has benefits beyond the prevention of fractures, it has begun evaluating the effectiveness of screening for vitamin D deficiency. The draft research plan for this topic was posted for public comment today and is available at http://www.uspreventiveservicestaskforce.org/tfcomment.htm.