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Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It?

by Ian R Reid 1,2,* and Mark J Bolland 1,2
Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand
Auckland District Health Board, Auckland 1051, New Zealand
Author to whom correspondence should be addressed.
Nutrients 2020, 12(4), 1011;
Received: 9 March 2020 / Revised: 30 March 2020 / Accepted: 1 April 2020 / Published: 7 April 2020
(This article belongs to the Special Issue Osteoporosis Prevention and Nutrition)
Vitamin D and calcium have different biological functions, so the need for supplementation, and its safety and efficacy, need to be evaluated for each separately. Vitamin D deficiency is usually the result of low sunlight exposure (e.g., in frail older people, those who are veiled, those with dark-skin living at higher latitudes) and is reversible with calciferol 400–800 IU/day. Calcium supplements produce a 1% increase in bone density in the first year of use, without further increases subsequently. Vitamin D supplements do not improve bone density in clinical trials except in analyses of subgroups with baseline levels of 25-hydroxyvitamin D <30 nmol/L. Supplementation with calcium, vitamin D, or their combination does not prevent fractures in community-dwelling adults, but a large study in vitamin D-deficient nursing home residents did demonstrate fracture prevention. When treating osteoporosis, co-administration of calcium with anti-resorptive drugs has not been shown to impact on treatment efficacy. Correction of severe vitamin D deficiency (<25 nmol/L) is necessary before use of potent anti-resorptive drugs to avoid hypocalcemia. Calcium supplements cause gastrointestinal side effects, particularly constipation, and increase the risk of kidney stones and, probably, heart attacks by about 20%. Low-dose vitamin D is safe, but doses >4000 IU/day have been associated with more falls and fractures. Current evidence does not support use of either calcium or vitamin D supplements in healthy community-dwelling adults. View Full-Text
Keywords: calcium; vitamin D; osteoporosis; bisphosphonate calcium; vitamin D; osteoporosis; bisphosphonate
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Reid, I.R.; Bolland, M.J. Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It? Nutrients 2020, 12, 1011.

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