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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
1
Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand
2
Auckland District Health Board, Auckland 1051, New Zealand
*
Author to whom correspondence should be addressed.
Nutrients 2020, 12(4), 1011; https://doi.org/10.3390/nu12041011
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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