The US Preventive Services Task Force (USPSTF) found insufficient evidence to assess the benefits and harms of vitamin D and calcium supplementation for the primary prevention of fractures in community-dwelling, asymptomatic men and premenopausal women, according to a recommendation published in JAMA.1

In addition, the task force found insufficient evidence to assess the benefits and harms of daily supplementation with doses >400 IU vitamin D and >1000 mg calcium for the primary prevention of fractures in community-dwelling, postmenopausal women. The USPSTF recommends against daily supplementation with <400 IU vitamin D and <1000 mg calcium in this population.

The task force notes that the updated recommendations do not apply to individuals with a history of osteoporotic fractures, increased risk for falls, or a diagnosis of osteoporosis or vitamin D deficiency.

The updated recommendation is consistent with the previous 2013 USPSTF recommendation on vitamin D supplementation, with or without calcium, to prevent fractures. The task force reviewed evidence on vitamin D, calcium, and combined supplementation for prevention of fractures in community-dwelling adults, defined as not living in a nursing home or other institutional care setting.

The USPSTF included 11 randomized controlled trials in the evidence report and systematic review, with a total of 51,419 adults >50 years.2 Only 1 study reported on total fracture incidence, finding that supplementation with vitamin D decreased total fracture incidence (absolute risk difference [ARD], −2.26%; 95% CI, −4.53% to 0.00%). Three trials found no significant association with hip fracture (pooled ARD, −0.01%; 95% CI, −0.80% to 0.78%). In addition, 1 trial showed that supplementation using vitamin D with calcium had no effect on total fracture incidence (ARD, −0.35%; 95% CI, −1.02% to 0.31%), and 2 trials showed no effect on hip fracture incidence.

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Evidence for supplementation with calcium alone was limited, with very imprecise results. Results also show that supplementation with vitamin D alone or with calcium had no significant effect on all-cause mortality or incident cardiovascular disease. Supplementation with vitamin D and calcium was associated with an increased incidence of kidney stones in 3 trials (pooled ARD, 0.33%; 95% CI, 0.06%-0.60%), but supplementation with calcium alone was not associated with an increased risk (pooled ARD, 0.00%; 95% CI, −0.88% to 0.87%).

“More studies are needed to more clearly determine if supplementation with vitamin D, calcium, or both consistently prevents fractures,” the task force noted. “If future evidence shows a benefit, the magnitude of that benefit will need to be weighed against the magnitude of harms caused by supplementation.”

References

  1. US Preventive Services Task Force. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: US Preventive Services Task Force recommendation statement.  JAMA. 2018;319(15):1592-1599.
  2. Kahwati LC, Weber RP, Pan H, et al. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults evidence report and systematic review for the US Preventive Services Task Force.  JAMA. 2018;319(15):1600-1612.

This article originally appeared on Rheumatology Advisor