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 Researchers examined data from 33 previous trials with a total of
more than 51,000 people aged 50 or older who were living in the
community, not in nursing homes or other institutional settings.
They found no difference in fracture risk among people who got no
treatment, a placebo or dummy pill, or vitamin D and calcium alone
or in combination.
“It is time to stop taking calcium and vitamin D supplements for the
community-dwelling older adults,” said lead study author Dr. Jia-Guo
Zhao, a researcher in the department of orthopedic surgery at
Tianjin Hospital in China.
Vitamin D helps the body use calcium to support bone health, and
many older adults are advised to take one or both of these
supplements. The recommended daily intake of vitamin D for most
adults is 600 IU (international units), or 800 IU after age 70.
“The guidelines should be changed,” Zhao said by email. “We think
that improving the lifestyle, getting enough exercise and enough
sunshine, and adjusting the diet may be more important than taking
these supplements.”
Some people can get enough vitamin D from spending time outside, and
older adults can also lower their risk of falls and fractures by
doing things like maintaining a healthy weight or doing exercises
designed to improve balance and coordination.
When people take daily vitamin D doses of 1,000 IU or higher,
however, they run the risk of serious side effects, particularly
when used in combination with calcium. Some previous research has
linked high doses of vitamin D to an increased risk of falls,
fractures, kidney stones, certain cancers and premature death.
For the current study, researchers examined data only from clinical
trials that randomly assigned some people to take vitamin D or
calcium, alone or in combination, and some individuals to receive a
placebo or no treatment at all.
All of the trials looked at the risk of hip fractures, spinal
fractures or other types of broken bones.
The lack of associations between calcium, vitamin D and fracture
risk was seen in both men and women, regardless of supplement dose
or any previous history of fractures, researchers report in JAMA.
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One limitation of the study is that some of the trials in the
analysis didn’t include pre-treatment measurements of vitamin D
blood levels, which might have influenced how much the supplements
impacted fracture risk. Some of the trials also were not high
quality experiments, the authors note.
Even though severe calcium or vitamin D deficiencies can contribute
to loss of bone density and an increased risk of fractures, people
with this problem are typically too sick to be included in clinical
trials, noted Dr. Kurt Kennel, a specialist in endocrinology,
metabolism and nutrition at the Mayo Clinic in Rochester, Minnesota.
“A key message which is not new but reinforced by this study is that
menopausal women and older men with osteoporosis should not equate
calcium and/or vitamin D supplementation with adequate treatment to
reduce the risk of osteoporotic fractures,” Kennel, who wasn’t
involved in the study, said by email.
Osteoporosis, or a loss of bone density, occurs naturally with age
and can also be accelerated when women go through menopause.
When people do need more vitamin D or calcium, they should look at
their diet first, Kennel advised.
“Pretty much every guideline states that dietary calcium is the
initial approach to obtaining adequate calcium, thus in that regard
no changes to guidelines are needed,” Kennel said.
But people who already take supplements shouldn’t stop without
speaking to a doctor.
“Routine initiation of calcium and/or vitamin D supplementation in
older women and men for prevention of fracture should not be
advised,” Kennel added.
SOURCE: http://bit.ly/2BU47tr JAMA, online December 26, 2017.
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