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USPSTF: Evidence insufficient on role of vitamin D, calcium in fracture prevention

The U.S. Preventive Services Task Force has issued a draft recommendation stating that there is not enough evidence about the benefits and harms of vitamin D and calcium supplementation, alone or combined, for the primary prevention of fractures in men and premenopausal women.

The group also stated that among community-dwelling, postmenopausal women, there is not enough evidence to determine the benefits and harms of daily supplementation with 400 IU vitamin D and more than 1,000 mg calcium to prevent falls. Further, the task force recommends against this same group of women taking daily supplementation of 400 IU or less of vitamin D and 1,000 mg or less of calcium for the primary prevention of fractures.

According to task force members, these recommendations are not applicable to those who have a vitamin D deficiency, a diagnosis of osteoporosis, are at an increased risk for falls or have a history of osteoporotic fractures.

“Because of the aging population, osteoporotic fractures are an increasingly important cause of morbidity and mortality in the United States,” the task force members wrote.

“Approximately 2 million osteoporotic fractures occurred in the United States in 2005, and annual incidence is projected to grow to more than 3 million fractures by 2025. Nearly half of all women older than age 50 years will experience an osteoporotic fracture during their lifetime.”

“Hip fractures alone lead to approximately 300,000 hospitalizations annually in the United States,” they continued. “During the first 3 months after a hip fracture, a patient’s mortality risk is [five] to [eight] times that of a similarly aged person living in the community without a fracture. Nearly 20% of hip fracture patients are subsequently moved to a long-term care facility.”

The recommendation mirrors the task force’s 2013 final recommendation on this topic, according to a press release.

A task force member suggested several research opportunities that could possibly change the task force recommendations in the future.

“We need more research to understand whether taking higher doses of vitamin D or calcium helps to prevent fractures in women who have gone through menopause — or at any dose for men or younger women,” Carol Mangione, MD, MSPH, task force member and professor and primary care doctor from the David Geffen School of Medicine at the University of California, Los Angeles, said in the release.

The draft recommendation statement can be viewed on the task force’s website: www.uspreventiveservicestaskforce.org. Comments can be submitted until Oct. 23, 2017. by Janel Miller

Disclosure: Healio Family Medicine was unable to confirm authors’ relevant financial disclosures at the time of publication.