USPSTF: Insufficient evidence vitamin D, calcium prevent fractures

The U.S. Preventive Services Task Force said today that it recommends against low doses of vitamin D or calcium for the prevention of fractures in post-menopausal women.

The USPSTF also stated that the evidence is insufficient that doses of vitamin D greater than 400 IU and daily doses of 1,000 mg of calcium help prevent fractures in women who have gone through menopause. The data are also insufficient to determine if vitamin D or calcium, alone or combined, prevent fractures in men and in women who have not gone through menopause.

These final recommendations were based on a review of eight studies containing 47,672 participants, according to the USPSTF.

“We need more research to understand if 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 said in a press release.

According to the task force, hip fractures led to 300,000 hospitalizations annually from 2004 to 2014 in the United States. In addition, the task force indicated in the first 3 months after a fracture, a patient’s mortality risk is five to eight times greater than of a person about the same age without a fracture.

“Annual incidence [of osteoporotic fractures] is projected to increase to more than 3 million fractures by 2025. Nearly half of all women older than 50 years will experience an osteoporotic fracture during their lifetime,” they added.

Other final recommendations the USPSTF issued today include:

·vitamin D supplementation to prevent falls in adults older than 65 years and living at home received a ‘D’ grade.
Clinicians selectively checking older adults’ risks for falls and then offering tailored interventions that address those specific risks based on the patients’ circumstances received a ‘C’ grade.
Adults older than 65 years engaging in physical therapy or exercise to prevent falls received a ‘B’ grade.

“Falling is the most common cause of unintentional injury for older adults,” Alex Krist, MD, MPH, task force member, clinician, and professor of family medicine and population health at Virginia Commonwealth University,” said of these last three recommendations.

The final recommendations the USPSTF released today are consistent with its 2017 draft recommendations on vitamin D and calcium in fracture prevention in postmenopausal women and fall prevention among the elderly.

In a related editorial, Heike A. Bischoff-Ferrari, MD, DrPH, of the department of geriatrics and aging research at the University of Zurich in Switzerland, and colleagues wrote that the simultaneous release of the USPSTF recommendations is important.

“Providing both guidelines in tandem is valuable, as the complementary articles reinforce the importance of fall prevention in reducing the risk of fractures (and other injuries) among older adults, who sustain 75% of all osteoporotic fractures.”

They also noted that six trials that explore the role of vitamin D supplementation in adults that live community dwellings are in various stages of completion.

“Thus, clinicians will soon have more data to guide their treatment decisions in these important areas,” Biscoff-Ferrari and colleagues wrote.– by Janel Miller

References:

Bischoff-Ferrari HA, et al. JAMA. 2018;doi:10.1001/jama.2018.4023.

Guirguis-Blake JM, et al. JAMA. 2018;doi:10.1001/jama.2017.21962.

Kahwati LC, et al. JAMA. 2018;doi:10.1001/jama.2017.21640.

U.S. Preventive Services Task Force. JAMA. 2018;doi:10.1001/jama.2017.21640.

Disclosures: Neither Bischoff-Ferrari, Krist, nor Mangione report any relevant financial disclosures. Please see the studies for all authors’ relevant financial disclosures.