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Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It?

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-s...

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Autores principales: Reid, Ian R, Bolland, Mark J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231370/
https://www.ncbi.nlm.nih.gov/pubmed/32272593
http://dx.doi.org/10.3390/nu12041011
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author Reid, Ian R
Bolland, Mark J
author_facet Reid, Ian R
Bolland, Mark J
author_sort Reid, Ian R
collection PubMed
description 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.
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spelling pubmed-72313702020-05-22 Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It? Reid, Ian R Bolland, Mark J Nutrients Review 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. MDPI 2020-04-07 /pmc/articles/PMC7231370/ /pubmed/32272593 http://dx.doi.org/10.3390/nu12041011 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Reid, Ian R
Bolland, Mark J
Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It?
title Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It?
title_full Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It?
title_fullStr Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It?
title_full_unstemmed Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It?
title_short Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It?
title_sort calcium and/or vitamin d supplementation for the prevention of fragility fractures: who needs it?
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231370/
https://www.ncbi.nlm.nih.gov/pubmed/32272593
http://dx.doi.org/10.3390/nu12041011
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