Yes or No? Study analyses role of Vitamin D and calcium supplements role in osteoporosis prevention

Delhi: Calcium and vitamin D supplements are recommended to older adults for the prevention and treatment of osteoporosis. However, they offer very little benefit to healthy adults, in fact, they might be doing more harm than good, a review in the Medical Journal of Australia has suggested. The review was conducted by Ian R Reid and Mark J Bolland from the University of Auckland, Auckland, New Zealand.

According to the study, while the nutrients are important, the supplements did little to improve bone density or reduce fracture risk in the healthy older adult population.

The major trials in community‐dwelling individuals have not demonstrated fracture prevention with either calcium, vitamin D, or their combination, but the results of a large study in vitamin D‐deficient nursing home residents indicated a reduced fracture incidence.

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"Calcium supplements in healthy individuals are not needed, nor are they required in most people receiving treatment for osteoporosis, where they have not been shown to affect treatment efficacy," wrote the authors. "Calcium supplements cause constipation, bloating and kidney stones, and some evidence suggests they may cause a small increase in the risk of myocardial infarction."

Vitamin D is made in the skin when exposed to sunlight, so deficiency is usually the result of low sunlight exposure (eg, in frail older people and in individuals who are veiled). Trials show that vitamin D increases bone density when winter 25‐hydroxyvitamin D levels are below 25–30 nmol/L. However, assay expense and variability suggest that supplements are better targeted based on clinical status to frail older people and possibly to people with dark skin living at higher latitudes. A daily dose of 400–800 units (10–20 μg) is usually adequate.

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Low vitamin D is safe, but high doses resulted in more falls and fractures. Current evidence does not support the use of these supplements in healthy community‐dwelling adults.

"Just as we would not expect antibiotics given to individuals without an active infection to have beneficial effects, we should not expect supplements of calcium and vitamin D to benefit people who do not have demonstrable deficiency," the study authors wrote.

Vitamin D supplementation is also advised for frail older people, and in some cases, people who cover their bodies for religious or cultural reasons, who are at risk of vitamin D deficiency.

The study, "Controversies in medicine: the role of calcium and vitamin D supplements in adults," is published in the Medical Journal of Australia.

DOI: https://doi.org/10.5694/mja2.50393