Do you need supplements to preserve your bone health?

Taking daily calcium and vitamin D supplements to build bone strength and prevent osteoporosis-related fractures has long been standard advice from many health experts. So it probably came as a surprise to many people who routinely take the supplements when headlines earlier in 2012 suggested that a federal panel of experts was now recommending that healthy postmenopausal women should not take them to prevent osteoporosis because any protective benefits gained aren't enough to offset potential harms.

Only low doses considered

This recommendation by the U.S. Preventive Services Task Force (USPSTF) is part of a draft statement that looks at the supplements' potential benefits and harms. At first glance, it appears to downplay the supplements' role in preventing fractures. But in fact, the recommendation applies only to calcium supplements of up to 1,000 milligrams (mg) and vitamin D3 supplements of up to 400 international units (IU)—doses typically lower than what many doctors prescribe today.

The task force chose not to come out for or against higher doses, citing a lack of sufficient research. What's more, the recommendation is aimed at only healthy women with no osteoporosis risk factors and no history of adult fractures.

Behind the headlines

Because the statement drew widespread media attention that sometimes failed to include important details about the benefits of calcium and vitamin D, some physicians' groups fear women may misinterpret the recommendation and stop taking their supplements before they can discuss the implications with their doctors. What makes this prospect especially worrisome to Michele Bellantoni, M.D., associate professor of medicine and medical director at the Johns Hopkins Bayview Care Center, is the task force's estimate that more than half of women over age 50 will suffer an osteoporosis-related fracture.

"The headlines imply that vitamin D and calcium supplements can't help prevent bone fractures, period. But, in truth, the task force isn't outright stating that vitamin D and calcium supplements don't prevent fractures," Dr. Bellantoni says. "Instead, it's citing a lack of evidence that can prove beyond doubt the benefits of the supplements for some people."

Edward Wallach, M.D., professor of obstetrics and gynecology at Johns Hopkins, shares Dr. Bellantoni's concern. "Much information reported was incomplete. Specifically, while the task force advises older women against lower doses of vitamin D and calcium supplements, their advice is intended for healthy postmenopausal women who have no osteoporosis risk factors. It doesn't apply to women with risk factors such as low body weight, known osteoporosis, little calcium or vitamin D in the diet, a history of fracture or having a condition that predisposes one to osteoporosis." In these cases, or when a patient is known to have vitamin D or calcium deficiency, daily supplements are essential, says Dr. Wallach.

A main concern of the task force was whether the benefits of low-dose supplements outweighed their potential harms. While the group acknowledged some protective effect against fractures in the elderly, it wasn’t enough to offset a slight risk of developing kidney stones from taking calcium supplements.

Task Force Conclusions

The USPSTF based its recommendation on a review of the best available science: past research studies and clinical trials that investigated the use of vitamin D and calcium supplements to prevent fractures related to osteoporosis. As a result, the task force issued three conclusions:

  1. Low daily doses of vitamin D3 (400 IU) and calcium (1,000 mg) supplements don't prevent fractures in healthy older women and may lead to kidney stones in a small number of women.
  2. Current evidence from research studies is insufficient to assess whether vitamin D and calcium supplements at higher doses can safely prevent fractures in older women.
  3. Current evidence is insufficient to assess whether combined vitamin D and calcium supplements can safely prevent fractures in premenopausal women and adult men of any age.

The insufficient data resulted from inconsistencies in dosages, frequency of use and forms of vitamin D and calcium among the studies analyzed.

Stay Strong with Vitamin D

If you're over 55 and finding it harder to complete daily physical tasks, such as walking up and down stairs, low levels of vitamin D may be to blame, according to a new study reported in our sister publication REMEDY's Healthy Living, Winter 2013. Vitamin D is important for muscle health, say the researchers, who believe that low levels of the so-called "sunshine vitamin" could lead to reduced muscle mass.

Since sunlight can be scarce in the winter months, get your daily dose of vitamin D from fatty fish, such as salmon and tuna, and fortified foods, such as milk and yogurt. Speak with your doctor before using any supplements containing high doses of vitamin D.

Diabetes Risk & Vitamin D

According to another of our sister publications—Diabetes Focus (Summer 2015)—low levels of this "sunshine" vitamin is a risk factor for type 2 diabetes, independent of obesity, as reported in a new study. As mentioned, when exposed to sunlight, the skin naturally produces vitamin D, which helps the body absorb calcium and maintain bone and muscle health.

Experts recommend a daily intake of 1,000 international units (IU) or more of vitamin D from sources such as sun, diet or supplements. In the summertime, a 15- to 30-minute walk outside each day should be enough for most people to meet those requirements to help reduce diabetes risk and improve health.

Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50; Updated by Remedy Health Media

Publication Review By: the Editorial Staff at Healthcommunities.com

Published: 18 Jul 2013

Last Modified: 14 May 2015