USPSTF Issues Recommendation for Vitamin D, Calcium Supplementation for Fracture Prevention

The US Preventive Services Task Force (USPSTF) found insufficient evidence to assess the benefits and harms of vitamin D and calcium supplementation for the primary prevention of fractures in community-dwelling, asymptomatic men and premenopausal women, according to a recommendation published in JAMA.¹

In addition, the task force found insufficient evidence to assess the benefits and harms of daily supplementation with doses >400 IU vitamin D and >1000 mg calcium for the primary prevention of fractures in community-dwelling, postmenopausal women. The USPSTF recommends against daily supplementation with <400 IU vitamin D and <1000 mg calcium in this population.

The task force notes that the updated recommendations do not apply to individuals with a history of osteoporotic fractures, increased risk for falls, or a diagnosis of osteoporosis or vitamin D deficiency.

The updated recommendation is consistent with the previous 2013 USPSTF recommendation on vitamin D supplementation, with or without calcium, to prevent fractures. The task force reviewed evidence on vitamin D, calcium, and combined supplementation for prevention of fractures in community-dwelling adults, defined as not living in a nursing home or other institutional care setting.

The USPSTF included 11 randomized controlled trials in the evidence report and systematic review, with a total of 51,419 adults >50 years.² Only 1 study reported on total fracture incidence, finding that supplementation with vitamin D decreased total fracture incidence (absolute risk difference [ARD], −2.26%; 95% CI, −4.53% to 0.00%). Three trials found no significant association with hip fracture (pooled ARD, −0.01%; 95% CI, −0.80% to 0.78%). In addition, 1 trial showed that supplementation using vitamin D with calcium had no effect on total fracture incidence (ARD, −0.35%; 95% CI, −1.02% to 0.31%), and 2 trials showed no effect on hip fracture incidence.

Evidence for supplementation with calcium alone was limited, with very imprecise results. Results also show that supplementation with vitamin D alone or with calcium had no significant effect on all-cause mortality or incident cardiovascular disease. Supplementation with vitamin D and calcium was associated with an increased incidence of kidney stones in 3 trials (pooled ARD, 0.33%; 95% CI, 0.06%-0.60%), but supplementation with calcium alone was not associated with an increased risk (pooled ARD, 0.00%; 95% CI, −0.88% to 0.87%).

“More studies are needed to more clearly determine if supplementation with vitamin D, calcium, or both consistently prevents fractures,” the task force noted. “If future evidence shows a benefit, the magnitude of that benefit will need to be weighed against the magnitude of harms caused by supplementation.”

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References

1. US Preventive Services Task Force. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: US Preventive Services Task Force recommendation statement.  JAMA. 2018;319(15):1592-1599.
2. Kahwati LC, Weber RP, Pan H, et al. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults evidence report and systematic review for the US Preventive Services Task Force.  JAMA. 2018;319(15):1600-1612.