No Real Solutions from Task Force for Older Women on Vitamin D, Calcium to Avoid Fractures
Low dose not effective and larger dose may not
be either for postmenopausal women or men
Feb. 26, 2013 – Older women trying to prevent
the danger of fractures by taking vitamin D and calcium must be
scratching their heads today after a puzzling recommendation
yesterday from the U.S. Preventive Services Task Force. They said
that taking less than 400 IU of vitamin D3
and less than 1,000 mg of calcium is ineffective and the
evidence is inconclusive that higher doses are effective either.
This was among several recommendations issued
yesterday by the Task Force pertaining to these supplements.
They also found that the current evidence is
also insufficient to make a recommendation on vitamin D and calcium
supplements for the prevention of fractures for men and
“Vitamin D and calcium are known to play an
important role in maintaining health, including bone health.
However, despite the large number of studies done there are few
conclusive answers about the ability of vitamin D and calcium
supplements to prevent fractures,” stated Task Force member and
chair Virginia Moyer, M.D., M.P.H.
“The Task Force has determined the evidence is
inconclusive that higher doses of vitamin D and calcium supplements
are effective in preventing fractures in postmenopausal women. The
evidence was also inconclusive for fracture prevention in men and
premenopausal women. What we do know is that doses less than or
equal to 400 IU of vitamin D (or 1000 mg of calcium) are not
effective at preventing fractures in postmenopausal women.”
Senior Citizen Bone Disorders
As they get older, millions of people (mostly
women, but men too) develop, or are at risk of,
osteoporosis, where bones become fragile and may fracture if
It is one consequence of not getting enough
calcium and vitamin D over the long term.
Supplements of both vitamin D3 (at
700–800 IU/day) and calcium (500–1,200 mg/day) have been
shown to reduce the risk of bone loss and fractures in
elderly people aged 62–85 years.
Men and women should talk with their health
care providers about their needs for vitamin D (and calcium)
as part of an overall plan to prevent or treat osteoporosis.
Office of Dietary Supplements of National
Institutes of Health
“It’s important to remember that this
recommendation applies to people who do not have a known vitamin D
deficiency or osteoporosis,” said Task Force member Jessica Herzstein, M.D., M.P.H.
“Vitamin D plays a role in a wide range of
general health functions, and there appears to be minimal harms in
taking vitamin D supplements. Clinicians and patients may take this
into consideration when determining whether to recommend or take
vitamin D for general health.”
Because the Task Force recognizes that vitamin
D has benefits beyond the prevention of fractures, it has begun
evaluating the effectiveness of screening for vitamin D deficiency.
The draft research plan for this topic was posted for public comment
today and is available at
The Task Force is an independent volunteer
panel of national experts in prevention and evidence-based medicine
that works to improve the health of all Americans by making
evidence-based recommendations about clinical preventive services
such as screenings, counseling services, and preventive medications.
IOM and Dietary Reference Intakes for Calcium and Vitamin D
Calcium and vitamin D are
two essential nutrients long known for their role in bone
health. Over the last ten years, the public has heard
conflicting messages about other benefits of these
nutrients—especially vitamin D—and also about how much calcium
and vitamin D they need to be healthy.
To help clarify this issue,
the U. S. and Canadian governments asked the Institute of
Medicine (IOM) to assess the current data on health outcomes
associated with calcium and vitamin D. The IOM tasked a
committee of experts with reviewing the evidence, as well as
updating the nutrient reference values, known as Dietary
Reference Intakes (DRIs).
These values are used
widely by government agencies, for example, in setting standards
for school meals or specifying the nutrition label on foods.
Over time, they have come to be used by health professionals to
counsel individuals about dietary intake.
The committee provided an
exhaustive review of studies on potential health outcomes and
found that the evidence supported a role for these nutrients in
bone health but not in other health conditions. Overall, the
committee concludes that the majority of Americans and Canadians
are receiving adequate amounts of both calcium and vitamin D.
Further, there is emerging evidence that too much of these
nutrients may be harmful.
People who are physically active and get enough
calcium can strengthen their bones - even in old age
Sept. 12, 2008
Vitamins and Minerals: About Vitamin D
Vitamins are organic
substances (made by plants or animals), minerals are inorganic
elements that come from the earth; soil and water and are
absorbed by plants. Animals and humans absorb minerals from the
plants they eat. Vitamins and minerals are nutrients that your
body needs to grow and develop normally.
Vitamins and minerals have a
unique role to play in maintaining your health. For example
Vitamin D helps your body absorb the amount of calcium (a
mineral) it needs to form strong bones. A deficiency in vitamin
D can result in a disease called rickets (softening of the bones
caused by the bodies inability to absorb the mineral calcium.)
The body cannot produce calcium; therefore, it must be absorbed
through our food.
Other minerals like
chromium, copper, iodine, iron, selenium, and zinc are called
trace minerals because you only need very small amounts of them
each day. The best way to get enough vitamins is to eat a
balanced diet with a variety of foods. You can usually get all
your vitamins from the foods you eat.
About Vitamin D
Vitamin D is a fat-soluble
vitamin that is naturally present in very few foods, added to
others, and available as a dietary supplement. It is also
produced endogenously when ultraviolet rays from sunlight strike
the skin and trigger vitamin D synthesis. Vitamin D obtained
from sun exposure, food, and supplements is biologically inert
and must undergo two hydroxylations in the body for activation.
The first occurs in the
liver and converts vitamin D to 25-hydroxyvitamin D [25(OH)D],
also known as calcidiol. The second occurs primarily in the
kidney and forms the physiologically active
1,25-dihydroxyvitamin D [1,25(OH)2D], also known as calcitriol.
Vitamin D is essential for
promoting calcium absorption in the gut and maintaining adequate
serum calcium and phosphate concentrations to enable normal
mineralization of bone and prevent hypocalcemic tetany.
It is also needed for bone
growth and bone remodeling by osteoblasts and osteoclasts.
Without sufficient vitamin D, bones can become thin, brittle, or
misshapen. Vitamin D sufficiency prevents rickets in children
and osteomalacia in adults.
Together with calcium,
vitamin D also helps protect older adults from osteoporosis.
Vitamin D has other roles in
human health, including modulation of neuromuscular and immune
function and reduction of inflammation. Many genes encoding
proteins that regulate cell proliferation, differentiation, and
apoptosis are modulated in part by vitamin D. Many
laboratory-cultured human cells have vitamin D receptors and
some convert 25(OH)D to 1,25(OH)2D. It remains to be determined
whether cells with vitamin D receptors in the intact human carry
out this conversion.
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