If you do not have evidence of osteoporosis or vitamin D deficiency focus on outdoor exercise, rather than vitamin D supplements.
An influential group of medical experts say most adults should not bother taking low doses of vitamin D and calcium to prevent fractures and falls. This is according to recommendations published Tuesday, April 17, 2018, in the Journal of the American Medical Association.
Vitamin D supplementation was found to have unimpressive results in preventing falls, according to the review of research, and high doses of vitamin D were even linked with higher rates of falls.
But the group also found evidence that exercise may help prevent falls that lead to bone fractures in people age 65 and older, and that fall-prevention strategies — such as vision screening and gait assessment — could also reduce the risk.
“What we try to do is look at the evidence and see what the science says, and try to help patients and clinicians understand the evidence,” says Alex H. Krist, MD, the task force vice-chair and a professor of medicine at Virginia Commonwealth University in Richmond.
“If patients are unclear about what to do, they should talk with their clinician about what’s right for them. But routinely taking these lower doses of vitamin D and calcium is probably not going to prevent falls or fractures,” Dr. Krist says.
Falls and Bone Fractures Can Be Devastating
The recommendations are of keen interest to Americans due to the aging of the U.S. population and the high rates of osteoporosis and bone fracture found in older people. About 2 million fractures related to osteoporosis occurred in 2005, according to the USPSTF, a rate that is expected to increase to 3 million by 2025.
Hip fractures are a particularly devastating type of injury, often leading to loss of independence and even subsequent death. Falls are the leading cause of injury-related health problems and death in older adults, according to the authors of the study. In 2015, an estimated 33,000 older adults died due to falls.
Vitamin D, dietary calcium, and exercise are all considered important to building strong bones in childhood and adolescence and to keeping bones healthy during adulthood. Previous studies suggested that taking calcium and vitamin D supplements can also help keep bones strong and prevent falls and fractures. But further research in recent years has cast doubt on that advice, particularly for adults with no apparent risk factors for bone problems.
USPSTF Findings on Vitamin D and Calcium
In the newly published analysis, experts say that current evidence is simply insufficient to assess the balance and harms of taking vitamin D and calcium, alone or in combination, at the commonly recommended doses of 400 IU (international units) daily of vitamin D and 1,000 mg of calcium. The task force found:
- Insufficient evidence to estimate the benefits of vitamin D, calcium, or both to prevent fractures in men or premenopausal women
- Daily supplementation with 400 IU or less of vitamin D and 1,000 mg or less of calcium had no benefit to prevent fractures in postmenopausal women.
- Insufficient evidence to estimate the benefits of doses greater than 400 IU of vitamin D and 1,000 mg of calcium to prevent fracture in postmenopausal women
- Vitamin D and calcium supplementation increased the risk of kidney stones.
In the study on strategies to prevent falls, the task force found:
- Insufficient evidence to recommend vitamin D supplementation to prevent falls
- Some evidence suggesting exercise can prevent falls in adults 65 and older who are at increased risk for falls
- Effective exercise interventions consists of training for gait, balance, strength, flexibility, function, and endurance, with training interventions occurring three times per week.
- Multifactorial interventions, such as altering the environment to avoid tripping and vision testing, were linked to a reduction in falls.
The recommendations, which were based on a comprehensive review of studies, were similar to previous guidance issued by the USPSTF in 2012–13. But the task force downgraded its previous recommendation on vitamin D supplementation for preventing falls from a B grade (meaning there was evidence of some benefit) to a D grade, which is a recommendation against vitamin D supplementation based on evidence of no benefit or because of harms associated with taking the supplement, such as the increased risk of kidney stones.
|Read on: Many Older Adults Can Skip the Vitamin D and Calcium Supplements, Experts Say | Everyday Health|