It may be time for many postmenopausal women to put down the calcium and vitamin D supplement bottles for good, as the latest in a string of influential health care organizations has recommended against the use of such supplements to prevent fractures.
Today, in the Annals of Internal Medicine the US Preventive Services Task Force (USPSTF) officially joined the chorus of groups recommending against calcium and vitamin D supplementation in postmenopausal women as a means to reduce fracture risk. In a review of evidence from 6 randomized trials evaluating the use of vitamin D and calcium to prevent fractures in postmenopausal women who are not living in a nursing home or other institution, the task force found no evidence of a benefit from supplementation with 400 IU of vitamin D3 and 1000 mg of calcium. Additionally, the review found evidence of an increased risk of kidney stones, with 1 in every 273 women who take these supplements for 7 years developing this problem.
A draft of the review and recommendation was published last year. The task force continues to recommend vitamin D supplementation for the prevention of falls in men and women aged 65 years or older who have previously fallen or who have a vitamin D deficiency.
The jury is still out on whether higher-dose supplements may be beneficial for postmenopausal women or whether vitamin D and calcium supplements may help prevent fractures if taken by younger women or men, the task force notes. The task force also noted that there has been conflicting evidence about whether excess calcium intake may contribute to cardiovascular problems.
The recommendation is consistent with the findings of a 2010 Institute of Medicine (IOM) report, which found that most US individuals get enough calcium and vitamin D from their diet and sun exposure and that supplementation may lead to excess levels of these nutrients. Overdoing vitamin D intake can cause vitamin D toxicity; taking in too much calcium can cause constipation, kidney stones, and other systemic problems.
Clifford Rosen, MD, a member of the IOM committee and past president of the American Society for Bone and Mineral Research, said the task force recommendations are consistent with the findings of the IOM report in concluding that supplementation is unlikely to help healthy individuals and that it may hurt them. He noted that there are emerging data suggesting potential cardiovascular risks related to calcium supplementation that, if confirmed, may further tip the balance toward indicating harm.
Rosen did emphasize, however, that calcium and vitamin D supplementation may have benefits for certain subgroups, such as those living in nursing homes and individuals aged 70 years or older with low bone density.
Whether the task force’s recommendation will change healthy women’s behavior or physicians’ recommendations remains to be seen. Use of calcium and vitamin D supplements is very common, with more than half of postmenopausal women taking them. There is a huge industry supporting the practice, said Rosen, noting that taking these supplements, often more than once daily, has become part of the culture for many individuals.
Rosen said he would offer healthy postmenopausal women with normal bone mass the same advice he gives his wife—not to take the supplements.
“There is no evidence of benefit and there may be risk,” he said.