The United States Preventive Services Task Force recommends against daily supplementation with doses of vitamin D ≤ 400 IU and calcium ≤ 1,000 mg for the primary prevention of fractures in postmenopausal women living in the community setting.
The Task Force found insufficient evidence to assess the benefits and harms of daily supplementation with higher doses in this population. Evidence also was insufficient to recommend for or against daily vitamin D and calcium supplementation to prevent fractures in premenopausal women or in men.
Fracture prevention in older patients is important because fractures (especially hip fractures) are associated with chronic pain, disability, and increased mortality. One half of all postmenopausal women will have an osteoporosis-related fracture in their lifetime. Vitamin D and calcium supplements are inexpensive and readily available without a prescription.
To form a recommendation, the Task Force commissioned two systematic evidence reviews and a meta-analysis on vitamin D supplementation with or without calcium. Researchers reviewed the evidence to assess the effects of vitamin D and calcium on bone health outcomes in community-dwelling adults and the adverse effects of supplementation. Based on the evidence, researchers concluded with moderate certainty that daily supplementation with doses of vitamin D ≤ 400 IU and calcium ≤ 1,000 mg has no net benefit for the primary prevention of fractures, and that it increases the incidence of kidney stones.
The recommendation applies to nonistitutionalized, asymptomatic adults without previous history of fractures. In previous recommendations related to fracture prevention, the Task Force recommended screening for osteoporosis in women age 65 or older and in younger women at high risk for fracture. The Task force also recommends vitamin D supplementation to prevent falls in community-dwelling adults age 65 and older who are at increased risk for falls.