Vitamin D and calcium are essential for overall health, but don’t reduce the risk of falls or fractures in generally healthy older adults, according to a new draft recommendation from the US Preventive Services Task Force.
When it comes to preventing the risk of a fall or fractures in older adults, the task force recommends against relying on supplemental vitamin D and calcium – and, for the first time, men are included in this guidance.
Older adults may still need to take vitamin D or calcium for overall health but should take different steps to protect from fractures or reduce the risk of falling.
In 2018, the task force recommended against daily supplementation with 400 units or less of vitamin D and 1,000 milligrams or less of calcium for the primary prevention of fractures in postmenopausal women. But it concluded there has not been enough evidence to make a recommendation for the primary prevention of fractures in men.
The task force’s draft recommendation would update the current guidance to include recommending against supplementation in men ages 60 or older and it would remove mention of specific doses. The draft recommendation is not yet final, but will be available on the task force’s website for public comment through January 21, along with a draft evidence review.
“When we did the 2018 recommendation, we did not have a sufficient number of male participants in the studies of fractures and falls with vitamin D. Since that time, there’s been enough to at least draw some conclusions, and we’ve drawn the same conclusion – it’s not helpful in terms of prevention,” said task force member Dr. Goutham Rao, chair of the Department of Family Medicine and Community Health and chief clinician experience officer for the University Hospitals Health System in Cleveland, Ohio.
“The other thing is that there were some questions about whether high doses might be beneficial of vitamin D and calcium,” Rao said. “But what we found is that there was no dose in our most recent recommendation that was associated with any benefit.”
However, Rao added that outside of preventing falls and fractures in older adults, vitamin D and calcium are still vital nutrients that are essential for overall health. Vitamin D helps the body absorb calcium, and benefits the immune system, the brain and muscle performance, among other functions.
“One of the key messages we need to get out there is nobody is suggesting that you not take vitamin D and calcium, because the National Academy of Medicine has specific recommendations for how much vitamin D and calcium you should have in your diet or through supplements on a daily basis, and it’s very important for bone health, for brain health, for all sorts of things,” he said. “It’s just with respect to fractures and falls that we didn’t see the benefit.
‘Everyone should have … daily allowance’
The draft recommendation can come across as “challenging” because people might interpret that the recommendations are saying that vitamin D and calcium are not important at all, said Dr. Sherri-Ann Burnett-Bowie, an associate professor of medicine at Harvard Medical School and a clinical investigator in the Endocrine Division at Mass General Brigham, who was not involved in the USPSTF’s new draft recommendation.
“As stated within the draft recommendation, everyone should have the recommended daily allowance, which is anywhere between 600 to 800 units of vitamin D every day if you’re 1 year or older, and between 700 and 1,200 milligrams of calcium,” Burnett-Bowie said, adding that many people in the United States consume less than the recommended amounts of calcium.
“There are racial and ethnic differences in who consumes the recommended daily allowance in their diet – with higher rates of dietary calcium inadequacy in non-Hispanic Black or non-Hispanic Asian individuals. So, if the goal is to only consume calcium or vitamin D from diet or dietary supplements, which include Ensure or Boost, then a lot of people are not going to get there by diet alone,” she said. “Taking supplemental calcium, with vitamin D to facilitate absorbing calcium, fills in what someone may not be able to achieve based on diet alone.”
The USPSTF draft recommendation specifically recommends against supplementation with vitamin D, with or without calcium, for the primary prevention of fractures in postmenopausal women and men ages 60 or older who live in their own homes in the community and not nursing homes, long-term care facilities or are hospitalized.
In a systematic review of research, the task force concluded “with moderate certainty” that supplementation with vitamin D showed no net benefit for the primary prevention of fractures and falls in that age group.
The task force also noted that supplementation with vitamin D with or without calcium can increase the incidence of kidney stones, though the magnitude of this harm was assessed as small. Calcium is a key component of most kidney stones.
“If you are taking the standard amount, there would be low likelihood of harm,” Burnett-Bowie said. “If you are staying within the recommended daily allowance, it’s unusual for kidney stones to occur.”
Taking vitamin D supplements did not result in a “significantly lower risk” of fractures among middle-age and older adults in one study published in 2022 in the New England Journal of Medicine.
Specifically, consuming 2,000 IU (international units) a day of supplemental vitamin D3 without calcium over the course of more than five years did not reduce total fractures, hip, wrist or pelvic fractures when compared with taking a daily placebo, according to the study. A placebo is a fake pill given to patients, so they think they are getting the real supplement.
“We found that supplementation with vitamin D versus placebo in the largest randomized control trial – including 25,871 adults enrolled from 50 states – did not reduce fracture risk, and this was in generally healthy middle-age and older adults,” said study author Dr. Meryl LeBoff, chief of the calcium and bone section in the Endocrinology, Diabetes and Hypertension Division at Brigham and Women’s Hospital in Boston and professor of medicine at Harvard Medical School, who was not involved in the new USPSTF draft recommendation.
But while the finding aligns with the new USPSTF draft recommendation, it is “not generalizable to adults with severe vitamin D deficiency, low bone mass, osteoporosis, on osteoporosis medications, those with malabsorption, or those with high fall risk, or older adults living in residential communities,” LeBoff said. Osteoporosis is a disease that causes bones to become so brittle that a fall or even a mild stress might cause a fracture.
How to reduce the risk of a fall
Each year in the United Sates, more than 1 out of 4 older adults experience a fall, which may cause broken bones, hip fractures or other injuries.
Steps older adults can take to reduce their risk of falls and fractures include getting screened for osteoporosis, especially for women 65 and older, Rao said, and regular exercise. If someone has osteoporosis, they may be prescribed treatment to prevent fractures.
“Our recommendation is focused on the prevention of falls and the prevention of fractures – that’s what we want to emphasize, that vitamin D and calcium are not helpful in that regard. But there are things that you can do as well, including screening for osteoporosis and structured exercise,” he said.
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It can be helpful to regularly do strength-training exercises by lifting weights or using resistance bands, and improve balance with exercises like yoga, Pilates or tai chi.
When doing everyday activities, stand up slowly as getting up too quickly can cause blood pressure to drop and may cause you to lose balance.
Some adults also may benefit from having their vision and hearing tested to reduce their risk of falls, or using assistive devices such as canes or walkers.
In the winter, it’s also important to take extra caution when walking on wet or icy surfaces, and to consider staying indoors when the weather is bed.
Additionally, remember to tell your doctor about any falls or fractures that may have occurred since your last check-up as these can alert a physician to any new medical problems or issues that may have emerged and can be treated.