You are here: HomeRecommendations for Primary Care PracticePublished RecommendationsFinal Summary Vitamin D and Calcium to Prevent Fractures: Preventive Medication Release Date: February 2013 This topic is in the process of being updated. Please go to the Update in Progress section to see the latest documents available. Summary of Recommendations and Evidence PopulationRecommendationGradePremenopausal WomenThe USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation for the primary prevention of fractures in premenopausal women. Go to the Clinical Considerations for suggestions for practice regarding the I statements. IMenThe USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation for the primary prevention of fractures in men. Go to the Clinical Considerations for suggestions for practice regarding the I statements.
INoninstitutionalized Postmenopausal WomenThe USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of daily supplementation with greater than 400 IU of vitamin D and greater than 1,000 mg of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women. The USPSTF recommends against daily supplementation with 400 IU or less of vitamin D3 and 1,000 mg or less of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women. DCommunity-dwelling Adults, 65 Years or Older, at Increased Risk for FallsThe USPSTF has previously concluded in a separate recommendation that vitamin D supplementation is effective in preventing falls in community-dwelling adults aged 65 years or older who are at increased risk for falls. Related Information for Consumers Vitamin D and Calcium to Prevent Fractures in Adults: Consumer Guide Related Information for Health Professionals
Vitamin D Supplementation for Prevention of Fractures and Falls - A Grid Vitamin D & Calcium Supplementation to Prevent Fractures in Adults - Clinical Summary of USPSTF Recommendation, 2013 Read the Full Recommendation Statement Clinical summaries are one-page documents that provide guidance to primary care clinicians for using recommendations in practice. This summary is intended for use by primary care clinicians. Final Update Summary: Vitamin D and Calcium to Prevent Fractures: Preventive Medication. U.S. Preventive Services Task Force. Related Putting Prevention into Practice: Vitamin D and Calcium Supplementation to Prevent Fractures in Adults.Summary of Recommendations and EvidenceThe U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation for the primary prevention of fractures in premenopausal women or in men (Table 1).
View/Print TableVitamin D and Calcium Supplementation to Prevent Fractures in Adults: Clinical Summary of the USPSTF RecommendationPopulationMen or premenopausal womenCommunity-dwelling postmenopausal women at doses > 400 IU of vitamin D3 and > 1,000 mg of calciumCommunity-dwelling postmenopausal women at doses ≤ 400 IU of vitamin D3 and ≤ 1,000 mg of calciumRecommendationNo recommendationNo recommendationDo not supplementGrade: I statementGrade: I statementGrade: D recommendationBehavioral counseling interventionsAppropriate intake of vitamin D and calcium is essential to overall health. However, there is inadequate evidence to determine the effect of combined vitamin D and calcium supplementation on the incidence of fractures in men or premenopausal women.There is adequate evidence that daily supplementation with 400 IU of vitamin D3 and 1,000 mg of calcium has no effect on the incidence of fractures in postmenopausal women.There is inadequate evidence regarding the effect of higher doses of combined vitamin D and calcium supplementation on fracture incidence in community-dwelling postmenopausal women.
Balance of benefits and harmsEvidence is lacking regarding the benefit of daily vitamin D and calcium supplementation for the primary prevention of fractures, and the balance of benefits and harms cannot be determined.Evidence is lacking regarding the benefit of daily supplementation with > 400 IU of vitamin D3 and > 1,000 mg of calcium for the primary prevention of fractures in postmenopausal women, and the balance of benefits and harms cannot be determined.Daily supplementation with ≤ 400 IU of vitamin D3 and ≤ 1,000 mg of calcium has no net benefit for the primary prevention of fractures.Other relevant USPSTF recommendationsThe USPSTF has made recommendations on screening for osteoporosis and vitamin D supplementation to prevent falls in community-dwelling older adults. .Vitamin D and Calcium Supplementation to Prevent Fractures in Adults: Clinical Summary of the USPSTF RecommendationPopulationMen or premenopausal womenCommunity-dwelling postmenopausal women at doses > 400 IU of vitamin D3 and > 1,000 mg of calciumCommunity-dwelling postmenopausal women at doses ≤ 400 IU of vitamin D3 and ≤ 1,000 mg of calciumRecommendationNo recommendationNo recommendationDo not supplementGrade: I statementGrade
: I statementGrade: D recommendationBehavioral counseling interventionsAppropriate intake of vitamin D and calcium is essential to overall health. .The USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of daily supplementation with greater than 400 IU of vitamin D3 and greater than 1,000 mg of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women. The USPSTF recommends against daily supplementation with 400 IU or less of vitamin D3 and 1,000 mg or less of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women. Go to the Clinical Considerations section for suggestions regarding the I statements.RationaleIMPORTANCEFractures, particularly hip fractures, are associated with chronic pain and disability, loss of independence, decreased quality of life, and increased mortality.1 One-half of all postmenopausal women will have an osteoporosis-related fracture during their lifetime.
Appropriate intake of vitamin D and calcium is essential to overall health. The Institute of Medicine has published recommended dietary allowances (Table 22,3). However, the benefits and harms of daily supplementation with greater than 400 IU of vitamin D3 and greater than 1,000 mg of calcium to prevent fractures are not clearly understood.View/Print TableInstitute of Medicine 2011 Recommended Dietary Allowances for Vitamin D and CalciumWomen19 to 50 years6001,00051 to 70 years6001,200> 70 years8001,200Pregnant women≤18 years6001,300> 18 years6001,000Breastfeeding women≤ 18 years6001,300> 18 years6001,000Men19 to 50 years6001,00051 to 70 years6001,000> 70 years8001,200Institute of Medicine 2011 Recommended Dietary Allowances for Vitamin D and CalciumWomen19 to 50 years6001,00051 to 70 years6001,200> 70 years8001,200Pregnant women≤18 years6001,300> 18 years6001,000Breastfeeding women≤ 18 years6001,300> 18 years6001,000Men19 to 50 years6001,00051 to 70 years6001,000> 70 years8001,200BENEFITS OF PREVENTIVE MEDICATIONIn premenopausal women and in men, there is inadequate evidence to determine the effect of combined vitamin D and calcium supplementation on the incidence of fractures.
In postmenopausal women, there is adequate evidence that daily supplementation with 400 IU of vitamin D3 combined with 1,000 mg of calcium has no effect on the incidence of fractures. However, there is inadequate evidence about the effect of higher doses of combined vitamin D and calcium supplementation on fracture incidence in noninstitutionalized postmenopausal women.HARMS OF PREVENTIVE MEDICATIONAdequate evidence indicates that supplementation with 400 IU or less of vitamin D3 and 1,000 mg or less of calcium increases the incidence of renal stones. The USPSTF assessed the magnitude of this harm as small.USPSTF ASSESSMENTNoninstitutionalized, Community-Dwelling Postmenopausal Women. The USPSTF concludes that evidence is lacking about the benefit of daily supplementation with greater than 400 IU of vitamin D3 and greater than 1,000 mg of calcium for the primary prevention of fractures, and the balance of benefits and harms cannot be determined.The USPSTF concludes with moderate certainty that daily supplementation with 400 IU or less of vitamin D3 and 1,000 mg or less of calcium has no net benefit for the primary prevention of fractures.
Men and Premenopausal Women. The USPSTF concludes that evidence is lacking about the benefit of vitamin D supplementation with or without calcium for the primary prevention of fractures, and the balance of benefits and harms cannot be determined.Clinical ConsiderationsPATIENT POPULATIONThis recommendation applies to noninstitutionalized or community-dwelling asymptomatic adults without a history of fractures. Community-dwelling is defined as not residing in an assisted living facility, nursing home, or other institutional care setting. This recommendation does not apply to persons with osteoporosis or vitamin D deficiency.CONSIDERATIONS FOR PRACTICE REGARDING THE I STATEMENTSPotential Preventable Burden. The health burden of fractures is substantial in the older adult population.In the Women's Health Initiative, a statistically increased incidence of renal stones occurred in women taking supplemental vitamin D and calcium. One woman was diagnosed with a urinary tract stone for every 273 women who received supplementation over a seven-year follow-up period.