Vitamin D, Calcium for Elderly Questioned
April 27, 2005 -- Two new studies question whether vitamin D and calciumsupplements can protect mobile, high-risk, over-70 seniors against future bonefractures.
Earlier studies showed that vitamin D and calcium supplements reduced therisks of fractures in elderly women.
But two new studies fail to show a fracture prevention effect for thepopular dietary supplements in the elderly.
Adrian Grant, MD, director of the Health Services Research Unit at theUniversity of Aberdeen, Scotland, studied 5,292 elderly, mostly female patientswho already had a fracture. During two to five years of follow-up, those takingvitamin D and calcium supplements had no fewer new fractures than those whodidn't take supplements. The study appears in the April 28 online edition ofThe Lancet.
David Torgerson, PhD, director of the York Trials Unit at the University ofYork, England, headed the other study, which followed 3,314 women who werefrail, in poor health, or who had previous fractures. Over two years, thosetaking the supplements had no fewer fractures than those who did not. The studyappears in the April 30 issue of the British Medical Journal.
"If you are at risk of bone loss and fracture, you need something elseother than calcium and vitamin D to reduce your risk," Torgerson tellsWebMD. "If you are reasonably healthy and have reasonable diet, there is noreason to waste your money on calcium or vitamin D supplements."
"Although vitamin D and calcium won't do any serious harm, it doesrequire taking something every day and it does have a cost," Grant tellsWebMD. "We know there are other approaches that can prevent furtherfractures. So if people are at high risk, they may wish to seek a doctor'sadvice on bone-active treatments."
Americans up to age 50 are advised to take 200 IU (international units) ofvitamin D daily. From ages 51 to 70, the advised dose is 400 IU. For peopleover age 70, it's 600 IU. Vitamin helps promote the absorption ofcalcium. The recommended intake for adults over the age of 50 is1,200 milligrams of calcium per day.
What should seniors make of these new findings? Not too much, argues PhilipSambrook of the Institute of Bone & Joint Research in Sydney, Australia, ina Lancet editorial accompanying the Grant study.
Sambrook notes that more than a third of the participants in the Grant studydid not take their calcium/vitamin D supplements as they were supposed to.
"Overall, the data are still consistent with a therapeutic benefit ofvitamin D on fractures in people deficient in vitamin D," Sambrookwrites.
He also says since vitamin D levels were not assessed at the start of thestudy it is not clear what effects might be expected in vitamin D-repletepeople.
Perhaps a more important criticism of the studies comes from John Hathcock,PhD. Hathcock is vice president for scientific and international affairs at theCouncil for Responsible Nutrition, a group that represents the supplementindustry.
Hathcock says that vitamin D and calcium by themselves are not a totalinsurance policy against fractures in the elderly. Earlier studies, he pointsout, show the reduction in fractures to be in the 30% to 40% range. TheTorgerson study did not have enough participants to detect a reduction infractures of less than 30%. And Hathcock says the Grant study, too, couldeasily have missed such an effect.
"These studies do not exclude modest but important benefits for vitaminD and calcium supplements," Hathcock tells WebMD. "This should notsuggest that anybody stop taking calcium and vitamin D supplements."
Grant says elderly people at risk of fracture should be taking medicationsthat build new bone mass. Such patients, he says, also need supplements.
"People who are taking very bone-active drugs, like bisphosphonates, areencouraged to take vitamin D and calcium at the same time," he says."Those who now are just taking vitamin D and calcium should consider --with their doctors -- whether they would benefit from bone-activemedications."
Earlier studies showed that vitamin D and calcium supplements reduced therisks of fractures in elderly women.
But two new studies fail to show a fracture prevention effect for thepopular dietary supplements in the elderly.
Adrian Grant, MD, director of the Health Services Research Unit at theUniversity of Aberdeen, Scotland, studied 5,292 elderly, mostly female patientswho already had a fracture. During two to five years of follow-up, those takingvitamin D and calcium supplements had no fewer new fractures than those whodidn't take supplements. The study appears in the April 28 online edition ofThe Lancet.
David Torgerson, PhD, director of the York Trials Unit at the University ofYork, England, headed the other study, which followed 3,314 women who werefrail, in poor health, or who had previous fractures. Over two years, thosetaking the supplements had no fewer fractures than those who did not. The studyappears in the April 30 issue of the British Medical Journal.
"If you are at risk of bone loss and fracture, you need something elseother than calcium and vitamin D to reduce your risk," Torgerson tellsWebMD. "If you are reasonably healthy and have reasonable diet, there is noreason to waste your money on calcium or vitamin D supplements."
"Although vitamin D and calcium won't do any serious harm, it doesrequire taking something every day and it does have a cost," Grant tellsWebMD. "We know there are other approaches that can prevent furtherfractures. So if people are at high risk, they may wish to seek a doctor'sadvice on bone-active treatments."
Americans up to age 50 are advised to take 200 IU (international units) ofvitamin D daily. From ages 51 to 70, the advised dose is 400 IU. For peopleover age 70, it's 600 IU. Vitamin helps promote the absorption ofcalcium. The recommended intake for adults over the age of 50 is1,200 milligrams of calcium per day.
Modest but Important Vitamin D, Calcium Effects Missed?
What should seniors make of these new findings? Not too much, argues PhilipSambrook of the Institute of Bone & Joint Research in Sydney, Australia, ina Lancet editorial accompanying the Grant study.
Sambrook notes that more than a third of the participants in the Grant studydid not take their calcium/vitamin D supplements as they were supposed to.
"Overall, the data are still consistent with a therapeutic benefit ofvitamin D on fractures in people deficient in vitamin D," Sambrookwrites.
He also says since vitamin D levels were not assessed at the start of thestudy it is not clear what effects might be expected in vitamin D-repletepeople.
Supplements Have Their Place
Perhaps a more important criticism of the studies comes from John Hathcock,PhD. Hathcock is vice president for scientific and international affairs at theCouncil for Responsible Nutrition, a group that represents the supplementindustry.
Hathcock says that vitamin D and calcium by themselves are not a totalinsurance policy against fractures in the elderly. Earlier studies, he pointsout, show the reduction in fractures to be in the 30% to 40% range. TheTorgerson study did not have enough participants to detect a reduction infractures of less than 30%. And Hathcock says the Grant study, too, couldeasily have missed such an effect.
"These studies do not exclude modest but important benefits for vitaminD and calcium supplements," Hathcock tells WebMD. "This should notsuggest that anybody stop taking calcium and vitamin D supplements."
Grant says elderly people at risk of fracture should be taking medicationsthat build new bone mass. Such patients, he says, also need supplements.
"People who are taking very bone-active drugs, like bisphosphonates, areencouraged to take vitamin D and calcium at the same time," he says."Those who now are just taking vitamin D and calcium should consider --with their doctors -- whether they would benefit from bone-activemedications."