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Clinical Summary

Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: Preventive Medication

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Population Men and premenopausal women >400 IU of vitamin D and >1000 mg of calcium in postmenopausal women ≤400 IU of vitamin D and ≤1000 mg of calcium in postmenopausal women
Recommendation No recommendation.
Grade: I statement (insufficient evidence)
No recommendation.
Grade: I statement (insufficient evidence)
Do not recommend.
Grade: D
Risk Assessment Low bone mass, older age, and history of falls are major risk factors for incident osteoporotic fractures. Other risks factors for low bone mass and fractures include female sex, smoking, use of glucocorticoids, and use of other medications that impair bone metabolism (eg, aromatase inhibitors). Absolute fracture risk is very low in premenopausal women compared with postmenopausal women.
Preventive Medication The recommendation against supplementation at lower doses was based on an overall assessment that supplementation at low doses provides no benefit. Evidence on the effect of supplementation on fractures at higher doses is conflicting, with some studies showing a reduction in certain fractures at higher doses and others showing no reduction or even an increase. More studies are needed to more clearly determine if supplementation with vitamin D, calcium, or both consistently prevents fractures. If future evidence shows a benefit, the magnitude of that benefit will need to be weighed against the magnitude of harms caused by supplementation (kidney stones).
Other Relevant USPSTF Recommendations The USPSTF recommends against vitamin D supplementation to prevent falls in community-dwelling adults 65 years or older. The USPSTF recommends exercise interventions to prevent falls in community-dwelling older adults at increased risk for falls; multifactorial interventions may also be effective in some persons as well. The USPSTF recommends screening for osteoporosis in women 65 years or older and in younger women at increased risk. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults.

For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement, and supporting documents, please go to http://www.uspreventiveservicestaskforce.org.

Current as of: April 2018

Internet Citation: Clinical Summary: Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: Preventive Medication. U.S. Preventive Services Task Force. April 2018.
https://www.uspreventiveservicestaskforce.org/Page/Document/ClinicalSummaryFinal/vitamin-d-calcium-or-combined-supplementation-for-the-primary-prevention-of-fractures-in-adults-preventive-medication

USPSTF Program Office   5600 Fishers Lane, Mail Stop 06E53A, Rockville, MD 20857