Older women should not take calcium, vitamin D: task force

Recommendations say evidence doesn't support benefit of low daily doses to prevent fractures.

14 jun 2012-- A leading U.S. government advisory panel has proposed that postmenopausal women not take low-dose calcium and vitamin D supplements daily to ward off bone fractures.
But the jury is still out on higher doses of these supplements, stated the U.S. Preventive Services Task Force (USPSTF), which issued the draft recommendations Tuesday. Public comment on the draft recommendations is invited until July 10.
The news was a bit of a bombshell, given that women have been told for so long to take calcium and vitamin D, said Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City and a spokeswoman for the American Heart Association. "What we're really seeing is no role for calcium for the prevention of osteoporotic fractures. At this point, there's no reason to be taking calcium," she noted.
But, the issue of which women should take which supplements is a complicated one and these preliminary recommendations are unlikely to change practice immediately, said Dr. Shiri Levy, service chief of endocrinology at West Bloomfield Henry Ford Hospital in Michigan, who already tells her patients to get calcium from food sources as much as possible.
"Taking calcium naturally in the diet is probably the best way for patients who don't have lactose intolerance and can drink milk and eat dairy products," she said. "For those not able to take dairy products regularly, then we would supplement to the degree that we can. I would individualize it for patients."
And, Levy pointed out, data from the landmark Women's Health Initiative study did indicate that women on supplements showed a decreased risk for fractures.
As Steinbaum noted, millions of women take vitamin D supplements with or without calcium in the hopes of diminishing the risk of fractures as they age.
According to previous research, half of postmenopausal women will suffer such a fracture in their postmenopausal years.
The USPSTF said there was no evidence to support using the low-dose supplements -- defined as 400 IU of vitamin D with 1,000 milligrams of calcium carbonate -- as protection against fractures.
There was "inadequate evidence" as to how higher doses -- meaning more than 400 IU of vitamin D paired with 1,000 milligrams of calcium -- might affect bone fracture risk, the task force noted.
And it's not clear at this point if vitamin D/calcium supplementation could help fight cancer and fractures in men and younger women, the recommendations added.
There can be a downside to taking such daily supplements, given that there may be a slightly heightened risk of kidney stones, the USPSTF stated.
Both supplements have garnered plenty of evidence for and against their use.
For instance, vitamin D might lower the risk of colorectal and other forms of cancer, according to some studies, while calcium recently has been linked to an increased risk of heart attacks.
The USPSTF recommendations say that vitamin D could still be useful in preventing falls in people aged 65 or older who are already at increased risk for falling.
Women at average risk for osteoporosis should have a baseline bone density scan at age 65, Levy said.
Women who have risk factors for the condition such as celiac disease, a family history of osteoporosis or premature menopause should have a baseline bone density test taken earlier, when they go through menopause, she added.
"If there is an increased risk, we do recommend a healthy lifestyle, appropriate diet including foods rich in calcium and vitamin D and weight-bearing exercise," Levy said.
In addition to natural food sources, many foods are now fortified with vitamin D and calcium.

More information: The draft recommendations can be viewed at the USPSTF website.