Fractures are a common occurrence in the older population, and they are one of the leading causes of disability and mortality globally.

It is estimated that 1 in 3 women and 1 in 5 men aged 50 years and above will experience an osteoporotic fracture in their lifetime. Osteoporosis is the primary underlying condition responsible for most fractures in adults, and the condition is characterized by low bone mass, loss of bone mineral density, and microarchitectural deterioration of bone tissue.

The two minerals most strongly associated with bone health are calcium and vitamin D. Calcium plays a vital role in maintaining bone mineral density, and vitamin D helps in the absorption of calcium from the intestinal tract.

Therefore, many studies have been conducted to assess the effectiveness of calcium and vitamin D in preventing fractures in individuals at risk of osteoporosis.

Calcium for Fracture Prevention

A systematic review and meta-analysis conducted by Tang et al. (2007) investigated the effectiveness of calcium in preventing fractures in women aged 50 years and above.

The study found that calcium supplementation reduced the risk of fractures by 12% (95% CI, 0.84-0.97), with the greatest effect observed in the hip (RR, 0.70; 95% CI, 0.58-0.86). However, the study further stated that calcium supplementation alone was not sufficient to prevent fractures, and a combination of calcium and vitamin D supplementation was more effective.

In a more recent study conducted by Bolland et al. (2015), the researchers examined the effects of calcium supplements on the risk of fracture and cardiovascular events in older adults.

The study reported that calcium supplementation did not reduce the risk of fractures, and it was associated with an increased risk of myocardial infarction. However, the results of this study have been questioned by other researchers.

Vitamin D for Fracture Prevention

A systematic review and meta-analysis conducted by Bischoff-Ferrari et al. (2009) investigated the effect of vitamin D supplementation on the risk of fracture.

The study included data from 12 randomized controlled trials (RCTs) and found that vitamin D supplementation reduced the overall risk of fracture by 20% (RR, 0.80; 95% CI, 0.72-0.89). The greatest reduction in fracture risk was observed in individuals who took vitamin D with calcium.

Related Article Vitamin D and calcium supplementation for fracture prevention: What’s the evidence?

The study further suggested that individuals aged 65 years and above should take a daily vitamin D supplement of at least 800 international units (IU) to reduce the risk of fractures.

In a more recent study published by Weaver et al. (2016), the researchers conducted a secondary analysis of the Women’s Health Initiative (WHI) trial to evaluate the effect of vitamin D supplementation on fracture risk in postmenopausal women.

The study found that vitamin D supplementation did not reduce the risk of fractures in postmenopausal women aged 50 years and above.

Current guidelines for calcium and vitamin D supplementation

The National Osteoporosis Foundation recommends a daily calcium intake of 1000-1200 mg/day for individuals aged 50 years and above, and a daily vitamin D intake of 800-1000 IU/day.

However, the Endocrine Society recommends higher doses of vitamin D for individuals who are at risk of vitamin D deficiency, and they suggest a daily intake of up to 2000 IU/day for individuals aged 65 years and above and individuals who are receiving treatment for osteoporosis.

It is important to note that excessive intake of calcium and vitamin D can have adverse effects on health.

High doses of calcium can increase the risk of kidney stones, and excessive vitamin D intake can lead to hypercalcemia, a condition characterized by abnormally high levels of calcium in the blood. Therefore, it is essential to follow the recommended daily intake guidelines for calcium and vitamin D.

Conclusion

The evidence suggests that calcium and vitamin D are essential nutrients for maintaining bone health, and they may play a role in reducing the risk of fractures in individuals at risk of osteoporosis.

However, the effectiveness of calcium and vitamin D supplementation in preventing fractures remains controversial, and more research is needed to determine the optimal doses and duration of supplementation. It is important for individuals to maintain a balanced diet that meets their daily recommended intake of calcium and vitamin D and to consult with their healthcare provider before starting any supplementation.