The U.S. Preventive Services Task Force has recommended against vitamin D and calcium supplementation in healthy postmenopausal women, citing research showing that such supplementation increases the risk of kidney stones and does not protect against fractures in this population.
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The USPSTF has recommended against vitamin D and calcium supplementation in healthy, postmenopausal women due to research showing that these supplements increased risk of kidney stones and did not protect against fractures.
Specifically, the USPSTF recommended – with moderate certainty – against supplementation with doses of vitamin D at 400 IU or less, and calcium at 1,000 IU or less in noninstitutionalized postmenopausal women. The evidence with respect to higher doses is insufficient for making a recommendation, Dr. Virginia A. Moyer reported on behalf of the USPSTF.
The evidence is also 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 and in premenopausal women, according to the recommendation statement, which was published online in the Feb. 25 issue of Annals of Internal Medicine (doi:10.7326/
0003-4819-158-9-201305070-00605).
Based on previously released recommendation statements, however, the USPSTF does recommend vitamin D supplementation for the prevention of falls in community-dwelling adults aged 65 years or older who are at increased risk for falls, and recommends that women aged 65 years and older be screened for osteoporosis.
Younger women with a fracture risk that is equal to or greater than that of a 65-year-old white woman with no additional risk factors should also be screened.
The new recommendations apply to noninstitutionalized or community-dwelling asymptomatic adults without a history of fractures; they do not apply to persons with osteoporosis or vitamin D deficiency.
The USPSTF acknowledged that the health burden of fractures is substantial in the older population, with nearly half of all women over age 50 years experiencing an osteoporosis-related fracture during their lifetime, but the task force noted that the increased risk of renal stones demonstrated in participants in the Women’s Health Initiative study who were taking supplemental vitamin D and calcium was also substantial.
"One woman was diagnosed with a urinary tract stone for every 273 women who received supplementation over a 7-year follow-up period," according to the recommendation statement.
In developing the recommendations, the USPSTF commissioned two systematic reviews of the evidence from 16 available randomized controlled trials and an updated meta-analysis of vitamin D supplementation with or without calcium supplementation.
The members of the USPSTF said they had no relevant financial disclosures.