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Vitamin D and calcium are essential for overall health, but do not reduce the risk of falls or fractures in generally healthy older adults, according to a new draft recommendation from the U.S. Preventive Services Task Force.
When it comes to preventing the risk of falls or fractures in older adults, the task force recommends against relying on vitamin D and calcium supplements – and, for the first time, men are included in these guidelines.
Older adults may still need to take vitamin D or calcium for their overall health, but should take different steps to protect themselves from fractures or reduce the risk of falls.
In 2018, the working group not recommended daily supplementation with 400 units or less of vitamin D and 1,000 milligrams or less of calcium for the primary prevention of fractures in postmenopausal women. But it concluded there was not enough evidence to make a recommendation for primary prevention of fractures in men.
The task force’s draft recommendation would update current guidelines to include the recommendation against supplementation in men aged 60 or older and remove mention of specific doses. The draft recommendation is not yet final, but will be available on the working group website for public comment until Jan. 21, along with a draft review of the evidence.
“When we made the 2018 recommendation, we did not have enough male participants in studies of vitamin D-related fractures and falls. Since then, there have been enough to draw at least some conclusions , and we drew the same conclusions. conclusion – it’s not helpful in terms of prevention,” said task force member Dr. Goutham Rao, chair of the Department of Family Medicine and Community Health and the health system’s chief clinical officer. from University Hospitals in Cleveland, Ohio.
“The other thing is that some questions have arisen about whether high doses of vitamin D and calcium might be beneficial,” Rao said. “But what we found was that no dose in our most recent recommendation was associated with any benefit.”
However, Rao added that aside from preventing falls and fractures in older adults, vitamin D and calcium remain essential nutrients for overall health. Vitamin D helps the body absorb calciumand benefits the immune system, brain and muscle performance, among other functions.
“One of the key messages we need to get across is that no one is suggesting that you not take vitamin D and calcium, because the National Academy of Medicine has specific recommendations on how much vitamin D and calcium you should you should be consuming in your diet or through supplements on a daily basis, and it’s very important for bone health, for brain health, for all kinds of things,” he said. “It’s. only with regard to fractures and falls that we have not seen any benefits.
The draft recommendation may seem “difficult” because people might interpret the recommendations as saying that vitamin D and calcium are not important at all, said Dr. Sherri-Ann Burnett-Bowie, an associate professor of medicine at Harvard University. Medical School and a clinical investigator in the Division of Endocrinology at Mass General Brigham, who was not involved in the new USPSTF draft recommendation.
“As noted in the draft recommendation, everyone should get the recommended daily intake, which is between 600 and 800 units of vitamin D per day if you are 1 year or older, and between 700 and 1,200 milligrams of calcium,” Burnett-Bowie said, adding that many people in the United States consume less than recommended amounts of calcium.
“Racial and ethnic differences exist in who consumes the recommended daily allowance in their diet – with higher rates of dietary calcium insufficiency among non-Hispanic Black or non-Hispanic Asian individuals. So if the goal is to only get calcium or vitamin D from diet or supplements, including Ensure or Boost, then many people won’t get there through diet alone,” he said. -she declared. “Taking a calcium supplement, with vitamin D to aid calcium absorption, makes up for what a person may not be able to achieve based on diet alone.”
The USPSTF draft recommendation specifically recommends against vitamin D supplementation, with or without calcium, for the primary prevention of fractures in postmenopausal women and men aged 60 years or older who live in their own homes in the community and not in retirement homes, long-term care. or are hospitalized.
In a systematic review of research, the working group concluded “with moderate certainty” that vitamin D supplementation had no net benefit for the primary prevention of fractures and falls in this age group.
The task force also noted that vitamin D supplementation with or without calcium may increase the incidence of kidney stones, although the magnitude of this damage was considered small. Calcium is a key element of most kidney stones.
“If you take the standard amount, the risk of harm will be low,” Burnett-Bowie said. “If you follow the recommended daily allowance, it is unusual for kidney stones to occur.”
Taking vitamin D supplements did not result in a “significantly lower risk” of fractures in middle-aged and older adults, according to a study published in 2022 in the New England Journal of Medicine.
Specifically, consume 2,000 IU (international units) per day of calcium-free vitamin D3 supplement over the course of a more than five years did not reduce total, hip, wrist or pelvis fractures compared to taking a placebo daily, the study found. A placebo is a fake pill given to patients, so they think they are getting the real supplement.
“We found that vitamin D supplementation versus placebo in the largest randomized controlled trial – including 25,871 adults recruited in 50 states – did not reduce the risk of fracture, and this included middle-aged adults and older, generally healthy,” said study author Dr. Meryl LeBoff, chief of the Calcium and Bone Section in the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s Hospital of Boston and professor of medicine at Harvard Medical School, who was not involved in the new USPSTF project. recommendation.
But although the results are consistent with the USPSTF’s new draft recommendation, they “are not generalizable to adults with severe vitamin D deficiency, low bone mass, osteoporosis, who are taking medications against osteoporosis, to those with malabsorption or those at high risk of falling, or to older adults living in residential communities,” LeBoff said. Osteoporosis is a disease that causes bones to be so fragile that a fall or even mild stress can cause a fracture.
Every year in the United States, more than one in four elderly people Suffer a fall that could result in fractures, hip fractures or other injuries.
Steps older people can take to reduce their risk of falls and fractures include osteoporosis screening, especially for women 65 and older, Rao said, and regular exercise. If a person suffers from osteoporosis, treatment may be prescribed. to prevent fractures.
“Our recommendation focuses on preventing falls and preventing fractures – that’s what we want to emphasize, that vitamin D and calcium are not helpful in that regard. But there are things you can also do, including screening for osteoporosis and doing structured exercise,” he said.
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It can help to do regular strength training exercises by lifting weights or using resistance bands, and to improve balance with exercises like yoga, Pilates or tai chi.
When doing your daily activities, get up slowly, as getting up too quickly can cause your blood pressure to drop and make you lose your balance.
Some adults may also benefit from vision and hearing tests to reduce their risk of falls, or the use of assistive devices such as canes or walkers.
In winter, it’s also important to take extra caution when walking on wet or icy surfaces, and consider staying indoors when the weather is in bed.
Additionally, be sure to tell your doctor about any falls or fractures that may have occurred since your last checkup, as these may alert a doctor to any new medical problems or problems that may have arisen that could be treated. .