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Vitamin D and calcium supplements reduce fracture risk in institutionalised elderly people

By Nicole Mackee
Vitamin D and calcium supplements should continue to have a key role in preventing hip and other fractures in institutionalised elderly people, according to a leading endocrinologist. 

Professor Peter Ebeling, Head of the Department of Medicine in the School of Clinical Sciences at Monash Health in Melbourne, said coadministration of vitamin D and calcium supplements has been found to be effective in institutionalised elderly people who were likely to have the lowest vitamin D levels. 

Professor Ebeling was commenting on a paper published in the BMJ, that was seeking to clarify the role of vitamin D supplementation. 

The authors, from New Zealand and Scotland, reviewed evidence to determine if prescribing vitamin D in patients with low 25-hydroxyvitamin D levels affected the patients’ clinical outcomes. They found that while vitamin D supplementation alone did not improve musculoskeletal outcomes, there was some evidence to support a benefit with vitamin D combined with calcium. 

The authors reported that meta-analyses of vitamin D supplemented with calcium prevented hip and nonvertebral fractures in two trials of severely vitamin D deficient (mean baseline 25-hydroxyvitamin D 20 nmol/L), frail, elderly women in residential care. Evidence of benefit was not found among seven trials of community-dwelling people. 

People at high risk of vitamin D deficiency should be counselled about lifestyle measures, and may benefit from low-dose vitamin D supplements (400 to 800 IU/day), the authors concluded. For other people, they said, the current evidence did not support the use of vitamin D supplementation to prevent disease. 

Professor Ebeling, who is also Medical Director of Osteoporosis Australia, said a meta-analysis of eight studies and 30,970 participants (with 195 hip fracture and 2231 total fracture event) published earlier this year showed vitamin D and calcium supplementation produced a statistically significant 15% reduced risk of total fractures, and a 30% reduced risk of hip fractures. This reflected findings from a large randomised trial in French nursing homes from the early 1990s (Osteoporos Int 2016; 27: 367-376; N Engl J Med 1992; 327: 1637-1642). 

Professor Ebeling also pointed to a 2010/2011 Victorian Health Monitor report that found that just under 8% of the Victorian population had 25-hydroxyvitamin D levels below 25 nmol/L (www2.health.vic.gov.au/about/key-staff/chief-health-officer/cho-publications/low-vitamin-d-in-victoria).

‘That equates to 300,000 Victorians so, at a population level in Australia, the number of people with moderately severe vitamin D deficiency is quite high. These are the types of people who would benefit from a combined approach with vitamin D with calcium,’ Professor Ebeling told Endocrinology Today

However, he said, where possible, patients should be advised to reduce their fracture risk without supplementation, by including three serves of calcium-containing foods in their diet per day, maintaining optimum levels of vitamin D of above 50 nmol/L and engaging in regular weight-bearing exercise. 

Also, he added, patients who present to hospital with broken bones after minimal trauma should be investigated and treated for osteoporosis.
BMJ 2016; 355: i6201. 

Picture credit: © Shironosov/iStockphoto.com. Models used for illustrative purposes only.