What is the efficacy of calcium and vitamin D supplements in reducing the risk of fracture in patients with osteoporosis?

Updated: Sep 26, 2019
  • Author: Monique Bethel, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Several large studies have demonstrated that supplementation with a combination of calcium and vitamin D can reduce fracture risk. [192] A meta-analysis of 12 double-blind, randomized, controlled trials for nonvertebral fractures and eight trials for hip fractures found that nonvertebral fracture prevention with vitamin D was dose dependent and that a higher dose reduced fractures by at least 20% for individuals aged 65 years or older. [193] However, a longitudinal and prospective cohort study concluded that gradual increases in dietary calcium intake did not further reduce fracture risk or osteoporosis in women. [194]

Another meta-analysis concluded that vitamin D alone is not effective in preventing fractures, but vitamin D given together with calcium reduced hip fractures and total fractures, and possibly vertebral fractures. [195] The conclusions were based on seven large studies that were randomized with at least one intervention arm in which vitamin D was given and included analysis of fractures as an outcome and at least 1000 participants.

More information is needed regarding risks associated with long-term calcium supplementation. Bolland et al and Li et al found an increased risk for myocardial infarction associated with calcium supplements. [196, 197] Others have not found an association. [198, 199] Dietary calcium intake has not been associated with an increased risk of cardiovascular events. [197] Additionally, some [200] but not all [201] studies suggest an increased risk of nephrolithiasis with calcium and vitamin D supplements, but not with calcium ingested in the diet. [202]


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