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Vitamin D and calcium are important for overall health but generally do not reduce the risk of falls or fractures in healthy older adults, according to a new draft recommendation from the US Preventive Services Task Force.
To reduce this risk, the task force recommends supplementing with vitamin D and calcium – and for the first time, men are included in this guideline.
Older people should still take vitamin D or calcium for general health, but they should take different measures to prevent fractures or reduce the risk of falls.
In 2018, the task force It is recommended to prevent extra food every day Prevention of primary fractures in postmenopausal women with 400 units or less of vitamin D and 1,000 milligrams or less of calcium. But he concluded that there is insufficient evidence to recommend preventing fractures in men for the first time.
The task force's draft recommendation updates the guidelines to include a recommendation to avoid supplementation for men age 60 and older, and omits reference to specific amounts. The draft recommendation is not final but is available at Task force website For public comment until January 21, along with a review of draft evidence.
“When we made the 2018 recommendation, we didn't have enough male participants in cross-sectional studies and vitamin D deficiency. Since then, we've had enough to draw at least some conclusions, and we've drawn the same conclusions. Conclusion: Not useful in prevention,” said task force member Dr. Dr. Gautham Rao, Chair of the Department of Family Medicine and Community Health and Chief of the Cleveland University Hospitals Health System Clinical Experience Officer said.
“The other thing is there's been some question about whether higher doses are beneficial for vitamin D and calcium,” Rao said. “But what we found was that there was no amount associated with any benefit in our recent recommendation.”
However, Rao adds, in addition to preventing falls and fractures in older adults, vitamin D and calcium are still important nutrients for overall health. Vitamin D It helps the body absorb Calcium And it benefits the immune system, brain and muscle performance, among other functions.
“One of the key messages we want to get out there is that no one is suggesting you don't take vitamin D and calcium because the National Academy of Medicine has specific recommendations for how much vitamin D and calcium you should have in your diet. Supplements every day, and it's very important for bone health, mental health, all kinds of things.” “The only thing we haven't seen is the breakage and the fallout,” he said.
Dr Sherry-Anne Burnett-Bowie, an associate professor of medicine and clinical professor at Harvard Medical School, said the draft resolution could come across as “challenging” because people could interpret it as saying that vitamin D and calcium are not necessary at all. by the Endocrine Division of the Investigating Department of Mass. Gen. Brigham, who was not involved in the draft recommendation.
“According to the draft recommendation, everyone should have the recommended daily allowance, which is 600 to 800 units of vitamin D per day if you are 1 year of age and older, and 700 to 1,200 milligrams per day.” calcium,” Burnett-Bowey said, adding that Many people in the United States consume less than the recommended amount of calcium.
“There are racial and ethnic differences in who consumes the recommended daily allowance in their diet, with higher levels of dietary calcium deficiency in non-Hispanic blacks or non-Hispanic Asians. So if the goal is to get calcium or vitamin D from diet or supplements, including Insure or Boost, most people will not get it through diet alone.” “Taking extra calcium with vitamin D to facilitate calcium absorption is something a person can't get through diet,” she says. It fills things up.”
The draft recommendation specifically recommends vitamin D supplementation with or without calcium to prevent fractures in postmenopausal women and men 60 and older living at home and in nursing homes, long-term care facilities, or men. Hospitals.
In a systematic review of research, the task force concluded with “moderate certainty” that supplementation with vitamin D has no benefit in preventing primary fractures and falls in older age groups.
Although this rate of harm was assessed as small, the task force suggested that vitamin D supplementation with or without calcium may increase the incidence of kidney stones. Calcium is a major component of many of them. Kidney stones.
“If they're taking the normal dose, they're less likely to get hurt,” Burnett-Bowie said. “If you stay within the recommended daily allowance, kidney stones are uncommon.”
The Council for Responsible Nutrition, a trade association representing dietary supplement and functional food manufacturers and suppliers, disagreed with the draft recommendation, saying it would not include adults with low or vitamin D deficiency.
“These are the people who will benefit the most from supplemental vitamin D and calcium,” said Dr. Andrea Wong, the group's senior vice president of scientific and regulatory affairs. he said in a statement. Wednesday.
“Seniors with limited sun exposure, restricted diets, or darker skin tones are more likely to be deficient, making targeted supplementation critical to their health,” she says. “Leaving extra food unnecessary for the general population reduces its value to those who need it most. It is time for guidelines that reflect the full breadth of science and prioritize public health equity.
In the year New England Journal of Medicine.
In particular, taking 2,000 IU (international units) per day of additional vitamin D3 without calcium Compared with a daily placebo over five years, total fractures, hip, wrist or hip fractures did not decrease, the study found. A placebo is a fake pill to trick patients into thinking they are getting the real supplement.
“We found that supplementation with vitamin D and placebo did not reduce fracture risk, including 25,871 adults enrolled from all 50 states, and this was generally true in healthy middle-aged and older adults,” said study author Dr. Merrill LeBoeuf, M.D., chief of the calcium and bone division of endocrinology, diabetes, and hypertension at Boston's Brigham and Women's Hospital and professor of medicine at Harvard Medical School, is involved in the new USPSTF draft recommendation.
Although the findings are consistent with the new USPSTF recommendations, “it may not be generalizable to adults with severe vitamin D deficiency, low bone mass, osteoporosis, osteoporosis medications, malabsorption, or those at high risk of falls, or those living in a residential home.” communities,” LeBoeuf said. Osteoporosis is a disease that causes bones to become very brittle, and even a fall or minor stress can cause a fracture.
Every year in the United States, More than 1 in 4 elderly people Practice falling, which can result in broken bones, broken hips, or other injuries.
Steps that the elderly can take Reduce the chance of falling and breaking They include getting screened for osteoporosis, especially in women age 65 and older, and getting regular exercise. If a person has osteoporosis, treatment may be prescribed To prevent breakage.
“Our recommendation is focused on preventing falls and preventing fractures. That's what we want to emphasize: vitamin D and calcium are not helpful in this regard. But there are things you can do, including screening for osteoporosis and structured exercise.”
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Get up slowly in your daily routine, as getting up too quickly can cause low blood pressure and loss of balance.
Some adults may benefit from having their vision and hearing tested or using assistive devices such as a cane or walker to reduce their risk of falling.
During the winter, it's important to take extra precautions when walking in wet or snowy areas, or to consider staying indoors when the weather is bad.
Also, remember to tell your doctor about any falls or fractures that may have occurred since your last check-up, as these may alert you to any new medical problems or issues.