Putting Prevention into Practice

An Evidence-Based Approach

Vitamin D and Calcium Supplementation to Prevent Fractures in Adults



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Am Fam Physician. 2014 Jun 1;89(11):897-898.

  Related U.S. Preventive Services Task Force Recommendation Statement: Vitamin D and Calcium Supplementation to Prevent Fractures in Adults: Recommendation Statement.

This clinical content conforms to AAFP criteria for continuing medical education (CME). See CME Quiz Questions.

Author disclosure: No relevant financial affiliations.

Case Study

A 55-year-old woman presents to your office for a refill of her blood pressure medication. She is otherwise healthy and does not take other medications. She states that her older sister has been taking vitamin D and calcium supplements for several years “to keep her bones strong,” and asks whether she should take vitamin D and calcium as well.

Case Study Questions

  1. According to the U.S. Preventive Services Task Force (USPSTF), which one of the following is the most appropriate response to this patient's inquiry?

    • A. Recommend that she start taking 400 IU of vitamin D3 and 1,000 mg of calcium daily.

    • B. Recommend that she start taking 800 IU of vitamin D3 and 1,500 mg of calcium daily.

    • C. Refer her for a bone mineral density assessment before making a recommendation.

    • D. Recommend that she not take low doses of vitamin D and calcium because they have not been shown to prevent fractures in community-dwelling, postmenopausal women.

  2. According to the USPSTF, which of the following statements about vitamin D and calcium supplementation are correct?

    • A. Vitamin D and calcium supplementation is associated with an increased incidence of renal stones.

    • B. In postmenopausal women, there is adequate evidence that daily supplementation with 400 IU of vitamin D3 combined with 1,000 mg of calcium has no effect

The views expressed in this work are those of the authors, and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of Defense, or the Canadian Armed Forces.

SOURCES

U.S. Preventive Services Task Force. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;158(9):691–696.

Chung M, Lee J, Terasawa T, Lau J, Trikalinos TA. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155(12):827–838.

The case study and answers to the following questions are based on the recommendations of the U.S. Preventive Services Task Force (USPSTF), an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. More detailed information is available in the USPSTF Recommendation Statement and evidence report on the USPSTF website (http://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at http://www.uspreventiveservicestaskforce.org/uspstf/uspsvitd.htm.

A collection of Putting Prevention into Practice quizzes published in AFP is available at http://www.aafp.org/afp/ppip.


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