USPSTF Recommendation Against Low-dose Calcium, Vitamin D to Prevent Fractures Significant, Says FP Expert

Draft Statement on Hypertension Screening in Kids, Teens Finds Evidence Lacking

February 27, 2013 02:55 pm Matt Brown

The U.S. Preventive Services Task Force (USPSTF) overturned decades' worth of routine practice on Feb. 25, recommending against(www.uspreventiveservicestaskforce.org) daily supplementation with 400 IU or less of vitamin D3 and 1,000 mg of calcium carbonate for the primary prevention of fractures in noninstitutionalized postmenopausal women.

USPSTF Co-vice Chair Michael LeFevre, M.D., M.S.P.H., of Columbia, Mo., told AAFP News Now the task force's D recommendation is a significant move. "What we're saying is that a practice that we have commonly used for years -- literally, years -- routinely in postmenopausal women just doesn't work," LeFevre said.

"Historically speaking, we've been encouraged to look at a woman's presumed calcium intake -- and I have been taught in the past that very few women are going to get that recommended daily allowance from food and that we should be routinely supplementing women … but we've found good evidence that supplementing with calcium carbonate and vitamin D will not prevent fractures in postmenopausal women."

The USPSTF also concluded that current evidence is insufficient to assess the balance of benefits and harms of

story highlights

  • The U.S. Preventive Services Task Force (USPSTF) recommends against daily supplementation with 400 IU or less of vitamin D3 and 1,000 mg of calcium carbonate for the primary prevention of fractures in noninstitutionalized postmenopausal women.
  • The USPSTF also found the evidence insufficient to recommend for or against combined vitamin D and calcium supplementation to prevent fractures in men or premenopausal women, as well as daily supplements of more than 400 IU of vitamin D3 and 1,000 mg of calcium to prevent fractures in noninstitutionalized postmenopausal women.
  • In addition, the USPSTF issued a draft recommendation indicating that current evidence is insufficient to assess the balance of benefits and harms of screening for hypertension in asymptomatic children and adolescents to prevent subsequent cardiovascular disease.
  • combined vitamin D and calcium supplementation for the primary prevention of fractures in premenopausal women or in men and
  • daily supplementation with more than 400 IU of vitamin D3 and 1,000 mg of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women.

Supplementation Not Best Approach

LeFevre said it is necessary to point out that calcium and vitamin D still are important in maintaining bone health, but that using supplements is not the best approach.

"The jury is out at this point in terms of using vitamin D at higher doses for preventing fractures or anything else, quite honestly," LeFevre said. "We don't know about other preparations of calcium, and we certainly should not be discouraging women from getting an adequate amount of calcium from food. But a calcium supplement is not the same as calcium from food."

LeFevre said that even in the absence of clear evidence of benefit, he will stop recommending supplements to most postmenopausal women, but will encourage women to get additional calcium through their diet and vitamin D through moderate sun exposure.

"I admit I'm a bit of an iconoclast about vitamin D in that I think that a little bit of sun doesn't hurt anybody," he said. "A lot of sun does harm, but an absolute prohibition on sun isn't something that we can necessarily defend. But that is the family physician talking, not the USPSTF member."

Evidence Lacking on Hypertension Screening in Children

The USPSTF also issued a draft recommendation(www.uspreventiveservicestaskforce.org) indicating that current evidence is insufficient to assess the balance of benefits and harms of screening for hypertension in asymptomatic children and adolescents to prevent the development of cardiovascular disease in childhood or adulthood.

"At this point, we simply do not have enough science to tell us what the benefits or harms are regarding screening for hypertension in this group," LeFevre said. Now, family physicians and pediatricians obviously have to make a decision on what to do in this case, even when the evidence is inadequate, so this is not a recommendation against screening, but one that is pointing out the gaps in screening and (issuing) a call for better research."

LeFevre said that in his own family medicine practice, it is common practice to take a blood pressure reading during a well-child visit, as well as during any regular adult visit to the clinic.

"We don't necessarily check blood pressure on every child that comes into the clinic, but we definitely do it at the well-child visit," he said. "What we just don't know at this point is what impact that screening will have on the child's cardiovascular health in the future."

The draft statement will be available for public comment until March 25.


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