U.S. Preventive Services Task Force Recommends Against Vitamin D & Calcium Supplements

Vitamin D + Calcium SupplementsThe U.S. Preventive Services Task Force issued a draft recommendation on June 12, 2012, in which, based on its review of the scientific literature, it declined to recommend Vitamin D and Calcium supplements for prevention of cancer or bone fractures from Osteoporosis. The Task Force found insufficient scientific evidence existing to support such recommendations.

In fact, in its draft recommendation, the Task Force specifically recommended against the low level daily supplements of 400 IU or less of Vitamin D and 1,000 mg of Calcium often prescribed to post-menopausal women for bone fracture prevention. The Task Force found conclusive evidence that supplementation at such levels provides no benefits and carries a small risk of harm.

In a consumer-friendly summary accompanying the draft recommendation, the Task Force summarized its findings as follows:

“For cancer, the Task Force found there isn’t enough information to say whether supplements can prevent cancer. For fractures, the science tells us there is no benefit in taking vitamin D and calcium supplements at low doses to prevent fractures in post-menopausal women. There isn’t enough information to say whether the supplements prevent fractures in men and in premenopausal women, or whether they prevent fractures in postmenopausal women if taken in higher doses.”

The Task Force and its Findings

The Task Force

The U.S. Preventive Services Task Force is an independent body of experts established by Congress in 1984, to make recommendations in the areas of prevention and evidence-based medicine. The Task Force is composed of 16 volunteer experts who are primarily clinicians, and is supported by the U.S. Agency on Healthcare Research and Quality (AHRQ). According to the AHRQ’s website,

“Created in 1984, the U.S. Preventive Services Task Force (USPSTF or Task Force) is an independent group of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, or preventive medications. The USPSTF is made up of 16 volunteer members who come from the fields of preventive medicine and primary care, including internal medicine, family medicine, pediatrics, behavioral health, obstetrics/gynecology, and nursing. All members volunteer their time to serve on the USPSTF, and most are practicing clinicians.

When Congress authorized the USPSTF, it required the Department of Health and Human Services (HHS) to support the Task Force’s work. The 1998 Public Health Service Act and the 2010 Patient Protection and Affordable Care Act instruct AHRQ to provide administrative, research, technical, and communication support to the Task Force.”

Background

In its Draft Recommendations issued Tuesday, the Task Force specifically recognized that,

  • “Cancer is the second most common cause of death in the United States. An estimated 571,950 deaths from cancer occurred in the United States in 2011, and
  • Osteoporotic fractures, particularly hip fractures, are associated with chronic pain and disability, loss of independence, worsened quality of life, and increased mortality. One half of all postmenopausal women will have an osteoporosis-related fracture during their lifetime.”

Findings

However, based on its review of the scientific literature, the Task Force determined that scientific evidence has established that low levels of Vitamin D and Calcium supplementation (less than or equal to 400 IU of Vitamin D3 and 1,000 mg of Calcium carbonate supplements) in fact do not help prevent cancer or osteoporotic fractures in post-menopausal women, but do carry a small increased risk of renal stones.

The Task Force concluded that there currently is insufficient scientific evidence:

  • “to determine the effect of vitamin D supplementation, with or without calcium, on overall cancer incidence and mortality in adults;
  • to determine “the effect of higher doses [greater than 400 IU of Vitamin D and 1,000 mg of Calcium] of combined vitamin D and calcium supplementation on fracture incidence in postmenopausal women,” and
  • “to determine the effect of combined vitamin D and calcium supplementation on the incidence of osteoporotic fractures” “in premenopausal women and in men.”

As to “Men and premenopausal women,” the Task Force concluded:

“The USPSTF concludes that evidence is lacking regarding the benefit of vitamin D supplementation, with or without calcium, for the primary prevention of cancer and osteoporotic fractures, and the balance of benefits and harms cannot be determined.”

The Task Force therefore declined to recommend Vitamin D or Calcium supplements (of any dosage) to premenopausal women or men for prevention of osteoporotic bone fractures, or to any adults for prevention of cancer.

As to “Noninstitutionalized, community-dwelling postmenopausal women,” the Task Force concluded:

“The USPSTF concludes that evidence is lacking regarding the benefit of vitamin D supplementation, with or without calcium, for the primary prevention of cancer, and the balance of benefits and harms cannot be determined.

The USPSTF concludes that evidence is lacking regarding the benefit of daily supplementation with >400 IU of vitamin D3 and 1,000 mg of calcium for the primary prevention of osteoporotic fractures, and the balance of benefits and harms cannot be determined.”

The USPSTF concludes with moderate certainty that daily supplementation with ≤400 IU of vitamin D3 and 1,000 mg of calcium carbonate has no net benefit for the primary prevention of osteoporotic fractures.”

The Task Force therefore recommended against low levels of Vitamin D and Calcium Supplementation (less than 400 IU of Vitamin D and 1,000 mg of Calcium) for fracture prevention in post-menopausal women.

The Task Force declined at this time to recommend high levels of Vitamin D and Calcium supplementation to post-menopausal women for prevention of bone fractures, and declined to recommend Vitamin D, with or without calcium supplements (of any dosage) to post-menopausal women for cancer prevention.

Additional Research Needed

The Task Force called for additional research in these areas. “Research is needed to determine whether daily supplementation with >400 IU of vitamin D3 and 1,000 mg of calcium reduces fracture incidence in postmenopausal women or older men,” the draft recommendation states. “The comparative effectiveness of different preparations of vitamin D (D2 versus D3) or different calcium formations should be evaluated. Prospective studies should [also] assess the potential benefits of vitamin D and calcium supplementation in early adulthood on fracture incidence later in life.”

Vitamin D Supplements for People Over 65 at Increased Risk of Falling.

Nevertheless, in its draft recommendation, the Task Force did note that it had previously found evidence that taking Vitamin D supplements may help people over age 65 who are at increased risk of falling. Here, the Task Force acknowledged that, because many fractures result from falls, Vitamin D supplements may be considered indirectly to contribute to lower fracture risk.

In its recommendations on Prevention of Falls in Community-Dwelling Older Aaults released in May, 2012, the Task Force said:

“The USPSTF recommends exercise or physical therapy and vitamin D supplementation to prevent falls in community-dwelling adults aged 65 years or older who are at increased risk for falls.”

The new draft recommendation on Vitamin D and Calcium Supplementation states:

“The USPSTF recommends vitamin D supplementation to prevent falls in community-dwelling adults aged 65 years and older who are at increased risk for falls. The USPSTF recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. These recommendation statements are available on the USPSTF Web site (http://www.uspreventiveservicestaskforce.org).”

Recommendations of Other Experts

The Institute of Medicine has previously issued a report (in November 2010) recommending that adults should consume 600 IU of Vitamin D (800 IU for those over 70) and 1,000 mg to 1,300 mg of calcium (from all sources – dietary combined with supplements) daily.

Another report and fact sheet previously issued by the Office of Dietary Supplements, National Institutes of Health also found that Vitamin D supplementation carries important health benefits.

Next Steps for the New Draft Recommendation on Vitamin D and Calcium Supplementation

The U.S. Preventive Services Task Force’s draft recommendation on Vitamin D and Calcium Supplementation will be open to public comment through July 10, 2012. The Task Force will then consider any comments received, and issue a final recommendation, containing any amendments it deems necessary, in light of the comments received.

According to reporting by the Washington Post, representatives of the Council for Responsible Nutrition, a trade group representing the dietary supplement industry, have already stated that they “strongly disagree with the draft recommendation” of the Preventive Services Task Force, and plan to submit comments during the comment period.

More Information

See related HelpingYouCare™ reports on:

National Osteoporosis Awareness & Prevention Month Spotlights Bone Health

NIH Features New Report on Good Nutrition for Healthy Bones

Vitamin E Supplements May Weaken Bones, New Mouse Study Suggests

New Studies Find Harm to Health from Vitamin Use

Osteoporosis Concerns: What’s New? Re-focus on Proper Movement and Posture

Studies Find Calcium Supplements May Increase Risk of Heart Attack

For more information on falls and bone fractures, see the HelpingYouCare™ resource pages on Falls/ Fractures/ Mobility Loss, including:

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