Vitamin D/Calcium Supplementation Not Recommended by Fed Panel USPSTF, Public Commentary Invited
These recommendations subject to public comment now do not as I see them discuss supplementation for HIV+ individuals.|
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 (B recommendation) (Figure). 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).
Vitamin D supplementation
Adults ages 65 and older at increased risk for falls
· Evidence shows that vitamin D supplementation prevents falls in community-dwelling (that is, people who do not live in assisted living or nursing homes) adults ages 65 and older.
· According to the Institute of Medicine, the recommended daily allowance for vitamin D is 600 IU for adults ages 51 to 70 years and 800 IU for adults older than 70 years.
Low-dose vitamin D to stop breaks gets thumbs-down
By Andrew M. Seaman
NEW YORK | Tue Jun 12
from Jules: research is often difficult to interpret, it depends on nuance in understanding the field, the science and the studies. The USPSTF has been known to issue other statements that have been received with stunning disbelief.
"Clifford Rosen, a spokesman for the Society of Bone and Mineral Research, notes that the task force discounts a finding from the Women's Health Initiative, a study of 36,282 healthy postmenopausal women, that supplements offer a 10%-11% reduced risk of fractures."
In Dec 2011 this was published in the Annals of Internal Medicine:
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
"On the basis of the aggregate internal validity of the body of evidence for each key question-in turn based on the number, methodological quality, and size of studies; consistency of results between studies; and directness of evidence-we concluded that combined vitamin D (300 to 1100 IU/d) and calcium supplementation (500 to 1200 mg/d), but not vitamin D supplementation alone, can reduce the fracture risk in older adults. However, the effects may vary according to setting, with smaller effects in community-dwelling elderly persons or postmenopausal women than in institutionalized elderly persons. The evidence is not sufficiently robust to draw a conclusion about the benefits or harms of vitamin D supplementation for cancer prevention. Direct evidence from RCTs for the effects of vitamin D (with or without calcium) supplementation on cancer outcomes is limited and does not agree with data from observational studies. Limited data from RCTs suggest that a high dosage (1000 IU/d) of vitamin D can reduce the risk for total cancer."
Download the PDF Here
(Reuters Health) - Postmenopausal women shouldn't take low doses of vitamin D and calcium to prevent broken bones, a government-backed expert panel said on Tuesday.
The U.S. Preventive Services Task Force (USPSTF), which makes recommendations on a range of prevention issues, said studies of the supplements suggest they do little to prevent fractures at doses lower than 400 IU of vitamin D and 1,000 milligrams (mg) of calcium daily. But it is clear that they come with a slightly increased risk of certain side effects, including kidney stones.
The recommendations are still in draft form and will be available for public comment on the USPSTF's website for about a month before they are finalized.
For higher doses of the supplements, the evidence is still too limited to make recommendations either way, the panel found. The same is true for cancer prevention, it said.
Dr. Kirsten Bibbins-Domingo, a member of the panel and a professor at the University of California, San Francisco, said it's important for people to know that the new recommendation only applies to postmenopausal women and those taking supplements.
"We know vitamin D is very important for the body and it's important for everyone to eat a healthy diet that includes vitamin D and calcium," she said.
The Institute of Medicine, an advisory panel to the U.S. government, recommends men and women get at least 600 IU of vitamin D and at least 1,000 mg of calcium every day. The exact recommendations vary depending on age and sex.
Vitamin D and calcium supplements are often recommended for women to prevent fractures, according to the USPSTF. The supplements are widely available and are usually inexpensive.
Dr. Silvina Levis, of the Osteoporosis Center at the University of Miami Miller School of Medicine in Florida, said she's happy with the recommendation against the low-dose supplements.
"It's been known for some time that that is too low of a dose," she said. But she added that she still believes there is a benefit to higher doses.
The new draft recommendations are based in part on a recent review of past research, which concluded that taking the supplements had mixed effects on cancer and broken bones (see Reuters Health report of December 19, 2011).
The review was based on 19 randomized controlled trials -- the "gold standard" of medical research -- and found supplementing a person's diet with 400 IU of vitamin D and 1,000 mg calcium may offer some protection against broken bones in the elderly. But the increased risk of kidney stones means there is "no net benefit," the panel found.
"We're fortunate that we have large studies that tell us with a moderate degree of certainty that -- in these dosages -- this supplementation is not effective in postmenopausal women with the goal of preventing fractures," said Bibbins-Domingo.
Another draft recommendation from the USPSTF out today calls for doctors to screen all women for domestic violence.
Panel to postmenopausal women: Don't take vitamin D, calcium
By Janice Lloyd, Liz Szabo and Nanci Hellmich, USA TODAY
A government advisory panel's recommendation Tuesday that healthy postmenopausal women should not take daily low doses of vitamin D and calcium to prevent bone fractures is a wakeup call to millions of Baby Boomer women that more is not always better.
The panel said there is insufficient evidence to evaluate larger doses, easy to overdo with chewy chocolate supplements that can seem like candy.
In its draft recommendations, the U.S. Preventive Services Task Force also said existing research is insufficient to assess the risks or benefits of taking vitamin D - with or without calcium - to prevent cancer in adults.
· MORE: To supplement or not to supplement
Some studies link higher levels of vitamin D with lower rates of colorectal cancer and reduced risks for other cancers, including breast, prostate and pancreatic cancer. These reports are mixed and therefore inconclusive, the advisory panel said.
This is the same panel that grabbed headlines recently by recommending against PSA (prostate-specific antigen) tests to screen for prostate cancer in healthy men and told women ages 50 to 74 to have a mammogram every other year, instead of annually
This latest report adds to many conflicting messages about the benefits and risks of vitamin D and calcium supplements.
For years, experts have been touting the health benefits of these nutrients. Both calcium and vitamin D are key nutrients for bone health.
The Institute of Medicine, which provides independent advice on health, recommends that people daily get 600-800 IUs (international units) of vitamin D and 700-1,300 milligrams of calcium, depending on their age.
Many foods, such as milk and yogurt products, are rich in calcium and fortified with vitamin D. Sunlight triggers the production of vitamin D in skin and is a major source of the vitamin for many people.
The task force's draft recommendation looked at doses up to 400 IUs (international units) of vitamin D and 1,000 milligrams of calcium for fracture prevention, and recommended against taking them, saying the nutrients slightly increase the risk for kidney stones. The authors add that there is insufficient evidence to draw conclusions about taking larger doses to prevent fractures.
Fractures are a significant health problem, the task force says; every year approximately 1.5 million fractures occur in the U.S. Nearly half of all women older than 50 will have an osteoporosis-related fracture during their lifetime.
"The science is still out for pre-menopausal women and men," with regard to low-dose supplements and fractures, says Timothy Wilt, the lead author on the panel report. "Many people take the supplements, but the science was insufficient to make recommendations for everyone."
Some health experts don't agree with the task force recommendation and say women should weigh options with their physicians based on their own ethnicity, diet and sun exposure, a major source of vitamin D.
The studies analyzed by the government panel have important limitations, says Jen Sacheck, an assistant professor and researcher in the antioxidants research laboratory at Tufts University in Boston. The research largely involved white people and no accommodation was made for how nutritional needs may vary by where a person lives, she says.
"It's a more complex picture than they're painting," she says. "If you live in New England there are many months of the year when you're not getting adequate amounts of vitamin D from the sun. I check blood levels of young and older people and find them to be low in New England."
If you're Hispanic, Asian or black, says Sacheck, or are lactose intolerant, you might not get enough calcium from dairy products. She says being overweight or obese also can also compromise the levels of the nutrients.
Taylor Wallace, senior director of scientific and regulatory affairs for the Council for Responsible Nutrition, a trade group that represents supplement makers, says research shows that supplementation with calcium and vitamin D is beneficial for bone health, particularly in post-menopausal women and the elderly. "You want try to your best to get your calcium and vitamin D from food, but most Americans do not, so when there is a gap, they can fill that gap with supplements."
He points out that last month this same government task force said supplementation with vitamin D was beneficial in preventing incidences of falls among adults ages 65 and older. "Since falls commonly result in fractures, it's common sense for the elderly to consider supplementing with vitamin D and calcium."
About 22% of U.S. adults report taking calcium supplements and 22% reporting using vitamin D supplements, the industry group says.
Most calcium supplements also contain vitamin D because the two nutrients work together, Wallace says. "Vitamin D helps pull calcium into the bones."
"We recommend consumers read the labels," on supplements, he adds. "More is not always better, including for the tasty stuff like the soft chews where people might be tempted to eat a bit more."
Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York and an American Heart Association spokeswoman, says the recommendation "changes everything. There seems to be no place for calcium for preventing cancer and fractures.
"To tell people, 'Take calcium and vitamin D to prevent fractures as you get older,' that's not panning out anymore," she says. "Even if you are at risk for a fracture, maybe you have to try other lifestyle changes, like diet and weight-bearing exercise."
Clifford Rosen, a spokesman for the Society of Bone and Mineral Research, notes that the task force discounts a finding from the Women's Health Initiative, a study of 36,282 healthy postmenopausal women, that supplements offer a 10%-11% reduced risk of fractures.
"I think the government panel's report is a little confusing," Rosen says.
JoAnn Manson, one of the Women's Health Initiative investigators, says in addition to reporting the lower fracture rate, the initiative found "bone density improved among postmenopausal women taking supplements."
Recent research has linked calcium supplements to increased risk of heart attacks, Manson says; she adds that it is best to get calcium from the diet, but some may want to add a low-dose supplement to reach recommended levels.
"The key point about calcium is that more is not better," says Manson, chief of the division of preventive medicine at Brigham and Women's Hospital in Boston.
The National Cancer Institute is funding a 20,000-person study to find whether taking a daily dietary supplement of 2,000 IU of vitamin D or one gram of omega 3 fatty acids reduces the risk of cancer, heart disease and stroke. Manson is directing the study and recruiting men and women for it through this year.
"The science is still out on cancer prevention," says Wilt.
Steinbaum acknowledges that consumers may feel confused and frustrated by changing recommendations. She hopes that people won't give up and feel there's nothing they can do to improve their health. The two old standbys - "eating better and exercising" - still have the greatest impact, she says.