High-dose vitamin D prevents fractures in elderly

A new analysis of nearly a dozen studies testing vitamin D in older individuals has concluded that it takes a daily dose of at least 800 international units (IU) to consistently prevent broken bones. A dose that high was found to reduce the risk of hip fracture by 30 percent and other breaks by 14 percent. Lower doses didn’t have any effect. The report, published in the New England Journal of Medicine, also suggests that too much calcium—perhaps more than 1,000 milligrams (mg) per day—can weaken the benefit. “These hip fractures cost a lot and are a really serious event. They are usually the end of independent life for a senior person; 50 percent do not regain their mobility. Reducing the risk by 30 percent with just a vitamin supplement would be an enormous public health opportunity,” study researcher Dr. Heike Bischoff-Ferrari of University Hospital Zurich in Switzerland told Reuters Health. The Institute of Medicine recommends that most adults get 1,000 to 1,200 mg of calcium per day and 600 to 800 IU of vitamin D. It sets a recommended upper limit at 2,000 mg of calcium and 4,000 IU of vitamin D. Bischoff-Ferrari said the lack of benefit seen in other studies “may be explained by adherence to treatment and vitamin D supplements taken outside the study medication.” Dr. Richard Bockman, a hormone expert at the Hospital for Special Surgery in New York, said the findings are an important counterbalance to last month’s widely-reported recommendation by the US Preventive Services Task Force. The government-backed task force advised against taking doses of less than 400 IU of vitamin D with 1,000 mg of calcium and concluded the evidence was unclear for higher doses. It also said the supplements carry a risk of side effects such as kidney stones. Bockman said the best trial is a 2003 study, known as the Trivedi trial, in which volunteers received an average of 800 IU per day as a single 100,000 IU dose every four months. “It clearly showed a reduction in fracture risk in people who were getting vitamin D,” he said. In an editorial, Dr. Robert Heaney of Creighton University Medical Center in Omaha, Nebraska, said the problem with the conflicting studies may be that most have failed to consider each person’s vitamin D levels to start with. Giving it to people who already have enough, or not giving enough to people with very low levels, may show no benefit, he said. “In this regard, as in several other respects, nutrients are unlike drugs. Once an adequate concentration has been achieved, additional intake has no effect,” said Heaney.