Calcium and vitamin D in the prevention of osteoporotic fractures

摘要

Although the adult population should be encouraged to have a dietary calcium intake greater than the RNI of 700 mg/day, individuals with probable osteoporosis and those at risk of osteoporosis should consider increasing their dietary calcium intake to 1000-1500 mg/day. The adult population should also be encouraged to maintain regular exposure to sunlight (5-10 min two or three times weekly without sunblock) during summer months. In healthy older people with a calcium intake > 700 mg/day and regular sunlight exposure, there is no need for calcium and vitamin D supplementation. In contrast, older people likely to have vitamin D insufficiency, such as those with limited or no exposure to sunlight, should receive calcium and vitamin D supplementation. Although calcium and vitamin D should be considered in care-home residents, this may be ineffective in those who are chair- or bed-bound, as their risk factor profile for falls and fractures may be very different from that of more ambulant residents. Combined calcium and vitamin D supplementation alone is ineffective in the secondary prevention of osteoporotic fractures in community-dwelling older people, where other treatment options should be considered. Nevertheless, patients receiving osteoporosis treatment should also be offered calcium and vitamin D supplementation daily, unless the clinician is confident that the patient has an adequate dietary calcium intake and is vitamin-D-replete.