Calcium and vitamin D for bone health in adults

Abstract

Low calcium and vitamin D intakes are established nutritional risk factors for osteoporosis. This chapter reviews the impact of these nutrients on calcium homeostasis and fracture risk and their role in the prevention and treatment of osteoporosis. It also reviews the impact of vitamin D on risk of falling. The calcium intake requirement is challenging to determine, and the IOM recommendations are based largely on calcium balance studies. The IOM recommends a calcium intake of 1,000-1,200 mg per day for older adults to support the preservation of bone mass. Food sources of calcium are preferred because higher intakes of calcium in supplement form have been associated with increased risk of kidney stones, and possibly also with increased risk of myocardial infarction and of death from heart disease. Vitamin D lowers fracture risk as a result of combined favorable effects on BMD, muscle performance, balance, and risk of falling. The magnitude of the risk reduction for falls and fractures with vitamin D supplementation is approximately 20 %. Daily, weekly, or monthly dosing of vitamin D3 is recommended, and high, infrequent dosing should be avoided because it increases risk of falls and fractures.