Need of Calcium and Vitamin D in Patients after a Recent Fracture

DOI: 10.4236/fns.2012.34076   PDF   HTML     4,157 Downloads   6,757 Views   Citations


Adequate calcium and vitamin D intake is advocated in guidelines of osteoporosis. However, the dosage needed to achieve an optimal calcium intake and vitamin D status is still a point of debate. Of 902 consecutive patients older than 50 years presenting at the time of fracture, 502 were evaluable for measurement of calcium intake and serum 25(OH)D concentration. We calculated the percentage of patients who needed calcium supplements to achieve intake of ?1000 mg/d and who needed cholecalciferol supplementation to achieve serum levels of ?50 nmol/l. Calcium intake ranged between 250 and 2050 mg/d and serum 25(OH)D between <10 and 130 nmol/l. A combination of calcium intake of ≥1000 mg/d and serum 25(OH)D concentration of ?50 nmol/l was present in 11% of patients. To achieve 1000 mg/d of calcium, 57% of patients needed supplementation of 500 mg/d and 12% needed 1000 mg/d. Systematic calcium supplements of 500 mg/d would achieve an intake of 1000 mg/d in 88%. To achieve serum 25(OH)D concentrations of 50 nmol/l, 41% of patients needed a supplement of 800 IU D3/d and 25% needed higher doses. Systematic supplementation of 800 IU/d would achieve 50 nmol/l in 75% of patients. Calcium intake and vitamin D status vary considerably between fracture patients. Conclusion: calcium supplements need to be titrated individually to achieve desirable levels. Most patients achieved 50 nmol/l of 25(OH)D with 800 IU D3/d. Prospective studies are needed to study how to achieve and maintain optimal serum vitamin D levels and adequate calcium intake.

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J. Bergh, S. Bidar, S. Bours, T. Geel and P. Geusens, "Need of Calcium and Vitamin D in Patients after a Recent Fracture," Food and Nutrition Sciences, Vol. 3 No. 4, 2012, pp. 539-547. doi: 10.4236/fns.2012.34076.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] J. R. Center, D. Bliuc, T. V. Nguyen and J. A. Eisman, “Risk of Subsequent Fracture after Low-Trauma Fracture in Men and Women,” Journal American Medical Association, Vol. 297, No. 4, 2007, pp. 387-394. doi:10.1001/jama.297.4.387
[2] A. C. M. van Geel, P. Geusens, I. F. Nagtzaam, C. M. J. R. Schreurs, D. J. M. van der Voort, P. E. L. M. Rinkens, A. D. M. Kester and G. J. Dinant, “Timing and Risk Factors of Clinical Fractures among Postmenopausal Women: A 5-Year Prospective Study,” BMC Medicine, Vol. 4, 2006, p. 24.
[3] A. C. M. van Geel, S. van Helden, P. P. Geusens, B. Winkens and G. J. Dinant, “Clinical Subsequent Fractures Cluster in Time after First Fractures,” Annals Rheumatic Diseases, Vol. 68, No. 1, 2009, pp. 99-102. doi:10.1136/ard.2008.092775
[4] S. van Helden, J. Cals, F. Kessels, P. Brink, G. J. Dinant and P. Geusens, “Risk of New Clinical Fractures within 2 Years Following a Fracture,” Osteoporosis International, Vol. 17, No. 3, 2006, pp. 348-354. doi:10.1007/s00198-005-2026-x
[5] S. van Helden, A. C. M. van Geel, P. P. Geusens, A. Kessels, A. C. Nieuwenhuijzen Kruseman and P. R. Brink, “Bone and Fall-Related Fracture Risks in Women and Men with a Recent Clinical Fracture,” Journal Bone Joint Surgery American, Vol. 90, No. 2, 2008, pp. 241-248. doi:10.2106/JBJS.G.00150
[6] J. A. Kanis, E. V. McCloskey, H. Johansson, O. Strom, F. Borgstrom and A. Oden, “Case Finding for the Management of Osteoporosis with FRAX—Assessment and Intervention Thresholds for the UK,” Osteoporosis International, Vol. 19, No. 10, 2008, pp. 1395-1408. doi:10.1007/s00198-008-0712-1
[7] R. L. Lindsay, S. L. Silverman, C. Cooper, D. A. Hanley, I Barton, S. B. Broy, A. Licata, L. Benhamou, P. Geusens, K. Flowers, et al., “Risk of New Vertebral Fracture in the Year Following a Fracture,” Journal American Medical Association, Vol. 285, No. 3, 2001, pp. 320-323. doi:10.1001/jama.285.3.320
[8] J. Ryg, L. Rejnmark, S. Overgaard, K. Brixen and P. Vestergaard, “Hip Fracture Patients at Risk of Second Hip Fracture—A Nationwide Population-Based Cohort Study of 169,145 Cases During 1977-2001,” Journal Bone Mineral Research, Vol. 24, No. 7, 2009, pp. 12991307. doi:10.1359/jbmr.090207
[9] P. P. Geusens, W. F. Lems, H. J. Verhaar, G. Leusink, S. Goemaere, H. Zmierczack and J. Compston, “Review and Evaluation of the Dutch Guidelines for Osteoporosis,” Journal Evaluation Clinical Practice, Vol. 12, No. 5, 2006, pp. 539-548. doi:10.1111/j.1365-2753.2006.00647.x
[10] J. A. Kanis, N. Burlet, C. Cooper, P. D. Delmas, J. Y. Reginster, F. Borgstrom and R. Rizzoli, “European Guidance for the Diagnosis and Management of Osteoporosis in Postmenopausal Women,” Osteoporosis International, Vol. 19, 2008, pp. 399-428. doi:10.1007/s00198-008-0560-z
[11] J. A. Kanis, J. Compston, A. Cooper, C. Cooper, R. Francis, D. Marsh, E. V. McCloskey, D. Reid, P. Selby and M. Ilkins, “Guideline for the Diagnosis and Management of Osteoporosis in Postmenopausal Women and Men from the Age of 50 Years in the UK,” World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, 2009.
[12] Anonymous, “Clinician’s Guide to Prevention and Treatment of Osteoporosis,” 2012.
[13] J. Pfeilschifter, “2006 DVO-Guideline for Prevention, Diagnosis, and Therapy of Osteoporosis for Women after Menopause, for Men after Age 60 Executive Summary Guidelines,” Experimental Clinical Endocrinology Diabetes, Vol. 114, No. 10, 2006, pp. 611-622.
[14] B. Dawson-Hughes, “Calcium and Vitamin D,” In: C. Rosen, Ed., Primer on the Metabolic Bone Diseases and sordersof Mineral Metabolism, 7th Edition, American Society of Bone and Mineral Research, Washington, 2008, pp. 231-233. doi:10.1002/9780470623992.ch47
[15] C. D. Hunt and L. K. Johnson, “Calcium Requirements: New Estimations for Men and Women by Cross-Sectional Statistical Analyses of Calcium Balance Data from Metabolic Studies,” American Journal Clinical Nutrition, Vol. 86, No. 4, 2007, pp. 1054-1063.
[16] J. Ma, R. A. Johns and R. S. Stafford, “Americans Are Not Meeting Current Calcium Recommendations,” American Journal Clinical Nutrition, Vol. 85, No. 5, 2007, pp. 1361-1366.
[17] N. O. Kuchuk, N. M. van Schoor, S. M. Pluijm, A. Chines and P. Lips, “Vitamin D Status, Parathyroid Function, Bone Turnover, and BMD in Postmenopausal Women with Osteoporosis: Global Perspective,” Journal Bone Mineral Research, Vol. 24, No. 4, 2009, pp. 693-701. doi:10.1359/jbmr.081209
[18] C. Tannenbaum, J. Clark, K. Schwartzman, S. Wallenstein, R. Lapinski, D. Meier and M. Luckey, “Yield of Laboratory Testing to Identify Secondary Contributors to Osteoporosis in Otherwise Healthy Women,” Journal Clinical Endocrinology Metabolism, Vol. 87, No. 10, 2002, pp. 4431-4437. doi:10.1210/jc.2002-020275
[19] B. Dumitrescu, S. van Helden, R. ten Broeke, A. Nieuwenhuijzen Kruseman, C. Wyers, G. Udrea, S. van der Linden and P. Geusens, “Evaluation of Patients with a Recent Clinical Fracture and Osteoporosis, a Multidisciplinary Approach,” BMC Musculoskeletal Disorders, Vol. 9, 2008, p. 109. doi:10.1186/1471-2474-9-109
[20] Anonymous, “Dietary Supplement Fact Sheet: Vitamin D,” Office of Dietary Supplements, National Institutes of Health, 2009.
[21] Standing Committee on the Scientific Evaluation of Dietary Reference Intakes FaNB, “Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride,” National Academy Press, Washington, 1997.
[22] Anonymous, “Voedingsaanbevelingen Voor Belgi?,” Hoge Gezondheidsraad, Brussel, 2009.
[23] H. A. Deutschmann, M. Weger, W. Weger, P. Kotanko, M. J. Deutschmann and F. Skrabal, “Search for Occult Secondary Osteoporosis: Impact of Identified Possible Risk Factors on Bone Mineral Density,” Journal Internal Medicine, Vol. 252, No. 5, 2002, pp. 389-397. doi:10.1046/j.1365-2796.2002.01040.x
[24] C. Becker, S. Crow, J. Toman, C. Lipton, D. J. McMahon, W. Macaulay and E. Siris, “Characteristics of Elderly Patients Admitted to an Urban Tertiary Care Hospital with Osteoporotic Fractures: Correlations with Risk Factors, Fracture Type, Gender and Ethnicity,” Osteoporosis International, Vol. 17, No. 3, 2005, pp. 410-416.
[25] S. Gaugris, R. P. Heaney, S. Boonen, H. Kurth, J. D. Bentkover and S. S. Sen, “Vitamin D Inadequacy among Post-Menopausal Women: A Systematic Review,” Quarterly Journal Medicine, Vol. 98, No. 9, 2005, pp. 667676. doi:10.1093/qjmed/hci096
[26] B. J. Edwards, C. B. Langman, A. D. Bunta, M. Vicuna and M. Favus, “Secondary Contributors to Bone Loss in Osteoporosis Related Hip Fractures,” Osteoporosis International, Vol. 19, No. 7, 2008, pp. 991-999. doi:10.1007/s00198-007-0525-7
[27] Anonymous, “Optimal Calcium Intake,” National Institutes Health Consensus Statement, Vol. 12, No. 4, 1994, pp. 1-31.
[28] K. M. Sanders, C. A. Nowson, M. A. Kotowicz, K. Briffa, A. Devine and I. R. Reid, “Calcium and Bone Health: Position Statement for the Australian and New Zealand Bone and Mineral Society, Osteoporosis Australia and the Endocrine Society of Australia,” Medical Journal Australia, Vol. 190, No. 6, 2009, pp. 316-320.
[29] J. P. Brown and R. G. Josse, “2002 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada,” Canadian Medical Association Journal, Vol. 167, No. 10, 2002, pp. S1-S34.
[30] Anonymous, “Management of Osteoporosis in Postmenopausal Women: 2010 Position Statement of the North American Menopause Society,” Menopause, Vol. 17, No. 1, 2010, pp. 25-54.
[31] J. W. Nieves, “Osteoporosis: The Role of Micronutrients,” American Journal Clinical Nutrition, Vol. 81, No. 5, 2005, pp. 1232s-1239s.
[32] R. P. Heaney, “The Vitamin D Requirement in Health and Disease,” Journal Steroid Biochemical Molecular Biology, Vol. 97, No. 1-2, 2005, pp. 13-19.
[33] R. P. Heaney, “Vitamin D: Criteria for Safety and Efficacy,” Nutrition Reviews, Vol. 66, No. 10, 2008, pp. S178-S181. doi:10.1111/j.1753-4887.2008.00102.x
[34] H. A. Bischoff Ferrari, “How to Select the Doses of Vitamin D in the Management of Osteoporosis,” Osteoporosis International, Vol. 18, No. 4, 2007, pp. 401-407. doi:10.1007/s00198-006-0293-9
[35] P. P. Geusens, “Review of Guidelines for Testing and Treatment of Osteoporosis,” Current Osteoporosis Reports, Vol. 1, No. 2, 2003, pp. 59-65.
[36] K. G. Saag and P. Geusens, “Progress in Osteoporosis and Fracture Prevention: Focus on Postmenopausal Women,” Arthritis Research Therapy, Vol. 11, No. 5, 2009, p. 251. doi:10.1186/ar2815
[37] P. Geusens, P. Sambrook and W. Lems, “Fracture Prevention in Men,” Nature Reviews Rheumatology, Vol. 5, No. 9, 2009, pp. 497-504. doi:10.1038/nrrheum.2009.148
[38] H. Bischoff Ferrari, “Vitamin D: What Is an Adequate Vitamin D Level and How Much Supplementation Is Necessary?” Best Practice Research Clinical Rheumatology, Vol. 23, No. 6, 2009, pp. 789-795. doi:10.1016/j.berh.2009.09.005
[39] J. N. Hathcock, A. Shao, R. Vieth and R. Heaney, “Risk Assessment for Vitamin D,” American Journal Clinical Nutrition, Vol. 85, No. 1, 2007, pp. 6-18.
[40] M. F. Holick, “Vitamin D Deficiency,” New England Journal Medicine, Vol. 357, No. 3, 2007, pp. 266-281. doi:10.1056/NEJMra070553
[41] Anonymous, “Assessment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis. Report of a WHO Study Group,” World Health Organization Technical Report Series, Vol. 843, 1994, pp. 1-129.
[42] Z. Sabbagh and H. Vatanparast, “Is Calcium Supplementation a Risk Factor for Cardiovascular Diseases in Older Women?” Nutrition Reviews, Vol. 67, No. 2, 2009, pp. 105-108. doi:10.1111/j.1753-4887.2008.00146.x
[43] N. A. Andrews, “Calcium Supplementation and Vascular Disease: A Legitimate New Worry?” International Bone Mineral Society BoneKEy, Vol. 5, No. 4, 2008, pp. 124129.
[44] R. P. Heaney, “Bone Health,” American Journal Clinical Nutrition, Vol. 85, No. 1, 2007, pp. 300s-303s.
[45] R. M. Francis, “What Do We Currently Know about Nutrition and Bone Health in Relation to United Kingdom Public Health Policy with Particular Reference to Calcium and Vitamin D?” British Journal Nutrition, Vol. 99, No. 1, 2008, pp. 155-159. doi:10.1017/S0007114507791924
[46] M. J. Bolland, P. A. Barber, R. N. Doughty, B. Mason, A. Horne, R. Ames, G. D. Gamble, A. Grey and I. R. Reid, “Vascular Events in Healthy Older Women Receiving Calcium Supplementation: Randomised Controlled Trial,” British Medical Journal, Vol. 336, No. 7638, 2008, pp. 262-266.
[47] I. R. Reid, R. Ames, B. Mason, H. E. Reid, C. J. Bacon, M. J. Bolland, G. D. Gamble, A. Grey and A. Horne, “Randomized Controlled Trial of Calcium Supplementation in Healthy, Nonosteoporotic, Older Men,” Archives Internal Medicine, Vol. 168, No. 20, 2008, pp. 22762282. doi:10.1001/archinte.168.20.2276
[48] W. K. Al Delaimy, E. Rimm, W. C. Willett, M. J. Stampfer and F. B. Hu, “A Prospective Study of Calcium Intake from Diet and Supplements and Risk of Ischemic Heart Disease among Men,” American Journal Clinical Nutrition, Vol. 77, No. 4, 2003, pp. 814-818.
[49] North-American-Menopause-Society, “Management of Osteoporosis in Postmenopausal Women: 2006 Position Statement of The North American Menopause Society,” Menopause, Vol. 13, No. 3, 2006, pp. 340-367.
[50] Anonymous, “Guideline on Osteoporosis and Fracture Prevention,” 2012.
[51] T. Chevalley, P. Hoffmeyer, J. P. Bonjour and R. Rizzoli, “An Osteoporosis Clinical Pathway for the Medical Management of Patients with Low-Trauma Fracture,” Osteoporosis International, Vol. 13, 2002, pp. 450-455. doi:10.1007/s001980200053

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