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The vitamin D and calcium controversy

an update

Lewis, Joshua R.a,b,c; Sim, Marca,b; Daly, Robin M.d

Current Opinion in Rheumatology: March 2019 - Volume 31 - Issue 2 - p 91–97
doi: 10.1097/BOR.0000000000000584
EPIDEMIOLOGY AND HEALTH-RELATED SERVICES: Edited by Kenneth Saag
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Purpose of review Calcium and vitamin D supplementation is widely recommended for prevention of falls and fracture, particularly in the elderly where calcium intakes and vitamin D levels are often inadequate. A number of meta-analyses have questioned the benefits of untargeted or ‘holistic’ supplementation for falls and fracture, and raised the possibility of adverse cardiovascular effects. This review provides an update on these controversies.

Recent findings Recent advances have largely centred around new trials of vitamin D and meta-analyses of published trials and observational studies. These articles have identified holistic vitamin D supplementation with or without calcium is unlikely to be an effective primary prevention strategy for falls or fracture. There has also been high-quality evidence that vitamin D, daily or as a bolus, does not reduce the risk of cardiovascular events.

Summary The benefits of vitamin D and calcium supplements for holistic fall and fracture prevention remain uncertain. Recent evidence supports the concept that high-dose vitamin D has adverse musculoskeletal effects. Future studies should focus on moderate daily doses. Finally, there remain inconsistent findings for adverse cardiovascular effects of calcium supplements with or without vitamin D. This uncertainty should be taken into account when evaluating the risk/benefits of supplementation.

aEdith Cowan University, School of Medical and Health Sciences, Joondalup

bUniversity of Western Australia, Medical School, Perth, Western Australia

cUniversity of Sydney, School of Public Health, Centre for Kidney Research, Westmead Children's Hospital, Sydney, New South Wales

dDeakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Melbourne, Australia

Correspondence to Dr Joshua R. Lewis, PhD, School of Medical and Health Sciences, Edith Cowan University, Joondalup Drive, Joondalup, Perth, WA 6027, Australia. Tel: +61 8 6304 4602; e-mail: joshua.lewis@ecu.edu.au

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