Vitamin D and fracture reduction
If you’re confused about the recent draft statement from the U.S. Preventive Services Task Force about vitamin D and calcium — so are we! We hope that the final recommendations that follow this draft and my explanation of the scary — but incomplete headlines — will make more sense.
Regarding the report, the U.S. Preventive Services Task Force recommends against daily supplementation with less than 400 IU of vitamin D and 1,000 mg of calcium for the prevention of fractures in postmenopausal women. At the same time, they report that there is not enough evidence to assess the benefits or harms of supplementation greater than 400 IU of vitamin D and 1,000 mg of calcium.
You may also remember that last year a similar, yet more generous report from the U.S. Institute of Medicine declared that between 600 and 800 IU of vitamin D were sufficient for postmenopausal women along with 1,200 mg of calcium from diet and supplements.
Both of these government proclamations met with an uproar from vitamin D researchers, and we can comfortably place both reports in the “pathetic” category. Here’s why:
– The catch here is that the government agencies have been looking at a series of older studies done using very low level vitamin D supplementation, 200 to 400 IU. These low levels of vitamin D are not effective and will do little good just as the new government reports suggest. However, these government reports do not take into account the many new articles on vitamin D that clearly show a dramatic fracture reduction benefit when higher levels of vitamin D are used and as a therapeutic blood level of vitamin D is achieved.
– The Task Force also implicates these supplements with the risk of kidney stones. As noted vitamin D authority, Dr. Robert Heaney of Creighton University, explains, kidney stones are NOT caused by vitamin D.
– In regards to these recent vitamin D recommendations, the operative word is LOW DOSE. As has long been noted by vitamin D researchers, there is a distinct blood level of vitamin D that is necessary to enhance calcium absorption, reduce parathyroid hormone levels, and thus provide for the reduction of fractures. If this blood level is not achieved, you will not see fracture-reduction benefits.
I have written about this vitamin D blood level threshold extensively, including a medical journal article in 2008 documenting the vast fracture reduction potential of vitamin D, when used in adequate doses. In fact, I and other researchers provide documentation to suggest that therapeutic levels of vitamin D may well reduce all osteoporotic fractures by a full 50%. I have also noted that no vitamin D clinical trial studies should be considered valid unless researchers document that the amount of vitamin D used was enough to reach the critical blood level required for optimal calcium absorption and thus for fracture reduction. That critical level, as established by Dr. Heaney, is at least 32ng/ml.
In essence, we at the Center for Better Bones agree that low-dose vitamin D should not be recommended for fracture reduction because it is ineffective. To the contrary of what the government task force suggests, we find ample documentation that reaching a therapeutic blood level of vitamin D (minimum of 32ng/ml) dramatically reduces fracture. You need to find out what your vitamin D blood level is and supplement if necessary. If you want more information on our perspective, check out some of my other vitamin D articles.
As for the calcium, we do not have any issue with the recommendation of a total from diet and supplementation of 1,200 mg. As I have been saying for years, calcium by itself neither prevents bone loss nor needless osteoporotic fractures. We need a balanced supply of at least 20 key nutrients, which come from diet and sunshine, and supplements as needed.
Do not let the scary headlines frighten you. Remember, you need to inform and empower yourself for Better Bones and a Better Body.
I’m Dr. Susan Brown. I am a clinical nutritionist, medical anthropologist, writer, and motivational speaker. Learn my time-tested 6 step natural approach to bone health in my online courses.
Leave a ReplyWant to join the discussion?
Feel free to contribute!