What are the current recommendations for calcium and vitamin D supplementation?

From the Guidelines

The current recommendation is against supplementation with vitamin D with or without calcium for the primary prevention of fractures in community-dwelling postmenopausal women and men 60 years or older. This is based on the latest guidelines from the US Preventive Services Task Force (USPSTF) [ 1 ]. The USPSTF found insufficient evidence on supplementation with higher doses of vitamin D and calcium, alone or combined, to prevent fractures in postmenopausal women, or at any dose in men and premenopausal women.

When considering calcium and vitamin D intake, it is essential to focus on dietary sources, such as dairy products, leafy greens, and fortified foods for calcium, and fatty fish, egg yolks, and fortified foods for vitamin D. Supplements should only be considered when dietary intake is insufficient. The recommended daily calcium intake is 1000-1200 mg, with higher amounts (1200-1500 mg) for postmenopausal women and older adults. Vitamin D recommendations are now 600-800 IU daily for most adults, with 800-1000 IU for those over 70 or at high risk for deficiency [ 1 ].

Key points to consider:

• Calcium supplements should be taken in divided doses of 500-600 mg with meals to maximize absorption
• Vitamin D supplements can be taken daily or weekly, with D3 (cholecalciferol) preferred over D2 (ergocalciferol) for better bioavailability
• Regular blood level monitoring is recommended for those taking vitamin D supplements to maintain optimal levels between 30-50 ng/mL
• The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older at increased risk of falls and selectively offering multifactorial interventions based on circumstances of prior falls, presence of comorbid medical conditions, and the patient’s values and preferences [ 1 ].

From the FDA Drug Label

Vitamin D3 50,000 IU is essential for absorption of calcium and necessary for healthy bones and a healthy immune system. Cholecalciferol Softgel capsule is essential for absorption of calcium and necessary for healthy and strong bones.

The recommended dosage of Vitamin D3 is one capsule (50,000 IU) per week, or as directed by a physician, to facilitate calcium absorption.

• The label does not provide information on calcium dosage recommendations.
• It is advised to take the capsule with food. 2

From the Research

Calcium and Vitamin D Recommendations

• The optimal amount of calcium intake varies by age and demographic, with recommendations ranging from 400 mg/day for infants to 1,500 mg/day for adults over 65 years old 3, 4.
• Adequate vitamin D is essential for optimal calcium absorption, with daily supplementation of 800 IU recommended in most guidelines 5, 6.
• Calcium supplementation should be tailored to the patient's need, with 500 mg per day typically required to achieve a total intake of 1,200 mg 5.
• The preferred source of calcium is through calcium-rich foods such as dairy products, with calcium-fortified foods and calcium supplements also available 3, 4.

Changes in Recommendations Over Time

• The National Institutes of Health Consensus Development Conference on Optimal Calcium Intake in 1994 and 1995 established guidelines for optimal calcium intake, which have been largely consistent with later recommendations 3, 4.
• More recent studies have emphasized the importance of vitamin D supplementation, with daily supplementation of 800 IU recommended in most guidelines 5, 6.
• The use of calcium citrate has been recommended as a preferred form of calcium supplementation, due to its improved absorption and reduced risk of renal calculus formation 6.

Clinical Applications

• Calcium and vitamin D supplementation is essential for the prevention and treatment of osteoporosis, with a combination of calcium and vitamin D recommended in most guidelines 5, 6.
• The use of fixed-combination packs of bisphosphonates and calcium has been shown to improve patient understanding and adherence to treatment regimens 7.
• Healthcare providers should consider individual patient needs and preferences when recommending calcium and vitamin D supplementation, taking into account factors such as dietary intake, age, and medical history 5, 6.