What are the best supplements for individuals with fractured bones?

Best Supplements for Fractured Bones

For individuals with fractured bones, calcium and vitamin D supplementation are the most important supplements to support bone healing, though evidence suggests their benefit is primarily in those with deficiencies rather than as universal supplements for all fracture patients.

Calcium and Vitamin D: The Foundation

Calcium Supplementation

• Calcium is essential for bone mineralization during fracture healing 1
• Recommended dosing:
  • 1000-1200 mg/day of calcium 2
  • Most effective when combined with vitamin D

Vitamin D Supplementation

• Vitamin D controls calcium absorption and is essential for bone growth 3
• Recommended dosing:
  • 800 IU/day is the minimum effective dose 2
  • Avoid high doses (>4000 IU/day) as they may actually increase fracture risk 2
  • Avoid monthly high-dose regimens (60,000-100,000 IU) as they appear harmful 2

Who Benefits Most from Supplementation?

Supplementation is most beneficial for specific populations:

1. Individuals with vitamin D deficiency (serum 25-hydroxyvitamin D <25-30 nmol/L) 4, 2

   • Correction of severe deficiency is necessary before using potent anti-resorptive medications to avoid hypocalcemia 4

2. Elderly populations, especially those in institutional settings 4, 5

   • A significant reduction in fractures was observed in nursing home residents with severe vitamin D deficiency and low calcium intake 5

3. Individuals with poor dietary calcium intake 5

Important Considerations and Cautions

Duration and Compliance

• Good compliance and at least 3-5 years of therapy are required for fracture prevention benefits 2

Safety Concerns

• Calcium supplements:

  • Can cause gastrointestinal side effects, particularly constipation 4
  • Increase risk of kidney stones 4, 6
  • May increase risk of heart attacks by approximately 20% 4

• Vitamin D:

  • Low-dose supplementation is generally safe 4
  • High doses (>4000 IU/day) have been associated with increased falls and fractures 4, 2
  • Evidence suggests a U-shaped effect, where both too little and too much can be harmful 2

Limited Evidence for Healthy Adults

• Current evidence does not support use of either calcium or vitamin D supplements in healthy community-dwelling adults without fractures or deficiencies 4, 6
• The USPSTF recommends against daily supplementation with 400 IU or less of vitamin D3 and 1000 mg or less of calcium for fracture prevention in community-dwelling postmenopausal women 3, 6

Post-Traumatic Bone Turnover Considerations

• A fracture event may induce post-traumatic bone loss in the non-fractured skeleton, particularly in osteoporotic patients 1
• Calcium mobilization from the skeleton may occur during fracture healing when calcium and vitamin D status is insufficient 1
• This suggests supplementation may be particularly important after a fracture to prevent secondary bone loss

Practical Approach for Fracture Patients

1. Assess baseline vitamin D status and calcium intake
2. For those with deficiencies or at high risk (elderly, institutionalized):
   • Supplement with 800-1000 IU/day vitamin D
   • Provide 1000-1200 mg/day calcium
3. Monitor for side effects, particularly with calcium supplementation
4. Continue supplementation for adequate duration (at least during the fracture healing period)