What are the recommendations for vitamin D supplementation and calcium supplementation in a 67-year-old female with osteoporosis?

From the Guidelines

For a 67-year-old female with osteoporosis, the recommended daily supplementation is 800 IU of vitamin D and calcium, as suggested by the USPSTF recommendation statement 1. The vitamin D supplementation helps maintain adequate serum levels of 25-hydroxyvitamin D, which is essential for calcium absorption and bone health. Some key points to consider:

• Calcium supplementation should be divided into doses to maximize absorption, as the body can only absorb limited amounts at once.
• Calcium citrate is often preferred for older adults as it doesn't require stomach acid for absorption and can be taken without food.
• These supplements should be used alongside prescribed osteoporosis medications, not as a standalone treatment.
• It's also important to ensure adequate protein intake and engage in weight-bearing and resistance exercises at least 2-3 times weekly to help maintain bone density.
• Regular monitoring of vitamin D levels and kidney function is recommended, as excessive supplementation can lead to hypercalcemia or kidney stones in susceptible individuals. The USPSTF recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors 1. The USPSTF also recommends vitamin D supplementation to prevent falls in community-dwelling adults aged 65 years or older who are at increased risk for falls because of a history of recent falls or vitamin D deficiency 1. However, the evidence is not strong enough to support a specific recommendation for the daily supplementation of vitamin D and calcium in adults with osteoporosis. Therefore, the decision to supplement with vitamin D and calcium should be made on a case-by-case basis, taking into account the individual's overall health, risk factors, and medical history.

From the FDA Drug Label

Directions As a dietary supplement for adults, take two (2) drops orally once daily, or as directed by a healthcare provider. The dropper supplied delivers approximately 40 drops per mL. The FDA drug label does not answer the question.

From the Research

Vitamin D and Calcium Supplementation Recommendations

• For a 67-year-old female with osteoporosis, vitamin D and calcium supplementation are recommended to prevent fractures and improve bone health 2, 3.
• The recommended daily intake of vitamin D is between 500 and 800 IU, with or without calcium supplementation, to increase bone mineral density (BMD) in women with a mean age of approximately 63 years 2.
• For women older than 65, a daily intake of 800-900 IU of vitamin D and 1200-1300 mg of calcium is recommended to increase bone density, decrease bone turnover, and decrease nonvertebral fractures 2.
• Calcium and vitamin D supplementation should be prescribed until the vitamin D deficit is resolved 4.
• It is essential to note that calcium and vitamin D supplementation are most effective when used in combination, as calcium supplements or calcium/vitamin D combinations are currently recommended as co-medication with anti-resorptive therapy in all recently published guidelines on the treatment of osteoporosis 5.

Importance of Calcium Co-Medication

• Calcium co-medication is crucial in bisphosphonate therapy of osteoporosis, and its consistent use or effectiveness may be impaired by several factors, including low prescription rate or lack of advice to purchase calcium 5.
• A fixed-combination pack of bisphosphonate and calcium can increase the likelihood that postmenopausal osteoporotic patients will receive both a bisphosphonate and calcium, which in turn is likely to enhance the correct intake of combination therapy 5.
• The use of a fixed-combination pack can simplify the dosage regimen, improve patient understanding of dosing instructions, and increase preference for the combination packaging over separate packs 5.

Additional Considerations

• Lifestyle changes, including weight reduction, increasing physical activity, and avoiding alcohol consumption and smoking, should be recommended to all patients with osteoporosis 4.
• Osteoporosis treatment options mainly include antiresorptives and anabolic agents, and monotherapy with antiresorptive agents, particularly oral bisphosphonates, should be considered routinely as the first option for treatment of postmenopausal women 4, 6.