What is the most appropriate dietary supplementation regimen for a 69-year-old woman with osteoporosis and a femoral neck fracture?

From the Guidelines

For this 69-year-old woman with a femoral neck fracture and known osteoporosis, the most appropriate dietary supplementation regimen would be calcium 1000-1200 mg daily and vitamin D 800 IU daily, as this combination has been shown to reduce the risk of non-vertebral fractures by 15-20% 1. The calcium should be divided into two or three doses throughout the day to maximize absorption, preferably with meals.

• Calcium carbonate is most cost-effective but should be taken with food,
• while calcium citrate can be taken without food. Vitamin D is crucial for calcium absorption and bone mineralization. Given her age and fracture, this patient would also benefit from a comprehensive osteoporosis treatment plan including
• weight-bearing exercises when appropriate,
• smoking cessation if applicable, and
• prescription medication such as bisphosphonates, denosumab, or teriparatide as determined by her physician. These supplements support bone healing after fracture and help prevent future fractures by maintaining bone mineral density, particularly important in elderly patients with established osteoporosis. It is essential to note that high-dose vitamin D supplementation (≥ 800 IU/d) has been shown to reduce the risk of hip fracture and any non-vertebral fracture in persons age 65 years or older 1. Additionally, it is recommended that patients figure out the calcium content that they get from their dietary sources and then only use supplements to get a total calcium dose of 1,000 to 1,200 mg per day 1. Checking levels of 25-OH vitamin D is also strongly recommended, either before starting any cancer therapy that is associated with bone loss or when the first DXA scan shows osteopenia or osteoporosis 1.

From the FDA Drug Label

All men received at least 1000 mg calcium and at least 800 IU vitamin D supplementation daily. All men received at least 1000 mg calcium and 400 IU vitamin D supplementation daily. Consider supplemental calcium and Vitamin D based on individual patient needs

The most appropriate dietary supplementation regimen for a 69-year-old woman with osteoporosis and a femoral neck fracture is:

• Calcium: at least 1000 mg daily
• Vitamin D: at least 400 IU daily, but potentially up to 800 IU daily, based on individual patient needs 2, 3

From the Research

Dietary Supplementation Regimen for Osteoporosis

The most appropriate dietary supplementation regimen for a 69-year-old woman with osteoporosis and a femoral neck fracture involves calcium and vitamin D supplementation.

• The recommended daily dose is 1,000-1,200 mg calcium and 800 IU vitamin D, as stated in 4 and 5.
• Calcium supplementation should be tailored to the patient's need, usually 500 mg per day, to achieve a total intake of 1,200 mg or 1,000 mg per day, as mentioned in 5.
• Vitamin D supplementation with 800 IU per day is a practical and safe strategy without the need for prior determination of vitamin D levels, as stated in 5.
• It is essential to correct calcium deficiency preferably by enhancing dietary intake and to target supplementation on individuals at high risk of fracture or in whom calcium and vitamin D deficiency is highly prevalent, as mentioned in 4.

Considerations and Precautions

• There is a potential link between calcium supplementation and an increased risk of myocardial infarction, as reported in 6.
• The optimal dosing schedule for calcium and vitamin D supplementation is unknown and needs further study, as stated in 4 and 7.
• Calcium and vitamin D supplementation may benefit people with a high risk of deficiency, but may not be required in people without risk factors, as mentioned in 8.
• The decision to supplement with calcium and vitamin D should be based on the calculation of the absolute fracture risk of the patient, as stated in 7.

Additional Recommendations

• Impact and resistance exercises and physical activity can increase bone density and prevent falls, as mentioned in 8.
• Antiresorptive drugs such as bisphosphonates and denosumab remain first-line treatment options for osteoporosis, as stated in 8.
• Specialist referral should be considered for patients who sustain fractures while undergoing osteoporosis therapy, as mentioned in 8.