Recommended Vitamin D and Calcium Supplementation for a 73-Year-Old Woman with High Fracture Risk

For a 73-year-old woman with high fracture risk, the recommended supplementation is 800 IU of vitamin D daily and 1,200 mg of calcium daily. 1, 2

Vitamin D Recommendations

For adults aged 71 years and older, including women with high fracture risk, the recommended daily vitamin D intake is 800 IU 1, 2
High-dose vitamin D supplementation (≥800 IU/day) reduces hip fracture risk by 30% (HR 0.70,95% CI 0.58-0.86) and nonvertebral fracture risk by 14% (HR 0.86,95% CI 0.76-0.96) in adults 65 years and older 1
Vitamin D supplementation alone without calcium is unlikely to reduce fracture risk 3, 4
The target serum vitamin D level should be at least 20 ng/mL (50 nmol/L) for optimal bone health 1, 2
For patients with documented vitamin D deficiency (<20 ng/mL), initial correction may require higher doses, such as 50,000 IU weekly for 8 weeks, followed by maintenance therapy of 800-1,000 IU daily 1

For women aged 71 years and older, the recommended daily calcium intake is 1,200 mg 1, 2
Calcium supplementation should be calculated based on dietary intake to achieve the total recommended daily amount of 1,200 mg, not exceeding it 1
For most patients, approximately 500 mg per day of supplemental calcium is required to achieve a total intake of 1,200 mg when considering dietary sources 5
Calcium citrate has approximately 24% better absorption than calcium carbonate, independent of intake with meals 5
Take calcium supplements in divided doses of no more than 600 mg for optimal absorption 1

Combined calcium and vitamin D supplementation reduces hip fracture risk by 16% (RR 0.84,95% CI 0.74-0.96) and overall fracture risk by 5% (RR 0.95% CI 0.90-0.99) 1, 6
The combination of calcium supplementation with vitamin D supplementation is particularly effective in those at risk of marginal and low vitamin D status 7
Daily supplementation with 800 IU vitamin D in combination with calcium may decrease the incidence of non-vertebral fractures, especially in older individuals with low baseline vitamin D status and low calcium intake 3
Good compliance and at least 3-5 years of therapy are required for optimal fracture prevention 4

High-dose calcium supplementation may be associated with an increased risk of kidney stones (hazard ratio, 1.17 [CI, 1.02 to 1.34]) 6
Some studies suggest a potential increased risk of myocardial infarction with calcium supplements, though methodological concerns have been raised about these findings 6, 5
Avoid single large vitamin D doses (300,000-500,000 IU) as they may be associated with adverse outcomes 1
High vitamin D doses, either at monthly (60,000-100,000 IU) or daily intervals (>4000 IU), may be harmful regarding falls, fracture risk, and BMD, suggesting a U-shaped effect of vitamin D on the musculoskeletal system 4

For patients with high fracture risk, pharmacological treatment with anti-osteoporosis drugs should be considered alongside calcium and vitamin D supplementation 6
All clinical trials of anti-osteoporosis drugs included calcium and vitamin D supplementation as part of the medical treatment 6
For patients receiving denosumab for osteoporosis treatment, calcium and vitamin D supplementation is essential, with at least 1000 mg calcium and 400 IU vitamin D supplementation daily 8
Checking 25-OH vitamin D levels is recommended when DXA shows osteopenia/osteoporosis 1, 2