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It’s a long-standing discussion in the scientific community that is now more valid than ever with a growing aging population, the demographic group most affected by osteoporosis: what is the real role of calcium and vitamin D supplementation in the prevention and treatment of this bone condition? And does supplementation cause additional health risks?

Recent meta-analyses have compiled information and shed light on this debate.

The optimal calcium and vitamin D supplementation for skeletal health is uncertain, studies say. Many adults who receive adequate amounts of these two nutrients from diet and sun exposure do not need to take any supplements. But despite these natural options, osteoporosis numbers reveal the urgency for effective therapies for this global public health crisis. 

Worldwide, on average, 43% of women break a bone from a minor fall or impact after age 50, revealing a fragile composition and potential diagnosis. The percentage is highest in Japan (73.3%) and the United Kingdom (60.9%), and lowest in Brazil (21.6%).

In the United States, an estimated 10 million people age 50 and over have osteoporosis. Most are women, but nearly 2 million men are also affected. Around 43 million more people, including 16 million men, have low bone mass, which puts them at higher risk of developing the condition.

Statistics in Latin America

Latin Americans will suffer an estimated 655,648 hip fractures in 2050, at an estimated direct cost of $13 billion in medical care and rehabilitation. Mortality rates in the year following a hip fracture are 25-30% and are higher in men than women. What’s more:

• The prevalence of vertebral osteopenia in women aged 50 and over has been reported at 45.5% to 49.7%, and vertebral osteoporosis at 12.1% to 17.6%; whereas the prevalence of femoral neck osteopenia has been reported at 46% to 57.2%, and femoral neck osteoporosis at 7.9% to 22%.

• The Latin American Vertebral Osteoporosis Study (LAVOS), which was conducted in four countries (Argentina, Brazil, Colombia, and Mexico) and the Commonwealth of Puerto Rico, showed that the prevalence of vertebral fractures in women over 50 is around 15%. This prevalence rises from 7% in ages 50-60 to 28% after age 80.

• In Mexico in 2010, the prevalence of osteopenia was 32.8% and osteoporosis 8%. A total of 75,763 fragility fractures have occurred this year.

In the race to prevent osteoporosis, at least seven medications have been developed to slow the loss of bone mass. Each comes with a series of side effects to consider and limitations on who can use them.

Taking vitamin D and calcium supplements remains a non-pharmaceutical alternative that is usually recommended as part of osteoporosis treatment, even for older adults who are already taking medications for this condition.

Vitamin D and calcium supplementation and risks

Low concentrations of vitamin D have been associated with impaired calcium absorption, a negative calcium balance, and a compensatory rise in parathyroid hormone (PTH), which controls the level of calcium in the blood. This imbalance can affect not just bone health, but also other mechanisms.

Postmenopausal women are recommended to take 1,200 mg of calcium and 800 international units (IU) or 20 mg of vitamin D every day. The optimal dose for premenopausal women has not been established. For men, the recommended daily dose is 1,000 mg of calcium and 600 IU of vitamin D.

High annual doses of 500,000 IU and daily doses above 2,000 mg of calcium and 4,000 IU of vitamin D are not recommended.

Experts suggest combining supplements with a diet rich in products that contain these nutrients, such as dairy products and fortified milk. 

The impact of these nutrients on kidney and cardiovascular health (especially myocardial infarction) is still being determined. In particular, scientists are looking at what happens if recommended doses are exceeded and whether these supplements interact with other conditions, such as: 

• Nephrolithiasis (kidney stones)

• Kidney failure

The long-term Women’s Health Initiative (WHI) study reported a higher risk of kidney disease and kidney stones in postmenopausal women who received calcium and vitamin D supplements, compared to the group that took a placebo.

In addition to its role in bone and calcium homeostasis, vitamin D may potentially regulate many other cell functions. However, there are not enough data to confirm a causal relationship.

As for osteoporosis prevention, fracture risk can be determined with the Fracture Risk Assessment Tool (FRAX), which estimates the 10-year probability of a hip fracture or an osteoporotic fragility fracture by using local epidemiological and patient data such as age, body mass index, and seven other clinical factors. This strategy can be very helpful in determining the therapeutic approach for each patient.

This story was produced using content from original studies or reports, as well as other medical research and health and public health sources cited in this article.