Addressing the Musculoskeletal Components of Fracture Risk with Calcium and Vitamin D: A Review of the Evidence |
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| Authors: | S Boonen H A Bischoff-Ferrari C Cooper P Lips O Ljunggren P J Meunier J-Y Reginster |
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| Institution: | (1) Leuven University Center for Metabolic Bone Diseases and Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium;(2) Division of Aging and Division of Rheumatology, Immunology and Allergy, The Robert B. Brigham Arthritis and Musculoskeletal Diseases Clinical Research Center, Brigham and Women’s Hospital, Boston, MA, USA;(3) MRC Environmental Epidemiology Unit and University of Southampton School of Medicine, Southampton General Hospital, Southampton, UK;(4) Department of Endocrinology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands;(5) Institution for Medical Sciences and Surgical Sciences, University Hospital, Uppsala, Sweden;(6) Université Paris-Descartes, Faculty de Medecine R. Llaennec, Lyon, France;(7) Unité d’Exploration de l’Os et du Cartilage, Liège, Belgium |
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| Abstract: | Osteoporotic fractures are an extremely common and serious health problem in the elderly. This article presents the rationale
for calcium and vitamin D supplementation in the prevention and treatment of osteoporotic fractures and reviews the literature
evidence on the efficacy of this strategy. Two musculoskeletal risk factors are implicated in osteoporotic fractures in the
elderly: the loss of bone mass due to secondary hyperparathyroidism and the increased propensity to falls. Calcium and vitamin
D reverse secondary hyperparathyroidism with resultant beneficial effects on bone mineral density (BMD). Additionally, calcium
and vitamin D supplementation significantly improves body sway and lower extremity strength, reducing the risk of falls. The
effects of combined calcium and vitamin D on parathyroid function and BMD provide a strong rationale for the use of this therapy
in the prevention and treatment of osteoporosis and osteoporotic fractures. There is general agreement that, in patients with
documented osteoporosis, calcium and vitamin D supplementation should be an integral component of the management strategy,
along with antiresorptive or anabolic treatment. Frail elderly individuals constitute another major target population for
calcium and vitamin D because evidence from randomized studies in institutionalized elderly subjects demonstrates that these
supplements reduce osteoporotic fracture risk, particularly in the presence of dietary deficiencies. However, the results
of trials in community-dwelling subjects have been equivocal. Within the primary-care setting, further research is required
to establish appropriate target subgroups for calcium and vitamin D supplementation; overall, the data are consistent with
a benefit individuals with insufficient calcium and/or vitamin D, although patients with documented osteoporosis will derive
further benefit in terms of fracture prevention from the addition of an antiresorptive agent. |
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| Keywords: | Osteoporosis Vitamin D Calcium Fracture Fall |
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