Basic treatment
Basic treatment means supplementation with 500 mg calcium and 2,000 IU of vitamin D per day.
The first choice is a calcium rich diet. There is evidence from some trials that oral intake of calcium by nutrition
is not sufficient, particularly in older adults. Therefore, calcium supplementation should be recommended. However,
a very high calcium supplementation (more than 1000 mg) might lead to a higher risk of myocardial infarction and
stroke. Evidence that calcium supplements prevent fractures is weak and inconsistent.
General recommendation of vitamin D is 800 to 1,000 IU per day. Because of the fact that the main proportion of
older adults shows a vitamin D deficiency, we recommend a higher supplementation up to 2,000 IU per day. There is
also some evidence in the literature, that high single dose of vitamin D increases the risk of falls. The reason for
this observation is still unclear and needs further investigation.
Literature
- Bolland MJ, Leung W, Tai V, Bastin S, Gamble GD, Grey A, Reid IR.
Calcium intake and risk of fracture: systematic review. BMJ. 2015 Sep 29;351:h4580.
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Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, Reid IR.
Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010 Jul 29;341:c3691.
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Mao PJ, Zhang C, Tang L, Xian YQ, Li YS, Wang WD, Zhu XH, Qiu HL, He J, Zhou YH.
Effect of calcium or vitamin D supplementation on vascular outcomes: a meta-analysis of randomized controlled trials. Int J Cardiol. 2013 Oct 30;169(2):106-11.
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Bischoff-Ferrari HA, Dawson-Hughes B, Orav EJ, Staehelin HB, Meyer OW, Theiler R, Dick W, Willett WC, Egli A.
Monthly High-Dose Vitamin D Treatment for the Prevention of Functional Decline: A Randomized Clinical Trial. JAMA Intern Med. 2016 Feb;176(2):175-83.
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Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D, Nicholson GC.
Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA. 2010 May 12;303(18):1815-22.