Bone health

Vitamin D supplements get a ‘D’ for fall prevention

The U.S. Preventive Services Task Force has downgraded its recommendation for use of vitamin D supplements in falls prevention.

In an update to its 2012 advice, the USPSTF now recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls.

After reviewing the most recent evidence the Task Force downgraded its advice on vitamin D supplements from a B (recommend) to a D (recommend against) grade on the basis that supplementation has little if any benefit and this may be outweighed by possible harms.

It also has a weak (C grade) recommendation for multifactorial interventions to prevent falls.

The new advice follows conflicting findings on the impact of vitamin D supplements in five trials, including one that found increased risks of both falls and fractures with higher doses of vitamin D supplements.

An accompanying commentary notes that the recommendations apply only to community-dwelling adults not known to have osteoporosis or vitamin D deficiency.

“For patients at increased risk for osteoporosis, those with vitamin D deficiency, or both, it remains reasonable to consider vitamin D supplementation (800-1000 IU/d or more), consistent with recommendations of other professional societies,” the authors write in JAMA.

For fracture prevention, the Task Force has not changed its recommendations substantially since the last position statement was issued in 2012.

“The Task Force found insufficient evidence to recommend for or against vitamin D and calcium supplementation to prevent fractures in most adults at higher doses and recommends against them at lower doses,” its statement concludes.

For postmenopausal women the USPSTF recommends against daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium for the primary prevention of fractures.

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