NOF Response to USPSTF Recommendation on Calcium and Vitamin D

Comments Submitted to the USPSTF Draft Recommendation Statement on Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Adults: Preventive Medication

The National Osteoporosis Foundation (NOF), the leading health organization solely dedicated to osteoporosis and bone health, appreciates the opportunity to provide comments on the latest USPSTF Draft Recommendation Statement on Vitamin D. Calcium or Combined Supplementation for the Primary Prevention of Fractures in Adults: Preventative Medicine. Strong evidence supports the important role of calcium and vitamin D in bone health and we appreciate the need for further study to determine their role in fracture and fall prevention.

In the 2015 manuscript, “Calcium Plus Vitamin D Supplementation and the Risk of Fractures: an Updated Meta-Analysis from the National Osteoporosis Foundation,” the aim was to meta-analyze randomized controlled trials of calcium plus vitamin D supplementation and fracture prevention. Meta-analysis showed a significant: 15% reduced risk of total fractures (summary relative risk estimate [SRRE], 0.85; 95% confidence interval [CI], 0.73-0.98) and 30% reduced risk of hip fracture {SRRE, 0.70; 95% CI, 0.56-0.87}.

Our concern with the current USPSTF review is that it excludes studies considered in the previous review that enrolled persons with Vitamin D deficiency or insufficiency, because upon further consideration, Vitamin D interventions in these populations would be considered treatment rather than prevention. Whether treatment or prevention, the Task Force acknowledges that Vitamin D should be given to those with deficiency, and it is noted in the falls section, so should the recommendation not include that Vitamin D may decrease risk of falls in those who are deficient?

We are also concerned that further studies showing decreased falls among post-menopausal women were not included in the Task Force’s review because falls were a secondary outcome. There is a need for more randomized trails to determine whether Vitamin D has an effect on decreasing falls; we believe the Task Force’s recommending against Vitamin D supplementation for the prevention of falls in community dwelling adults is premature and may do more harm than good.