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Taking a break from
fractures:
A closer look at vitamin D
With an
aging population, and with people living longer, experts say bone
fractures will become a bigger and more costly problem unless more
is done to prevent them. Osteoporosis (reduced bone mineral density)
is most common in older adults, particularly women. It is a major
risk factor for bone fractures, which can cause significant
suffering while carrying high economic costs. While vitamin D has
been shown to reduce the risk of fracture in the elderly, a study
recently published in the Journal of the American Medical
Association (JAMA) raises the question of how much vitamin D is
enough.
The Recommended Dietary Allowance (RDA) of vitamin D for
older adults is between 400 and 600 International Units (IU) per
day. In their review of the existing literature, a team of
scientists including senior author Bess Dawson-Hughes, MD, director
of the Bone Metabolism Laboratory at the Jean Mayer USDA Human
Nutrition and Research Center on Aging at Tufts University, found
that this dose was not effective in reducing nonvertebral fracture
rates among study participants. The researchers concluded, though,
that higher daily doses, in the range of 700 to 800 IU, may reduce
the risk of fracture by approximately 25 percent.
Dawson-Hughes and her colleagues analyzed the results of
seven experimental trials that all compared fracture rates among
subjects 60 years of age and older given vitamin D supplements (with
or without calcium supplements) to those among similar subjects
given only calcium or placebo. Each study lasted between one and
five years, and looked specifically at hip fractures or other
fractures that did not involve the spine. The researchers found that
only subjects receiving higher doses of vitamin D supplementation
had significantly fewer fractures than did subjects in the
comparison groups.
"In the future, we may need to reconsider the current
recommended daily values of vitamin D for older adults," says
Dawson-Hughes. She adds, "We also need to look more closely at the
possible role that calcium supplementation may have in mediating the
effects of vitamin D. Fractures in the elderly can lead to severe
health consequences, including death. One promising prevention
strategy may be dietary supplementation with both calcium and
vitamin D."
Another meta-analysis on vitamin D published in JAMA last
year found that older adults can reduce their risk related to falls
by more than 20 percent by ensuring they get enough vitamin D.
Dawson-Hughes, an author on that paper, noted that "vitamin D may
also improve muscle strength, thereby reducing fracture risk through
fall prevention."
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