Current guidelines recommend calcium and vitamin D supplementation in postmenopausal women to prevent bone loss and osteoporotic fracture. Both calcium and vitamin D are essential components for bone health and their inadequate intake may predispose postmenopausal women to osteoporosis. In this context, it is recommended to basis for postmenopausal calcium supplementation from its ability to suppress bone resorption.
Sufficient calcium intake with and without vitamin D is necessary in maintaining bone health during the menopause period. However, among women who are taking calcium supplements, only a few subgroups with low calcium intake benefit, especially with vitamin D deficiency. As a result, routine administration of calcium to all postmenopausal women is not necessary. This occurs because calcium is a threshold nutrient, and in women with adequate food intake, higher calcium intake would be unlikely to provide further gain. However, it can still impose on older women a higher risk of cardiovascular events.
Since the risk-benefit of long-term calcium supplementation in elderly women, particularly individuals with coexisting cardiovascular risk factors have not yet been determined. It is logical to advise women at high risk of fractures to receive anti-resorptive agents that have been proven to reduce the risk of fractures. Those with low calcium intake should be encouraged to increase calcium intake through individualized specific diet or supplementation. There are still many important issues to be addressed, with the optimal dose and time of onset of calcium and vitamin D supplementation, individuals who may benefit most from calcium supplementation, and fractures that respond better to preventive treatment.
Study suggestion: What
role of calcium and vitamin D in the risk of fractures?
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– Heidari B, Hajian-Tilaki K, Babaei M. Effectiveness and safety of routine calcium supplementation in postmenopausal women. A narrative review. Diabetes Metab Syndr. 2020;14(4):435-442. doi:10.1016/j.dsx.2020.04.016