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Review
. 2014 Aug 7:58.
doi: 10.3402/fnr.v58.21796. eCollection 2014.

Calcium and vitamin D supplementation: state of the art for daily practice

Robert Y van der Velde  1 , Jacobus R B J Brouwers  2 , Piet P Geusens  3 , Willem F Lems  4 , Joop P W van den Bergh  5
Affiliations
Review

Calcium and vitamin D supplementation: state of the art for daily practice

Robert Y van der Velde et al. Food Nutr Res. .

Abstract

Background: Calcium and vitamin D play an essential role in bone metabolism but deficiency and/or inadequate intake are common.

Objectives: To describe a practical approach based on the literature regarding clinically important aspects of calcium and vitamin D supplementation.

Methods: A systematic evaluation of relevant literature in Medline was conducted. We included physiological studies, publications on relevant guidelines, meta-analysis, randomized clinical trials, and cohort studies.

Results: An adequate calcium intake and vitamin D supplementation is recommended in most guidelines xon fracture prevention. Daily supplementation with 800 IU is advocated in most guidelines, appears to be safe, and with this approach it is generally not necessary to determine vitamin D levels. There are no data on additional effects of loading doses of vitamin D on fracture or fall prevention. Calcium supplementation should be tailored to the patient's need: usually 500 mg per day is required. The intestinal absorption of calcium citrate is approximately 24% better than that of calcium carbonate independent of intake with meals. Data on difference between calcium absorption with calcium carbonate compared to calcium citrate with simultaneous use of proton pump inhibitors are lacking. Concern has arisen about a possible link between calcium supplementation and an increased risk of myocardial infarction. Probably only well-designed prospective randomized controlled trials will be able to allow definite conclusions on this subject.

Conclusion: Daily supplementation with 800 IU vitamin D is a practical and safe strategy without the need for prior determination of vitamin D levels. Calcium supplementation should be tailored to the patient's need based on total daily dietary calcium intake. In most patients 500 mg per day is required to achieve a total intake of 1,200 mg, or in some 1,000 mg per day. More calcium is absorbed from calcium citrate compared to calcium carbonate.

Keywords: calcium absorption; cardiovascular risk; fall prevention; fracture prevention; vitamin D supplementation.

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Figures

Fig. 1
Fig. 1
Relationship between serum 25(OH)D level and fractional calcium absorption (20).
Fig. 2
Fig. 2
Calcium absorption, solubility of calcium, contribution of active and passive absorption of calcium and pH in the various segments of the small and large intestine (19, 22, 23).
Fig. 3
Fig. 3
Concentration of dissolved elemental calcium (Y-axis, log scale) depending on pH for calcium citrate (blue line) and calcium carbonate (red line), corrected for CO2 tension in the digestive tract. Modified from Goss et al. (29).
Fig. 4
Fig. 4
Calcium intake and serum 25(OH)D in 50+ patients with a recent fracture.
Fig. 5
Fig. 5
Calcium intake and serum 25(OH)D in 50+ patients with a recent fracture, according to gender, age, fracture location and BMD.
Fig. 6
Fig. 6
Required dose of vitamin D to achieve a 25(OH)D level: ≥50 (top panel) and ≥75 nmol/L (bottom panel).
Fig. 7
Fig. 7
25(OH)D level achieved with use of a set dosage of vitamin D supplementation (800 IU and 2,000 IU per day).
See this image and copyright information in PMC

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