Calcium and vitamin D intake and the need of supplements in patients older than 50 years at the time of fracture

Abstract

Aims: Adequate calcium and vitamin D intake is advocated in guidelines of osteoporosis and was calculated in patients at the time they presented with a fracture. Methods: Of 902 consecutive fracture patients, 502 were available for evaluation of calcium intake (by questionnaire) and serum 25 (OH)D. We calculated the percentage of patients who needed ³500mg/d of calcium to achieve ³1000 mg/d and who needed ³800 IU/d of vitamin D to achieve ³50 nmol/l. Results: Mean calcium intake was 839 mg/d (range 250-2050 mg) and mean 25(OH)D 43 nmol/l (range <10 to 130 nmol/l). To achieve 1000 mg/d of calcium, 12% needed 1000 mg/d and 56% needed 500 mg/d, and to achieve 1200 mg/d, 32% and 61%, respectively, without surpassing 1500 mg/d. Systematic supplements of 500 mg/d would achieve 1000 mg/d in 88% and of 1000 mg/d in all, and increased the intake to >1500 mg/d in 30% of patients with 500 mg/d and in 85% with 1000 mg/d. To achieve 50 nmol/l of 25(OH)D, 40% needed 800 IU/d vitamin D, 26% needed higher doses, and, to achieve 75 nmol/l, 9% needed 2400 IU/d. Systematic supplements of 800 IU/d would achieve 50 nmol/l in 75% of patients and 2000 IU/d in 91%. None of the these individualized or systematic doses of vitamin D supplements would bring 25(OH)D above the toxic level. Conclusions: Baseline values and future need of adequate calcium and vitamin D intake vary between fracture patients. Supplements need to be titrated accordin to the desirable need and safety limits.