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January 9, 2018

How to Cut the Risk of Fractures

People worried about keeping bones strong should focus on these factors before taking supplements.

Many people, particularly women, take calcium and vitamin D supplements to protect their bones and reduce the risk of fractures as they age. But these supplements may not be as effective as we once thought, a new study suggests. In fact, the researchers found that older adults who take bone supplements are just as likely to suffer fractures as those who don’t.

The medical scientists reviewed over thirty published studies involving about 51,000 older adults who took either vitamin D and calcium or one or the other, while people in a control group received a placebo or no treatment. Nursing home residents and older adults living in other institutional facilities were not included in the study.

Look to your diet first when you need more calcium or vitamin D. Think of fortified milk and dairy products, canned sardines, salmon, tuna and leafy greens.

When researchers compared the risk of bone fractures among older adults who took vitamin D and/or calcium supplements to those who didn’t, they found supplements offered no benefit when it came to preventing broken bones. The results were the same for both men and women, regardless of how much vitamin D and calcium they took.

Both vitamin D and calcium are valuable nutrients important to bone health, but the form in which you get them and your age matter. Calcium is necessary for the formation and maintenance of bones, while vitamin D helps the body absorb calcium and maintain adequate levels of calcium in the blood.

Current recommendations advise adults to consume 600 IU of vitamin D and 1,000 milligrams of calcium per day (1,200 mg for women). After the age of 70, the recommendations increase to 800 IU for vitamin D and 1,200 milligrams for calcium. Many people turn to supplements to meet those recommendations or are advised by their physicians to do so.

These guidelines need to be replaced, one of the researchers, Jia-Guo Zhao, an orthopedic surgeon at Tianjin Hospital in China, believes. Getting enough exercise and sun exposure, along with eating enough calcium- and vitamin D-rich foods, are more important to bone health than supplements for seniors who are still able to walk and live on their own. Doctors should be urging seniors to get out and move and eat better, rather than taking supplements.

Too Little, Too Late

Unfortunately, the best time to build strong bones is a time when we don’t think much about our bones, and that is during our teens and twenties. After the age of 30, bones naturally begin to thin, and need adequate calcium and vitamin D to help maintain the density and strength already attained. The people included in the studies in this meta-analysis may have laid the groundwork for their weak bones years earlier, and supplements couldn't help them.

The results suggest that money might be better spent on healthy food, a good pair of walking shoes and a set of hand weights.

When you need more calcium or vitamin D, look to your diet first. Are you consuming enough high-calcium foods like milk and dairy products, canned sardines and salmon, and leafy greens? Do you eat foods high in vitamin D like fortified milk, salmon, mackerel, tuna and eggs? And because we need exposure to sunlight for our bodies to make vitamin D, spend time most days outside in the sun.

Don’t overlook the importance of exercise in slowing bone loss either. Walking is a simple weight-bearing exercise that is beneficial to our bones. Strength training exercises build and maintain muscles, and help prevent falls.

Older adults have every reason to be concerned about their bone health, particularly women, and as a result spend about two billion dollars a year on calcium and vitamin D supplements. However, the results of this study suggest that money might be better spent on healthy food, a good pair of walking shoes and a set of hand weights.

Do not stop taking calcium and vitamin D supplements if your physician has prescribed them, but it's a good idea to have a conversation with your doctor about their benefits and other steps you should be taking to help keep your bones strong.

The study is published in JAMA, The Journal of the American Medical Association.
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