A new analysis of nearly a dozen studies testing D-vitamin in older individuals have found that it takes a daily dose of at least 800 international units (I.E.) to consistently help prevent broken bones.
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The report, published in the New England Journal of Medicine, suggests that too much calcium--perhaps more than 1,000 milligrams (mg) per day--may weaken the advantage.
"These hip fractures cost a lot and is a really serious incident. They are usually the end of independent living for a senior person; 50 percent do not regain their mobility. Reduce risk by 30 percent with just a vitamin supplement would be occasion enormous public health, "said study researcher Dr. Heike Bischoff-Ferrari, University Hospital Zurich, Switzerland, Reuters Health.
The Institute of Medicine recommends that most adults getting 1,000 to 1,200 mg of calcium per day and 600 to 800 IU vitamin d. It outlines a recommended upper limit of 2,000 mg calcium and 4,000 IU vitamin d.
Bischoff-Ferrari said the lack of advantage seen in other studies "can be explained by adherence to treatment and vitamin d supplements taken outside the study medicine."
Dr. Richard Bockman, a hormone expert at the hospital for special surgery in New York, said the findings are an important counterweight to last month's widely reported recommendation by the u.s. Preventive Services Task Force.
Government-backed Taskforce deprecated to take doses of less than 400 IU of vitamin d with 1,000 mg of calcium and concluded evidence was unclear for higher doses. It also said food supplements carry a risk of side effects such as Kidney stones.
Bockman said best trial is a study, 2003, known as the Trivedi trial version, in which volunteers received an average of 800 IU per day as a single 100,000 IU dose every four months.
"It clearly showed a reduction in fracture risk in people who took vitamin D," he said.
Dr. Robert Heaney of Creighton University Medical Center in Omaha, Nebraska, said in an editorial, the problem of conflicting studies may be that most have been able to consider each person's vitamin d levels to start with.
Give it to people who already have enough, or does not provide enough for people with very low levels may show no benefit, he said.
"In this respect, as in many other respects, and nutrients are in contrast to drugs. Additional intake has no effect when there is a suitable concentration, "said Heaney.
Bischoff-Ferrari said the new results came without direct including Trivedi results. "The writers lost the data sets for a computer disaster," she said.
The new analysis is based on 11 attempts, which tested various adapted population variables oral vitamin d in people age 65 and older, mainly women, against an inactive placebo. Some of the experiments also included calcium.
Overall, there were 4,881 hip and other fractures (not including breaks in the spine) among more than 31,000 people.
Vitamin d cut is not the rate of hip fracture considerably, and the decline in other fractures were small. When the researchers looked at the people that get the highest doses of the vitamin, typically 800 IU daily, the benefits were clearer, with a 30-percent reduction in hip fractures and 14-percent decline in other broken bones.
"In particular, there was no reduction in the risk of hip fracture at any actual intake levels lower than 792 IU per day," the researchers said.
Advantages of the higher dose was seen regardless of age, additional calcium intake of patients living at home or in an institution, and the original levels of vitamin d.
Bischoff-Ferrari said the clearest effect was seen in nursing home patients who got the highest doses of vitamin D and regularly took their pills, because the nurses had to give them.
Equally important is the discovery that too much calcium-more than 1,000 mg per day-can dilute the vitamin d benefits for bones, she said. Because many dietary supplements contains 1,000 mg calcium, can people get in their diet to send people across the border.
' This is a very, very important public health message, "said Bischoff-Ferrari. "There are still doctors around who gives calcium without vitamin hip fracture patients. Imagine giving calcium supplement and increase fracture risk. "
In an earlier study, she added, fewer than 10 percent of the population comes into the hospital for a hip fracture had taken vitamin. And 60 percent of them had suffered a second fracture in the prior decade, yet "the red flag is not coming."
"In the medical world, vitamin d acts as a very low priority. It may be the lack of lobbying for it, the fact that it costs almost nothing ", and some people think it is too good to be true," she said. "But the data is impressive."
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