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14-06-2012 | Article

USPSTF: Evidence lacking for vitamin D in cancer or fracture prevention

Abstract

Draft recommendation

MedWire News: There is not enough evidence to support the routine use of vitamin D and calcium supplements to prevent fractures among postmenopausal women, nor vitamin D with or without calcium to prevent cancer among adult men and women, despite the widespread adoption of both approaches, cautions the US Preventive Services Task Force (USPSTF) in a draft recommendation.

"The USPSTF recommends against daily supplementation with ≤400 IU of vitamin D3 and 1000 mg of calcium carbonate for the primary prevention of fractures in noninstitutionalized postmenopausal women," the recommendation states.

It is mute on whether vitamin D supplementation is inadvisable for cancer prevention, however.

The advice applies to asymptomatic adults without previous history of fractures or cancer who are not living in an assisted-living facility, nursing home, or other institutional care setting.

In May the USPSTF issued a recommendation noting that in older, community-dwelling adults, vitamin D supplementation combined with exercise and/or physical therapy is moderately effective at preventing falls in those who are at increased risk for falling.

The current draft recommendation notes that although there is insufficient evidence to support a benefit from vitamin D supplementation in the target population, there is "adequate evidence that supplementation with ≤400 IU of vitamin D3 and 1000 mg of calcium carbonate increases the incidence of renal stones. The USPSTF assessed the magnitude of this harm as small."

The Task Force members note that both osteoporotic fractures and cancer are associated with substantial health burdens among older adults and that the risk for urinary calculi among women taking vitamin D and calcium carbonate in the Women's Health Initiative was one in 273 over 7 years of follow up.

The draft recommendation will be available on the USPSTF web site until July 10. The Task Force invites public comment.

By Neil Osterweil