Calcium and vitamin D supplementation are vital in osteoporosis management

Adequate calcium and vitamin D intakes are essential for bone repair and prevention of further falls of elderly patients hospitalized for hip fracture, says a new review.

The analysis of a large literature database showed that adequate nutrition is crucial for the treatment of osteoporosis patients with hip fractures (1). Calcium and vitamin D supplementation is associated with increased bone mineral density (BMD) of the hip and a reduction in further falls, especially in malnourished patients. Fall prevention, exercise and balance training incorporated into a comprehensive rehabilitation program have been shown to be essential in improving functional disability and survival of elderly patients hospitalized for hip fracture.

The researchers commented that vitamin D deficiency or insufficiency is common in elderly hip fracture patients due to lack of vitamin D-rich food intake and a diminished sunlight-induced synthesis of the micronutrient in the skin. Vitamin D is the key in intestinal absorption of calcium. Thus calcium and vitamin D supplementation is an indispensable component in the prevention and treatment of osteoporosis, unless calcium intake and vitamin D status are known to be optimal. For fracture prevention vitamin D supplementation is recommended to range between 800 to 1,000 IU per day to achieve a serum vitamin D (25 OHD) level of 75 nmol/L. There is also evidence that calcium and vitamin D enhance the fracture preventing efficacy of anti - osteoporosis drugs such as bisphosphonate agents. More data are required to better define an optimal treatment.

Hip fracture represents the most serious complication of osteoporosis and the most severe form of osteoporotic fracture, creating a huge medical and economic burden worldwide. Survival and quality of life decrease significantly following hip fracture, and five-year excess mortality increases by about 20%. Elderly patients with previous history of hip fracture are at very high risk for further fractures: a 2.5-fold increased risk of vertebral fracture and 2.3-fold risk of future hip fracture. The incidence of hip fracture increases exponentially with age in women between 60 and 85 years.

1. Ip T. P. et al. Management of osteoporosis in patients hospitalized for hip fractures. Osteoporos Int. 2010; 21(4): 605–614.