Increased intakes of vitamin D plus calcium may support bone health after menopause

Post-menopausal women who take a combination of hormones plus calcium and vitamin D supplements may be better protected from hip fractures than with either therapy alone, suggests a new US study.

In the clinical trial, rates of hip fracture were compared between nearly 30,000 postmenopausal women who followed different therapies: among the participants – who took a hormone combination (estrogen plus a progestogen, required for women with a uterus), estrogen alone or a placebo – in addition, some 16,000 took supplemental calcium (1,000 mg/day) plus vitamin D (400 mg/day) or a placebo (1). The study results showed that women using both therapies (hormones plus supplements) were much better protected from hip fractures than with either therapy alone or no therapy (placebo). The benefit of hormone therapy was parti-cularly strong in women who had total calcium intakes (supplements plus diet) of greater than 1,200 mg/day. Similarly, the benefit was strong in women who had higher intakes of vitamin D, but the individual effect of each one could not be determined because the two supplements were given together.

The researchers concluded that women taking postmenopausal hormone therapy should also take supple-mental calcium and vitamin D. Although they could not specify how much, they noted that the benefits seem to increase with increasing total intake of calcium and vitamin D. This recommendation differs from that of the US Preventive Services Task Force (USPSTF), made earlier this year. The USPSTF stated that the current evidence is insufficient to recommend calcium and vitamin D supplements for the primary prevention of fractures in premenopausal women (2).

1. Robbins J. et al. Women's Health Initiative clinical trials: interaction of calcium and vitamin D with hormone therapy. Menopause. Published online June 2013.
2. U.S. Preventive Services Task Force. Vitamin D and Calcium Supplementation to Prevent Fractures. February 2013. http://www.uspreventiveservicestaskforce.org/uspstf/uspsvitd.htm