Vitamin D Dosing Recommendations For People With Or At Risk For Osteoporosis
Patients with or at high risk for osteoporosis should take the lowest possible dosage of vitamin D3 with the shortest possible interval , according to study findings published in Joint Bone Spine.
Researchers presented new data and practices relevant to vitamin D levels in the general population in France to establish optimal vitamin D status and frequency of intermittent supplement dosing, and make recommendations for appropriate supplementation.
Previous literature has recommended a minimum serum 25-hydroxyvitamin D D) level of 30 ng/mL for patients who have osteoporosis or who are at high risk because of health conditions or receiving treatment that may have deleterious bone effects, as well as patients who have chronic kidney disease or are prone to falls. For a general population of healthy individuals, the literature contends that a level of at least 20 ng/mL is sufficient, but should not exceed 60 ng/mL. Approximately 50% of individuals in the general French population have serum 25D levels < 20 ng/mL.
The researchers recommend beginning supplementation with a loading phase consisting of 50,000 IU/wk of vitamin D3 for 8 weeks in patients with levels < 20 ng/mL and 50,000 IU/wk for 4 weeks in patients with levels between 20 and 30 ng/mL. Subsequently, long-term supplementation should be prescribed as 50,000 IU/mo.
Healthy Eating And Vitamin D Supplements
Eating a healthy, balanced diet is recommended for everyone. It can help prevent many serious health conditions, including heart disease, diabetes and many forms of cancer, as well as osteoporosis.
Calcium is important for maintaining bone health. Adults need 700mg a day, which you should be able to get from your daily diet. Calcium-rich foods include:
- leafy green vegetables
- fortified foods such as most fat spreads and some breakfast cereals
- dietary supplements
However, it can be difficult to get enough vitamin D from foods alone. So, consider taking a daily supplement containing 10 micrograms of vitamin D.
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How Much Calcium Does An Adult Need To Take In Every Day
The amount of calcium needed for healthy bones and teeth is different by age. The National Institutes of Health suggests these levels of daily intake for adults:
Daily suggested calcium intake for adults
- Adults 19-50 years: 1,000 mg.
- Adult men 51-70 years: 1,000 mg.
- Adult women 51-70 years: 1,200 mg.
- Adults 71 years and older: 1,200 mg.
- Pregnant and breastfeeding teens: 1,300 mg.
- Pregnant and breastfeeding adults: 1,000 mg.
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How Much Sun Exposure Do You Need
To get enough vitamin D, generally, you should try to get 1020 minutes of sun exposure to your bare skin outside peak sunlight hours daily without sunscreen and taking care not to burn.
Unfortunately, sunlight is not always a reliable source of vitamin D. The season and geographic latitude, use of sunscreen, city smog, skin pigmentation, and a persons age are just some of the factors that will affect how much vitamin D is produced in the skin through sunlight.
Because many of us spend most of our times indoors, low levels of vitamin D have become a worldwide problem and there is concern that this is having a negative impact on bone health.
Questions And Answers About Calcium And Vitamin D
Every day Im asked questions like, When should I take my calcium? Can I take too much Vitamin D? Can I get enough Vitamin D through sunlight? and more. Here are some answer to these frequently asked questions.
Q: When should I take my calcium supplement?
Its best to take calcium supplements with food so they absorb better ideally, spread them out over two meals for best absorption. Blood calcium can dip at night, so it helps to take some of your supplemental calcium with dinner.
Q: Can you take too much calcium?
Yes. Although we need calcium in relatively large quantities, you can take too much. For those looking to maximize bone health generally, supplement with calcium in the range of 300 mg/day. I dont recommend using over 1000 mg supplemental calcium, as doctors tended to prescribe in the past.
Q: I get plenty of sunshine. Why do I need Vitamin D?
Even if youre getting a lot of sunlight or taking supplements, you can still have low Vitamin D. Thats because each persons body absorbs and uses vitamin D differently, and the variation can be dramatic. As you go through life, your body may become less efficient at making, and using, Vitamin D for bone health. If you are getting enough direct sunlight , its still a good idea to get your Vitamin D level checked just to be sure.
Q: I’ve heard reading a lot about Vitamin K2 and calcium. Should I be taking that too?
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Vitamin D For Osteoporosis
Planning to eat right for healthier bones? Calcium is probably the nutrient you think of first. But vitamin D is just as important for keeping bones strong and preventing the bone disease osteoporosis.
Vitamin D helps your intestines absorb calcium from the food you eat. Getting enough of both nutrients is an important part of making sure your bones are dense and strong.
Unlike calcium, which you only get through food, your body makes vitamin D when sunlight hits your skin. Active people who live in sunny regions can get at least some of what they need from spending time outdoors every day. But in less temperate areas such as Minnesota, Michigan, and New York, the skin makes less vitamin D in the winter months, especially for older adults.
The amount your skin makes depends on where you live, how light or dark your skin is, and the time of day youâre outside. It could be about 15 minutes for a very fair-skinned person and an hour or two for someone with darker skin. But you have to be careful — too much time in the sun raises your chance of having skin cancer. Even though sunlight is a key part of your bodyâs vitamin D production, itâs best to protect your skin with clothing and sunscreen if youâll be outside for more than a few minutes.
How else can you get vitamin D? A few foods have it, such as:
- Fatty fish, like salmon, tuna, and mackerel
- Beef liver, cheese, and egg yolks
- Foods with added vitamin D, such as milk, orange juice, and cereal
Show Sources
Osteoporosis Canada Recommends Routine Vitamin D Supplementation For Canadian Adults Year
Healthy adults between 19-50 years of age, including pregnant or breast feeding women, require 400 1,000 IU daily. Those over 50 or those younger adults at high risk should receive 800 2,000 IU daily.
The best supplement to purchase is vitamin D3 . While most multivitamins or calcium supplements contain some vitamin D, the amounts can vary, so its important to read the label carefully to ensure you are getting the amounts you need. If you arent sure about the amounts in the supplements you are taking, please check with your pharmacist.
Adding vitamin D enhanced foods to your diet is another great way to increase intake of vitamin D. In Canada, vitamin D fortification is mandated for margarine, infant formula, formulated liquid diets, cows milk and substitutes, egg products, foods for use on a very low energy diet, meal replacements and nutritional supplements. Fortification is voluntary for butter substitutes, condensed milk, goats milk and goats milk powder.
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High Dosage Vitamin D And Osteoporosis
| The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. |
| First Posted : June 26, 2007Last Update Posted : November 3, 2011 |
- Study Details
| Drug: cholecalciferol Drug: placebo | Phase 4 |
| Study Type : |
| Quadruple |
| Primary Purpose: |
| High Dosage Vitamin D in the Treatment of Osteoporosis in Postmenopausal Women |
| Study Start Date : |
-
+ calcium 500 mg/cholecalciferol 400 IU x2/d
- Drug: placeboCalcium 500 mg/Cholecalciferol 400 IU x2/d and placebo 2/w
Information from the National Library of Medicine
| Ages Eligible for Study: | 50 Years to 80 Years |
| Sexes Eligible for Study: |
- bone mineral density in L2-4 or mean total hip with T-score < = -2.0
Whats A Good Vitamin D Dosage For Osteoporosis
According to recent studies, it appears less is more when it comes to using vitamin d for safeguarding against osteoporosis.2 In fact adults who took large amounts of this vitamin daily not only didnt see additional gains in bone density, but in some cases ended up worse off. Using a more moderate dose of supplemental vitamin D in the range of 1000-2000IUs will be enough to contribute to adequate bone density levels.
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Vitamin D And Osteopenia
Getting at least 10 minutes of daily sunlight helps to prevent osteopenia and fractures, says Torpy. According to the NOF, if you are over 50 years old, you need 800 to 1,000 IU of vitamin D daily to protect your bones from osteopenia. To reach these amounts, you probably need a vitamin D supplement. Ask your doctor to check the vitamin D level in your blood. The Office of Dietary Supplements considers a serum 25-Hydroxyvitamin D level of greater than 50 nmol/L adequate for bone health 2.
- Getting at least 10 minutes of daily sunlight helps to prevent osteopenia and fractures, says Torpy.
- According to the NOF, if you are over 50 years old, you need 800 to 1,000 IU of vitamin D daily to protect your bones from osteopenia.
Potential Concerns With Calcium Supplements
There are some concerns about taking large doses of calcium via supplements.
For example, calcium supplements have been associated with symptoms like constipation, kidney stones, and other digestive issues. There are also some concerns that they may be bad for heart health .
One review found an increased risk of heart attacks in those taking calcium supplements. That said, other studies have not shown a link between calcium supplements and negative outcomes for heart health .
As dietary intake of calcium has not been linked to these side effects, its best to focus on meeting your calcium needs through your diet and discussing the potential need for supplements with your healthcare provider.
Summary
While there are certain situations in which calcium supplements may be indicated, the current research doesnt support the use of calcium supplements to prevent or manage osteoporosis.
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How Common Is Osteoporosis
Roughly 9 million people in the United States have osteoporosis. Most people with osteoporosis are diagnosed after the age of 50.
The main concern in osteoporosis is you have a higher risk of breaking a bone. Your chance of breaking a bone in your lifetime if you have osteoporosis is 1 in 2 for women and 1 in 4 for men.1 Your risk of breaking a bone is greater if you:2
- are female
- drink three or more alcoholic drinks per day
- have a low calcium and vitamin D intake
- broke a bone in the past
How Much Calcium And Vitamin D Do You Need
NOF recommends that women age 50 and younger get 1,000 mg of calcium from all sources daily and that women age 51 and older get 1,200 mg. For men, NOF recommends 1,000 mg of calcium daily for those age 70 and younger and 1,200 mg for men age 71 and older.
And dont forget about vitamin D, which enables your body to absorb calcium. Most adults under age 50 need 400-800 international units daily and most adults age 50 and older need 800-1,000 IU daily. Some people need more vitamin D to maintain healthy blood levels of the vitamin, so be sure to talk with your healthcare provider to determine the amount thats right for you. Visit Calcium and Vitamin D: What You Need to Know for our complete recommendations on calcium and vitamin D.
Remember, regardless of what you hear or read, always talk to your healthcare provider about your individual needs for calcium and vitamin D and never stop taking your supplements without talking to your healthcare provider first.
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Mayo Clinic Q And A: How Much Vitamin D Do I Need
DEAR MAYO CLINIC: I have heard different recommendations from different sources regarding vitamin D. One doctor told my husband that everyone living in the Northern Hemisphere should take a vitamin D supplement every day, even in the summer. What do you recommend?
ANSWER: Understanding how much vitamin D you need can be confusing because there are different recommendations about how much vitamin D adults should get. Using the recommendations that fall on the low end, many adults dont get the amount of vitamin D they should. Because few foods contain vitamin D naturally, eating foods fortified with vitamin D and taking a supplement may be beneficial.
Vitamin D is important because it helps your body sustain normal levels of calcium and phosphorus. Because it works as a key that allows your body to absorb calcium, vitamin D plays a critical role in forming and maintaining healthy bones. It also helps keep your muscles, nerves and immune system healthy.
Research suggests that consistently getting enough vitamin D can significantly lower the risk for the bone-thinning disease osteoporosis. Low vitamin D also is associated with falls, multiple sclerosis, rheumatoid arthritis, chronic pain, diabetes, high blood pressure, cardiovascular disease and some cancers. However, an association does not mean low vitamin D causes these conditions, or that taking a vitamin D supplement will adequately prevent or treat them.
Healthy Vitamin D Levels For Osteoporosis
To summarise this article its best to keep your Vitamin D levels within the healthy range of 4000IUs or under daily. To achieve this get outside daily and expose your skin to direct sunlight for absorption of adequate Vitamin D. If you live in climates without much sunlight or in winter its suggested to try supplemental products. Couple exercise and diet strategies to further protect your bones and you will live a prosperous and healthy life.
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How Much Vitamin D Should You Get
The amount you need depends on your age:
- 600 IU a day for people ages 1 to 70, including women who are pregnant or breastfeeding
- 800 IU a day for anyone over 70
Some experts think that these recommendations are too low, especially for people who are more likely to get the bone-thinning disease osteoporosis. Ask your doctor how much vitamin D is best for you.
It is possible to get too much vitamin D. Doses above 4,000 IU a day can be harmful for people ages 9 and older. Its hard to get that much from food, but it might happen if you take too many vitamin D supplements.
What Is Vitamin D And What Does It Do
Vitamin D plays an important role in protecting your bones, both by helping your body absorb calcium and by supporting muscles needed to avoid falls. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you dont get enough vitamin D, youre more likely to break bones as you age.
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Too Much Of A Good Thing
Some professional societies encourage people to take as much as 5,000 IU to 10,000 IU of vitamin D each day. This study provides new information that might prompt some to rethink those recommendations.
âThis is further evidence that high doses are not advisable,â says Dr. Manson. âIn terms of bone health, once you get to a certain level of intake, increasing that amount isnât going to be beneficial.â
There is also some evidence that people are overdoing vitamin D supplementation on their own. Researchers looking at national survey data gathered from 1999 to 2014 found a 2.8% uptick in the number of people taking potentially unsafe amounts of vitamin D that is, more than 4,000 IU per day, according to a 2017 research letter published in JAMA. And during the same time period, the number of people taking 1,000 IU or more of vitamin D daily increased nearly 18%.
However, while most people should stick to a moderate daily dose of vitamin D, some people do need higher amounts, says Dr. Manson. These include people with conditions that prevent the body from properly absorbing nutrients, such as Crohnâs disease or ulcerative colitis and people who have had gastric bypass surgery. But in most people, high doses are unnecessary, and potentially harmful.
Optimal Vitamin D Dose For Reduction Of Falls And Fractures
It seems likely that vitamin D substitution improves physical performance and that elderly and those with severe vitamin D deficiency experience the greatest benefit. Based on evidence from RCTs and the meta-analyses, vitamin D supplementation reduces both falls and fractures. The beneficial effect of vitamin D is dose dependent and mainly demonstrated for cholecalciferol with a dose of at least 700 IU/day. Active vitamin D is not preferred because of the increased risk of hypercalcemia.
In addition to vitamin D status, calcium balance must be optimized. For persons older than 50 years, a total calcium intake of 1000 to 1200 mg per day was advised . Calcium supplementation may be needed when dietary calcium intake is insufficient, although a calcium intake greater than 700 mg/day may be only beneficial for better BMD when 25D levels are less than 50 nmol/L . The meta-analysis by Bischoff-Ferrari et al. showed no reduction in hip fracture risk with calcium supplementation. In addition, recent publications suggest an increased risk of myocardial infarction with calcium supplementation without coadministration of vitamin D . However, the risk of myocardial infarction was not increased in people with dietary calcium intake below a median dietary calcium intake of 805 mg/day . Thus, calcium supplementation may be considered when dietary calcium intake is below 700 mg/day, with a calcium supplementation dose that leads to a maximum total daily calcium intake of 1000 to 1200 mg.
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