Washington, D.C., December 26, 2017—In response to a new meta-analysis, “Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults1,” published today in JAMA (Journal of the American Medical Association), the Council for Responsible Nutrition (CRN), the leading trade association for the dietary supplement and functional food industry, issued the following statement:
Statement by Andrea Wong, Ph.D., vice president, scientific & regulatory affairs, CRN:
“All Americans, and older adults specifically, have a basic need for calcium and for vitamin D as both are essential nutrients and are necessary for a host of critical functions in the body, including building strong bones. According to government research, Americans do not get enough of either calcium or vitamin D. In fact, the current Dietary Guidelines for Americans identify both calcium and vitamin D as shortfall nutrients of public health concern.
For older adults, specifically, we know that getting enough nutrients can be problematic, so dietary supplements become even more important—not as a replacement for food—but as an addition to a diet that should be rich in calcium-containing foods such as milk, cheese, and spinach, as examples. People find it even more difficult to get enough vitamin D from food because few foods are rich in vitamin D. Generalized recommendations relying on this study should be mindful that further reductions in calcium and vitamin D consumption may exacerbate these public health concerns.
This study is a well thought-out meta-analysis, but its limitations should be considered before making sweeping generalizations about calcium and vitamin D supplementation. For example, the authors noted four limitations, including their acknowledgement that “Some trials included in the analysis didn’t test baseline vitamin D blood concentration for all participants; the results for some subgroups might have been different if all individuals were tested.” Without knowing the blood levels of subjects before they began the intervention, one can’t assess whether the individuals were deficient in the first place. Another significant limitation not acknowledged by the authors involves the inclusion of the Women’s Health Initiative (WHI)2, a study which included a particularly large number of subjects, and consequently heavily weights the meta-analysis. Unfortunately, the WHI data has been widely acknowledged as having limitations of its own having to do with subjects not taking the supplements as directed by the protocol, as well as those who took calcium and vitamin D supplements on their own (outside the protocol) before and during the study. However, a subsequent re-analysis3 of the WHI data demonstrated a reduced risk of hip fractures in subjects receiving calcium and vitamin D who did not take personal calcium or vitamin D supplements at baseline. Further, another meta-analysis4 using the WHI re-analysis also showed that calcium plus vitamin D supplementation significantly reduced risk of total fractures and hip fractures in middle-aged to older adults.
CRN recommends that people discuss their individual needs for calcium and vitamin D with their healthcare practitioners. If there is the possibility of reducing the risk of a devastating fracture by supplementing with calcium and vitamin D, as some research has found, people should not be dissuaded from supplementation by a meta-analysis that is meant as a general recommendation, and may not apply to each individual.”
Note to Editor: The Council for Responsible Nutrition (CRN), founded in 1973, is a Washington, D.C.-based trade association representing 150+ dietary supplement and functional food manufacturers, ingredient suppliers, and companies providing services to those manufacturers and suppliers. In addition to complying with a host of federal and state regulations governing dietary supplements and food in the areas of manufacturing, marketing, quality control and safety, our manufacturer and supplier members also agree to adhere to additional voluntary guidelines as well as to CRN’s Code of Ethics. Visit www.crnusa.org. Follow us on Twitter @CRN_Supplements and LinkedIn.
2N Engl J Med 2006; 354:669-683.
3Osteoporos Int 2013;24:567-580.
4Osteoporos Int. 2016; 27: 367–376.