Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 421

The use of supplements for primary prevention of osteoporosis‐related fractures in healthy populations lacks sufficient evidence to be recommended. An evidence review of 11 RCTs of vitamin D supplementation alone or with calcium found no association with reduced fracture incidence among community‐dwelling adults without known vitamin D deficiency, osteoporosis, or prior fracture (‘healthy populations’).¹⁷ With regard to potential risk of harm, supplementation with vitamin D alone, or in combination with calcium, did not increase all‐cause mortality, cardiovascular events, or cancer risk; and supplementation with calcium alone did not increase the incidence of kidney stones. However, supplementation with both vitamin D and calcium was associated with an increase in the incidence of kidney stones. USPSTF conclusions and recommendations in 2018 were as follows¹⁹:

 The current evidence is insufficient to assess the balance of the benefits and harms of vitamin D and calcium supplementation, alone or combined, for the primary prevention of fractures in community‐dwelling, asymptomatic men and premenopausal women. (Insufficient ‘I’ statement.)

 The current evidence is insufficient to assess the balance of the benefits and harms of daily supplementation with doses greater than 400 IU of vitamin D and greater than 1000 mg of calcium for the primary prevention of fractures in community‐dwelling, postmenopausal women. (Insufficient ‘I’ statement.)

 Recommends against daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium for the primary prevention of fractures in community‐dwelling, postmenopausal women. (Discourage ‘D’ statement.)

 These recommendations do not apply to people with a history of osteoporotic fractures of increased risk for falls, or a diagnosis of osteoporosis or vitamin D deficiency.