In yet another controversial announcement, the U.S. Preventive Services Task Force (USPSTF) is recommending that healthy postmenopausal women put away their vitamin D and calcium supplements, stating there s not enough evidence to demonstrate that either prevents bone fractures. The decision hails from the same panel that advised against PSA testing for men last month and just like the PSA guideline, the latest recommendation is spurring lots of controversy and confusion among both physicians and the public.
But perhaps the recommendation isn t so outlandish after all. For instance, according to the Institute of Medicine (IOM), most Americans are already meeting the daily recommended amounts of vitamin D and calcium, in part because many foods including milk and yogurt are rich in or fortified with those nutrients.
For their report, the Task Force looked at postmenopausal women who took doses of 400 IU of vitamin D and 1,000 mg of calcium or less daily. Depending on age, the IOM recommends 600-800 IU and 700-1,300 mg of each, respectively. The authors did not find enough evidence to suggest that such doses prevented fractures. They did, however, see a slight increase in the risk of kidney stones among the women taking supplements, which led the panel to recommend against using them. With regard to premenopausal women, the USPSTF has not made any recommendations on daily intake of vitamin D or calcium.
Not surprisingly, many health experts don t agree with the latest decision, noting that the study was fraught with limitations. For instance, Clifford Rosen, a spokesman for the Society of Bone and Mineral Research, points out that the USPSTF did not take into account results from the Women s Health Initiative, which found that among healthy postmenopausal women, the supplements were associated with a 10 to 11 percent decreased risk of fractures. Further, the group of participants analyzed in the Task Force report was quite homogenous, thus not necessarily reflective of the wider population.
Others, however, agree with the decision, stating that calcium is best obtained from the diet, while time in the sun stimulates production of vitamin D. The key point about calcium is that more is not better, says Dr, JoAnn Manson, chief of the division of preventive medicine at Brigham and Women s Hospital in Boston, who is leading a new, large study to determine whether 2,000 IU of vitamin D or one gram of omega-3 fatty acids reduce the risk of various diseases.
In fact, ACSH s Dr. Ruth Kava, who is not keen on the USPSTF recommendation, will be a participating member of the research. The latest guidelines are going to confuse a lot of women because, for years, we ve been told that taking vitamin D and calcium supplements is a good idea, she says. And while you can obtain vitamin D from the sun, a lot of people are wearing high SPF sunscreens nowadays, which can block this mechanism.
ACSH's Dr. Gilbert Ross sees both sides of the coin. Though excess vitamin D or calcium can indeed lead to adverse effects, he says, I still think they are beneficial to take for many folks, including women who might not get outside too often or who don t consume enough dairy products.