Need of Calcium and Vitamin D in Patients after a Recent Fracture

Adequate calcium and vitamin D intake is advocated in guidelines of osteoporosis. However, the dosage needed to achieve an optimal calcium intake and vitamin D status is still a point of debate. Of 902 consecutive patients older than 50 years presenting at the time of fracture, 502 were evaluable for measurement of calcium intake and serum 25(OH)D concentration. We calculated the percentage of patients who needed calcium supplements to achieve intake of 1000 mg/d and who needed cholecalciferol supplementation to achieve serum levels of 50 nmol/l. Calcium intake ranged between 250 and 2050 mg/d and serum 25(OH)D between <10 and 130 nmol/l. A combination of calcium intake of ≥1000 mg/d and serum 25(OH)D concentration of 50 nmol/l was present in 11% of patients. To achieve 1000 mg/d of calcium, 57% of patients needed supplementation of 500 mg/d and 12% needed 1000 mg/d. Systematic calcium supplements of 500 mg/d would achieve an intake of 1000 mg/d in 88%. To achieve serum 25(OH)D concentrations of 50 nmol/l, 41% of patients needed a supplement of 800 IU D3/d and 25% needed higher doses. Systematic supplementation of 800 IU/d would achieve 50 nmol/l in 75% of patients. Calcium intake and vitamin D status vary considerably between fracture patients. Conclusion: calcium supplements need to be titrated individually to achieve desirable levels. Most patients achieved 50 nmol/l of 25(OH)D with 800 IU D3/d. Prospective studies are needed to study how to achieve and maintain optimal serum vitamin D levels and adequate calcium intake.