Supplementation

Calcium

It is recommended that an adult’s required daily intake (RDI) of calcium (1000-1300mg, depending on age and sex) is achieved through diet, including ‘calcium rich’ foods. Three serves of dairy foods per day, or calcium-rich non-dairy alternatives are recommended. However , if individual circumstances mean that this is not possible, supplementation may be needed.

For individuals who aren’t reaching their calcium RDI, supplementation may be required. A tablet of 500-600mg per day of elemental calcium is recommended in most cases to close the gap between dietary intake and RDI. Clinical trials have shown that calcium supplementation, especially when it is combined with vitamin D, helps to reduce the rate of bone loss and fractures in those who are deficient.

For people diagnosed with osteoporosis, calcium supplements on their own are not sufficient to maintain or improve bone density and reduce the risk of fractures. In most cases, specific osteoporosis medication is needed.

Vitamin D

Vitamin D is essential to bone and muscle health. Vitamin D deficiency is associated with a higher risk of falls in elderly people. . One third of Australians do not meet their daily required vitamin D levels for bone health.

The amount of sunshine an individual needs daily depends on: skin colour, location and season.  For people with moderately fair skin, exposure of the arms (or equivalent) for 6-7 minutes mid-morning or mid-afternoon in summer will maintain adequate vitamin D levels.  Darker skinned people will require 3-6 times longer exposure.

An adequate serum level of vitamin D is >50nmol/L at the end of winter/early spring.  Vitamin D levels should be 10/20nmol/L higher at the end of summer to allow for seasonal decrease in winter. For those who receive no or very little sun exposure (in particular, institutionalised elderly or disabled people, those who cover their skin for religious or cultural reasons), vitamin D supplementation is recommended to prevent vitamin D deficiency:

  • At least 600 IU per day for people under 70
  • At least 800 IU per day for people over 70
  • Sun avoiders or those at high risk of deficiency may require 1000-2000 IU per day

Groups at risk of vitamin D deficiency include:

  • Older people, particularly those in institutional care or housebound
  • Naturally dark skinned people (longer sun exposure time needed)
  • People who purposely avoid sun exposure
  • People who work indoors
  • People who cover their skin for cultural reasons
  • People with chronic disability, chronic disease or on medications that interfere with vitamin D metabolism
  • Obese people
  • Babies of Vitamin D deficient mothers

Testing should be carried out at the end of winter or beginning of spring. Recommended levels of supplementation (adults):

Vitamin D status

Range

Recommended

Mild deficiency

30-49 nmol/L

Supplement of 1,000-2,000 IU per day

Moderate deficiency

12.5-29 nmol/L

3,000-5,000 IU per day (for 6-12 weeks) followed by maintenance dose of 1,000-2,000 IU per day.

 

Large annual doses of vitamin D are not recommended.

A combined vitamin D-calcium supplement is recommended for elderly people, particularly those in residential care facilities, to reduce the risk of falls and fractures.

For more information, please refer to medical factsheets on calcium and vitamin D

For position papers on calcium and vitamin D, please click here

Author: Osteoporosis Australia Medical & Scientific Advisory Committee
Last updated: 07/14/2014 - 10:37