Your 67 yo F who lives independently fell last week. She has a DEXA showing a T score of -1.0. Her Vitamin D level is 40. How can we best prevent fractures?
a. Tai Chi
b. Vitamin D 400 IU daily
c. Fosamax
d. Calcium 500mg daily
"The U.S. Preventive Services Task Force recommended against taking daily supplementation of 400 IU or less of vitamin D3 and 1,000 mg or less of calcium for the primary prevention of fractures in community-dwelling postmenopausal women. This is a D recommendation (recommended against; there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefit). This recommendation does not apply to the treatment of persons with osteoporosis or vitamin D deficiency. The recommendation appeared in the Feb. 26 Annals of Internal Medicine"
The largest trial of fracture outcomes included in the meta-analysis was the Women's Health Initiative, which enrolled 36,282 healthy postmenopausal women ages 50 to 79. The intervention group received 400 IU of vitamin D3 and 1,000 mg of calcium daily compared to a placebo group. In the study, there was no statistically significant reduction in hip fracture (hazard ratio [HR], 0.88; 95% CI, 0.72 to 1.08) or total fractures (HR, 0.96; 95% CI, 0.91 to 1.02). However, the Task Force could not generalize the results of the Women's Health Initiative beyond the specific dose, preparation and population studied. Nearly 30% of study participants were already taking 500 mg or more of calcium daily before the start of the trial.
The Task Force has previously concluded in a separate recommendation that vitamin D supplementation is effective for community-dwelling adults aged 65 years or older who are at increased risk for falls (B recommendation; recommended.)
The Task Force also reported there is adequate evidence that supplementation with 400 IU or less of vitamin D3 and 1,000 mg or less of calcium increases the incidence of renal stones, although the magnitude is small. The Women's Health Initiative noted a statistically increased incidence of renal stones in women taking supplemental vitamin D and calcium. One woman was diagnosed with a urinary tract stone for every 273 women who received supplementation over a 7-year follow-up period"
Interestingly, there was a study in Oregon looking at older adults and whether an intervention of Tai Chi decreased falls. They looked at 256 inactive community dwelling adults (aged 70-92) who were randomized to participate in three times weekly Tai Chi or three times weekly stretching. At the end of the intervention, there were significantly fewer falls in the Tai Chi group and fewer injurious falls. These patients also showed significant improvement in measurements of functional balance, physical performance, and reduced fear of falling. The state of orgeon now offeres free Tai-Chi at all senior centers because of this study.
