Role of calcium and vitamin D in the prevention (and treatment) of osteoporotic fracture

The skeleton requires optimum development and maintenance of its integrity to prevent fracture throughout the life cycle. It is now generally accepted that bones break because the loads placed on them exceed their ability to absorb the energy involved. Current figures for the UK suggest that 1 in 3 women and 1 in 12 men over the age of 55 years will suffer from osteoporosis in their lifetime, at a cost of £1.7 billion per annum to the NHS. The pathogenesis of osteoporosis is multifactorial. Both the development of peak bone mass and the rate of bone loss are determined by key endogenous and exogenous factors. Re-defining vitamin D requirements in the UK is urgently needed because there is evidence of extensive hypovitaminosis D in men and women, which is especially prevalent in Asian population groups. Low vitamin D status is associated with an increased risk of falling and a variety of other health outcomes, and is an area that requires urgent attention. Calcium supplementation seems to have little effect on bone mineral density in younger post-menopausal women (< 5 years past the menopause) who are not vitamin D deficient, but calcium supplements may be effective in reducing bone loss in late menopausal women (> 5 years post-menopause), particularly in those with low habitual calcium intake (< 400 mg/day). Vitamin D and calcium supplementation have been shown to reduce fracture rates in the institutionalized elderly, but controversy remains about whether supplementation is effective in reducing fracture in free-living populations.