The Council for Responsible Nutrition (CRN) and Natural Products Association, Washington, D.C responded to a study, “Effects of Vitamin D Supplements on Bone Mineral Density: A Systematic Review and Meta-Analysis,” published in The Lancet. 

Duffy MacKay, ND, vice president, scientific and regulatory affairs, CRN: “The scientific literature supports that vitamin D is necessary for calcium absorption and bone density, and therefore the two nutrients work in combination to provide a protective effect for helping to prevent osteoporosis. One of the serious limitations of this meta-analysis was the lack of consideration of studies that looked at how vitamin D and calcium work together. For populations that are most vulnerable to vitamin D deficiencies and insufficiencies—especially older adults—getting vitamin D from food alone is particularly challenging, and so supplementation may be warranted. We have concerns that the author’s broad-based advice will do nothing but cause potentially dire consequences if people, particularly those at-risk for fracture, fail to obtain the recommended daily intake of vitamin D.

“We feel just as strongly that this meta-analysis not discourage healthy people from taking vitamin D for all the possible benefits. Beyond osteoporosis and bone health, vitamin D provides extensive benefits in other areas. The body of scientific literature, including new and emerging research, shows vitamin D plays an important role in cardiovascular health, immune health and diabetes; therefore, it is vital that doctors and other healthcare practitioners continue to test vitamin D levels. Because vitamin D is not easily obtained from food, and obtaining it through sunlight carries cancer risks, replenishing through supplementation is a safe and appropriate way to get vitamin D.

The Institute of Medicine recommends dietary intake for adults of 600-800 IU of vitamin D and 1,000-1,300 mg of calcium daily, and the 2010 Dietary Guidelines for Americans identifies supplements containing combinations of certain nutrients such as calcium and vitamin D as useful in postmenopausal women who have low levels of these nutrients in their diets to reduce the risk of osteoporosis. In addition, the Food and Drug Administration has an approved health claim for calcium, vitamin D and osteoporosis.

“Osteoporosis-related fractures in the U.S. cost an estimated $14 billion in 2012. They also place tremendous financial, mental and physical burdens on the individual. A new economic report from Frost and Sullivan found that over $12 billion in cumulative osteoporosis-attributed cost savings is potentially realizable, between 2013 and 2020, if U.S. women over the age of 55 diagnosed with osteoporosis were to use calcium and vitamin D dietary supplements at what the report identified as preventive intake levels. The daily cost per person in the targeted population to supplement would be $.16—not ‘expensive’ compared to the costs one, or the overall system, would incur if appropriate levels of vitamin D were not met. Supplementation is smart prevention.”

Dr. Cara Welch, senior vice president of scientific and regulatory affairs, with NPA, said, “It’s common knowledge that the beneficial effect of vitamin D in osteoporosis prevention occurs when the supplementation is vitamin D plus calcium. This meta-analysis misleads consumers by only looking at half the equation.

“The beneficial effect of vitamin D and calcium is due to the fact they work in tandem, and examining the outcomes of just vitamin D caused the researchers to start with a weak premise. In fact, FDA has an approved health claim for vitamin D and calcium regarding osteoporosis.

“This review does not do an adequate job of giving the public the whole story, and it draws a conclusion that should not discourage consumers from taking vitamin D. A deficiency in vitamin D is not uncommon and can be difficult to overcome with diet alone. NPA believes that dietary supplementation is both safe and effective for those who fall under this category. The Institute of Medicine’s recommended dietary allowances are 600-800 IU/day for adults over 50 years of age.