J Bone Metab.  2015 Nov;22(4):143-149. 10.11005/jbm.2015.22.4.143.

Calcium and Vitamin D Supplementations: 2015 Position Statement of the Korean Society for Bone and Mineral Research

Affiliations
  • 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongman, Korea.
  • 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
  • 3Department of Food and Nutrition, Keimyung University, Daegu, Korea.
  • 4Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea. hychung@khnmc.or.kr

Abstract

Calcium and vitamin D are essential components for bone health, thus calcium and vitamin D supplementation is an important strategy in the management of osteoporosis. However, the benefit of calcium and vitamin D supplementation on bone health is still controversial. Moreover, potentially harmful effects of excessive calcium supplementation on cardiovascular health are recently suggested. Too high a level of vitamin D has been also reported to have several, possibly related, harmful events. Korea is well known for low dietary calcium intake and vitamin D deficiency in its population. This position statement developed the following recommendation for adequate levels of calcium and vitamin D intake in Korean, postmenopausal women and men older than 50 years: Adequate calcium intake and optimal vitamin D level are essential for preventing and treating osteoporosis in postmenopausal women and men older than 50 years. We recommend a daily calcium intake of 800 to 1,000 mg/day. Food remains the best source of calcium; however calcium supplements should be considered when dietary intake of calcium is inadequate. We recommend dietary vitamin D intake of more than 800 IU per day, a level which appears to reduce the risk of fractures. When vitamin D deficiency is suspected, serum 25-hydroxy-vitamin D (25-[OH]D) level should be tested. We suggest that a serum 25-(OH)D level greater than 20 ng/mL is generally appropriate for prevention of osteoporosis. However, a serum 25-(OH)D level greater than 30 ng/mL is probably helpful for management of osteoporosis and prevention of fractures.

Keyword

Bone; Calcium; Cardiovascular diseases; Fractures; Osteoporosis; Vitamin D

MeSH Terms

Calcium*
Calcium, Dietary
Cardiovascular Diseases
Female
Humans
Korea
Male
Osteoporosis
Vitamin D Deficiency
Vitamin D*
Vitamins*
Calcium
Calcium, Dietary
Vitamin D
Vitamins

Cited by  9 articles

Medical Treatment of Osteoporosis/Prevention of Falls
Hyoung Keun Oh
J Korean Fract Soc. 2018;31(4):165-171.    doi: 10.12671/jkfs.2018.31.4.165.

Strategies for prevention of elderly hip fracture
Yeesuk Kim
J Korean Med Assoc. 2016;59(8):631-636.    doi: 10.5124/jkma.2016.59.8.631.

Pharmacologic supplementation of vitamin D
Jae Hyuk Lee
J Korean Med Assoc. 2017;60(4):330-335.    doi: 10.5124/jkma.2017.60.4.330.

Comparison in Adherence to Osteoporosis Guidelines according to Bone Health Status in Korean Adult
Hee-Sook Lim, Soon-Kyung Kim, Hae-Hyeog Lee, Dong Won Byun, Yoon-Hyung Park, Tae-Hee Kim
J Bone Metab. 2016;23(3):143-148.    doi: 10.11005/jbm.2016.23.3.143.

Coronary Calcification Is Reversely Related with Bone and Hair Calcium: The Relationship among Different Calcium Pools in Body
Sang-Hoon Lee, Soo-Jung Park, Kyu-Nam Kim, Doo-Yeoun Cho, Young-Sang Kim, Bom-Taeck Kim
J Bone Metab. 2016;23(4):191-197.    doi: 10.11005/jbm.2016.23.4.191.

Korean Society for Bone and Mineral Research Task Force Report: Perspectives on Intermittent High-dose Vitamin D Supplementation
Han Seok Choi, Yong-Ki Min, Dong Won Byun, Myung Hoon Hahn, Kyoung Min Kim, Beom Jun Kim, Ki-Won Oh
J Bone Metab. 2017;24(3):141-145.    doi: 10.11005/jbm.2017.24.3.141.

The Effect of Education and Vitamin D Supplementation on the Achievement of Optimal Vitamin D Level in Korean Postmenopausal Women
Chae Jin Lee, Sung Soo Kim, Won Yoon Suh, Jong Sung Kim, Jin Gyu Jung, Seok Joon Yoon, Yu Ri Seo, Hyeon Jeong Yang
J Bone Metab. 2019;26(3):193-199.    doi: 10.11005/jbm.2019.26.3.193.

Increased Risk of Osteoporosis in Gastric Cancer Survivors Compared to General Population Control: A Study with Representative Korean Population
Su-Min Jeong, Dong Wook Shin, Ji Eun Lee, Sang-Man Jin, Sung Kim
Cancer Res Treat. 2019;51(2):530-537.    doi: 10.4143/crt.2018.164.

Bone Loss after Solid Organ Transplantation: A Review of Organ-Specific Considerations
Kyoung Jin Kim, Jeonghoon Ha, Sang Wan Kim, Jung-Eun Kim, Sihoon Lee, Han Seok Choi, Namki Hong, Sung Hye Kong, Seong Hee Ahn, So Young Park, Ki-Hyun Baek
Endocrinol Metab. 2024;39(2):267-282.    doi: 10.3803/EnM.2024.1939.


Reference

1. Krall EA, Dawson-Hughes B. Heritable and life-style determinants of bone mineral density. J Bone Miner Res. 1993; 8:1–9.
Article
2. Chevalley T, Rizzoli R, Nydegger V, et al. Effects of calcium supplements on femoral bone mineral density and vertebral fracture rate in vitamin-D-replete elderly patients. Osteoporos Int. 1994; 4:245–252.
Article
3. Varenna M, Binelli L, Casari S, et al. Effects of dietary calcium intake on body weight and prevalence of osteoporosis in early postmenopausal women. Am J Clin Nutr. 2007; 86:639–644.
Article
4. Compston J, Bowring C, Cooper A, et al. Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. Maturitas. 2013; 75:392–396.
Article
5. Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, et al. Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr. 2007; 86:1780–1790.
Article
6. Shea B, Wells G, Cranney A, et al. Meta-analyses of therapies for postmenopausal osteoporosis. VII. Meta-analysis of calcium supplementation for the prevention of postmenopausal osteoporosis. Endocr Rev. 2002; 23:552–559.
Article
7. Michaëlsson K, Melhus H, Warensjö Lemming E, et al. Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study. BMJ. 2013; 346:f228.
Article
8. Bolland MJ, Avenell A, Baron JA, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010; 341:c3691.
Article
9. Bolland MJ, Barber PA, Doughty RN, et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ. 2008; 336:262–266.
Article
10. Umesawa M, Iso H, Ishihara J, et al. Dietary calcium intake and risks of stroke, its subtypes, and coronary heart disease in Japanese: the JPHC Study Cohort I. Stroke. 2008; 39:2449–2456.
Article
11. Shin CS, Kim KM. The risks and benefits of calcium supplementation. Endocrinol Metab (Seoul). 2015; 30:27–34.
Article
12. Bikle DD. Vitamin D and bone. Curr Osteoporos Rep. 2012; 10:151–159.
Article
13. Forman JP, Giovannucci E, Holmes MD, et al. Plasma 25-hydroxyvitamin D levels and risk of incident hypertension. Hypertension. 2007; 49:1063–1069.
Article
14. Giovannucci E, Liu Y, Hollis BW, et al. 25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008; 168:1174–1180.
Article
15. Mattila C, Knekt P, Männistö S, et al. Serum 25-hydroxyvitamin D concentration and subsequent risk of type 2 diabetes. Diabetes Care. 2007; 30:2569–2570.
Article
16. Choi HS, Kim KA, Lim CY, et al. Low serum vitamin D is associated with high risk of diabetes in Korean adults. J Nutr. 2011; 141:1524–1528.
Article
17. Giovannucci E, Liu Y, Rimm EB, et al. Prospective study of predictors of vitamin D status and cancer incidence and mortality in men. J Natl Cancer Inst. 2006; 98:451–459.
Article
18. Laaksi I, Ruohola JP, Tuohimaa P, et al. An association of serum vitamin D concentrations <40 nmol/L with acute respiratory tract infection in young Finnish men. Am J Clin Nutr. 2007; 86:714–717.
Article
19. Kamen D, Aranow C. Vitamin D in systemic lupus erythematosus. Curr Opin Rheumatol. 2008; 20:532–537.
Article
20. Choi HS. Vitamin d status in Korea. Endocrinol Metab (Seoul). 2013; 28:12–16.
Article
21. Lips P, Hosking D, Lippuner K, et al. The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. J Intern Med. 2006; 260:245–254.
Article
22. Choi HS, Oh HJ, Choi H, et al. Vitamin D insufficiency in Korea--a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008. J Clin Endocrinol Metab. 2011; 96:643–651.
Article
23. Hong H, Kim EK, Lee JS. Effects of calcium intake, milk and dairy product intake, and blood vitamin D level on osteoporosis risk in Korean adults: analysis of the 2008 and 2009 Korea National Health and Nutrition Examination Survey. Nutr Res Pract. 2013; 7:409–417.
Article
24. Shin CS, Choi HJ, Kim MJ, et al. Prevalence and risk factors of osteoporosis in Korea: a community-based cohort study with lumbar spine and hip bone mineral density. Bone. 2010; 47:378–387.
Article
25. Yang YJ, Kim J. Factors in relation to bone mineral density in Korean middle-aged and older men: 2008-2010 Korea National Health and Nutrition Examination Survey. Ann Nutr Metab. 2014; 64:50–59.
Article
26. Joo NS, Dawson-Hughes B, Kim YS, et al. Impact of calcium and vitamin D insufficiencies on serum parathyroid hormone and bone mineral density: analysis of the fourth and fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-3, 2009 and KNHANES V-1, 2010). J Bone Miner Res. 2013; 28:764–770.
Article
27. Kim KM, Choi SH, Lim S, et al. Interactions between dietary calcium intake and bone mineral density or bone geometry in a low calcium intake population (KNHANES IV 2008-2010). J Clin Endocrinol Metab. 2014; 99:2409–2417.
Article
28. Lau EM, Woo J, Lam V, et al. Milk supplementation of the diet of postmenopausal Chinese women on a low calcium intake retards bone loss. J Bone Miner Res. 2001; 16:1704–1709.
Article
29. Nakamura K, Saito T, Kobayashi R, et al. Effect of low-dose calcium supplements on bone loss in perimenopausal and postmenopausal Asian women: a randomized controlled trial. J Bone Miner Res. 2012; 27:2264–2270.
Article
30. Wang X, Chen H, Ouyang Y, et al. Dietary calcium intake and mortality risk from cardiovascular disease and all causes: a meta-analysis of prospective cohort studies. BMC Med. 2014; 12:158.
Article
31. Xiao Q, Murphy RA, Houston DK, et al. Dietary and supplemental calcium intake and cardiovascular disease mortality: the National Institutes of Health-AARP diet and health study. JAMA Intern Med. 2013; 173:639–646.
Article
32. Hsia J, Heiss G, Ren H, et al. Calcium/vitamin D supplementation and cardiovascular events. Circulation. 2007; 115:846–854.
Article
33. Bostick RM, Kushi LH, Wu Y, et al. Relation of calcium, vitamin D, and dairy food intake to ischemic heart disease mortality among postmenopausal women. Am J Epidemiol. 1999; 149:151–161.
Article
34. Challoumas D, Cobbold C, Dimitrakakis G. Effects of calcium intake on the cardiovascular system in postmenopausal women. Atherosclerosis. 2013; 231:1–7.
Article
35. Uenishi K, Ishida H, Kamei A, et al. Calcium requirement estimated by balance study in elderly Japanese people. Osteoporos Int. 2001; 12:858–863.
Article
36. Hunt CD, Johnson LK. Calcium requirements: new estimations for men and women by cross-sectional statistical analyses of calcium balance data from metabolic studies. Am J Clin Nutr. 2007; 86:1054–1063.
Article
37. Priemel M, von Domarus C, Klatte TO, et al. Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. J Bone Miner Res. 2010; 25:305–312.
Article
38. Hwang S, Choi HS, Kim KM, et al. Associations between serum 25-hydroxyvitamin D and bone mineral density and proximal femur geometry in Koreans: the Korean National Health and Nutrition Examination Survey (KNHANES) 2008-2009. Osteoporos Int. 2015; 26:163–171.
Article
39. Kuchuk NO, Pluijm SM, van Schoor NM, et al. Relationships of serum 25-hydroxyvitamin D to bone mineral density and serum parathyroid hormone and markers of bone turnover in older persons. J Clin Endocrinol Metab. 2009; 94:1244–1250.
Article
40. Melhus H, Snellman G, Gedeborg R, et al. Plasma 25-hydroxyvitamin D levels and fracture risk in a community-based cohort of elderly men in Sweden. J Clin Endocrinol Metab. 2010; 95:2637–2645.
Article
41. Ensrud KE, Taylor BC, Paudel ML, et al. Serum 25-hydroxyvitamin D levels and rate of hip bone loss in older men. J Clin Endocrinol Metab. 2009; 94:2773–2780.
Article
42. Bischoff-Ferrari HA, Shao A, Dawson-Hughes B, et al. Benefit-risk assessment of vitamin D supplementation. Osteoporos Int. 2010; 21:1121–1132.
Article
43. Tang BM, Eslick GD, Nowson C, et al. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007; 370:657–666.
Article
44. Bischoff-Ferrari HA, Willett WC, Orav EJ, et al. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med. 2012; 367:40–49.
Article
45. Hathcock JN, Shao A, Vieth R, et al. Risk assessment for vitamin D. Am J Clin Nutr. 2007; 85:6–18.
Article
46. Wallace RB, Wactawski-Wende J, O'Sullivan MJ, et al. Urinary tract stone occurrence in the Women's Health Initiative (WHI) randomized clinical trial of calcium and vitamin D supplements. Am J Clin Nutr. 2011; 94:270–277.
Article
47. Durup D, Jørgensen HL, Christensen J, et al. A reverse J-shaped association of all-cause mortality with serum 25-hydroxyvitamin D in general practice: the CopD study. J Clin Endocrinol Metab. 2012; 97:2644–2652.
Article
48. Durup D, Jørgensen HL, Christensen J, et al. A Reverse J-Shaped Association Between Serum 25-Hydroxyvitamin D and Cardiovascular Disease Mortality: the CopD Study. J Clin Endocrinol Metab. 2015; 100:2339–2346.
Article
49. Chowdhury R, Kunutsor S, Vitezova A, et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ. 2014; 348:g1903.
Article
50. Sousa Nanji L, Torres Cardoso A, Costa J, et al. Analysis of the Cochrane Review: thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev. 2014,1: CD002783. Acta Med Port. Acta Med Port; 28:12–14.
Article
Full Text Links
  • JBM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr