Role of calcium and vitamin D in the treatment of osteoporosis

Our objective has been to develop a position document on the role of calcium and vitamin D in the treatment of osteoporosis, identifying and assessing the grade of evidence which supports the recommendations.
To achieve this aim, the published studies on aspects of pharmacokinetics of calcium, and the usefulness of calcium and vitamin D in the reduction of risk of fragility-related fracture, given on its own, as well as, more commonly used in combination with other drugs, have been reviewed, developing through their analysis, the current recommendations. These have been produced through a pre-specified and reproducible process, which included an accepted model for the evaluation and citing of evidence which supports them. The document, once drafted by the co-ordinators, was reviewed and discussed by all the panel members, to produce the definitive recommendations.
Calcium and vitamin D in themselves have shown their usefulness in the reduction of risk of both vertebral fracture, and hip and non-vertebral fracture. Administered in combination with different drugs they also reduce the risk of new osteoporotic fractures. All treatments indicated for osteoporosis should be administered with a supplement of calcium and vitamin D. To ensure optimum absorption, the calcium and vitamin D should be administered in small doses throughout the day. The calcium salt most used is calcium carbonate, of which there has been the greatest experience, it being, also, the cheapest. Calcium carbonate should be administered with meals for the best absorption. There are no pivotal studies with drugs used for the treatment of osteoporosis carried out with other salts of calcium. Calcium carbonate slightly increases the risk of urolitiasis. Calcium citrate is indicated in those patients with achlorhydia and reduces the risk of urolitiasis, being indicated as the drug of first choice for these patients.

Read More