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Level III – Calcium and Vitamin D Chemoprophylaxis Counseling

Level III Services: Preventive services that clinicians and care systems could provide to patients, but only after careful consideration of the costs and benefits. Providing these services is left to the judgment of individual care systems, clinicians and their patients.

The USPSTF recommendations are fully endorsed by the ICSI Preventive Services work group.
Grade of Recommendation and Level of Certainty as Evaluated by USPSTF
  1. “The current evidence is insufficient to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation for the primary prevention of fractures in premenopausal women or in men.”
  2. “The current evidence is insufficient to assess the balance of the benefits and harms of daily supplementation with greater than 400 IU of vitamin D3 and greater than 1,000 mg of calcium for the primary prevention of fractures in no institutionalized postmenopausal women.”
  3. “Against daily supplementation with 400 IU or less of vitamin D3 and 1,000 mg or less of calcium for the primary prevention of fractures in non-institutionalized postmenopausal women.”
(USPSTF Last Revised 2013)
Grade of Recommendation:
  1. I Statement
  2. I Statement
  3. D

Level of Certainty:

  1. Insufficient
  2. Insufficient
  3. Moderate
“Benefits:
In premenopausal women and in men, there is inadequate evidence to determine the effect of combined vitamin D3 and calcium supplementation on the incidence of fractures. In postmenopausal women, there is adequate evidence that daily supplementation with 400 IU of vitamin D3 combined with 1,000 mg of calcium has no effect on the incidence of fractures. However, there is inadequate evidence regarding the effect of higher doses of combined vitamin D and calcium supplementation on fracture incidence in non-institutionalized postmenopausal women.
Harms:
Adequate evidence indicates that supplementation with 400 IU or less of vitamin D3 and 1,000 mg or less of calcium increases the incidence of renal stones. The USPSTF assessed the magnitude of this harm as small.
enefits-Harms Assessment:
Non-institutionalized, community-dwelling postmenopausal women.

The USPSTF concludes that evidence is lacking about the benefit of daily supplementation with greater than 400 IU of vitamin D3and greater than 1,000 mg of calcium for the primary prevention of fractures, and the balance of benefits and harms cannot be determined.
The USPSTF concludes with moderate certainty that daily supplementation with 400 IU or less of vitamin D3 and 1,000 mg or less of calcium has no net benefit for the primary prevention of fractures.
Men and premenopausal women.
The USPSTF concludes that evidence is lacking about the benefit of vitamin D supplementation with or without calcium for the primary prevention of fractures, and the balance of benefits and harms cannot be determined.”
Relevant Resources:
http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/vitamin-d-and-calcium-to-prevent-fractures-preventive-medication?ds=1&s=calcium
Implementation Tools and Strategies:
Vitamin D and Calcium Supplementation to Prevent Fractures
Vitamin, Mineral and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer