Table 5.

Recommendations for Vitamin D and Calcium Supplementation

Vitamin D Vitamin D supplementation should be universal (level V). Vitamin D supplementation is an effective intervention in fall prevention (level I). Routine baseline and follow-up monitoring are not supported because of cost effectiveness except in selected populations (ie, declining BMD, new fractures, initiating new osteoporosis medications) (level V). Adequate 25(OH)D concentration is >50 nmol/L (level I), with optimal levels >75 nmol/L (level II). Dose equivalent to 1000 IU/day (25 mcg/d) necessary to achieve this target (level I). High daily doses (>4,000 IU/d) or high load doses are not recommended (level II). Safe sunlight exposure should be encouraged (level I). However, it is not sufficient to correct serum levels of vitamin D in deficient residents (level II).

Calcium It is recommended that combination of calcium and vitamin D be optimized in all residents (level I). Increased dietary calcium should be encouraged in place of calcium supplements (level III-2) with dietician assessment as part of care. A total daily intake of 1300 mg calcium optimal from dietary means to be achieved (up to 500 mg/d of calcium supplementation) (level I). High-dose calcium supplementation alone may increase the risk of cardiovascular events (level II). Long-term compliance with calcium is very poor (level I). Anti-fracture efficacy of calcium supplements is marginal (level I).