Bone Health | Immunity | Overall Health

Vitamin D + Calcium

,
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  • Improved bone health
  • Possible longevity benefit
  • Possible immunity benefit

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Why we recommend

To assess vitamin D and calcium benefits, we compared results from multiple systematic reviews that assess the literature.1,2,3,4,5

One of the most compelling drivers for our recommendation comes from clinical guidelines from leading health societies around the world. For those over the age of 50, 6 of 8 health society guidelines recommend vitamin D, and 5 of 6 recommend calcium.3 For adults of all ages, 4 of 7 guidelines recommend vitamin D for the general population (See research benefits below).3 In other words, most adults benefit from vitamin D, especially the elderly who should also take calcium.

Additionally:

  • Across 6 studies, fractures were reduced in the elderly through vitamin D and calcium supplementation.4,9
  • 3 of 7 studies showed reduction in respiratory infection,2 suggesting a possible immunity benefit to vitamin D
  • In 8 of 12 systematic reviews, mortality was decreased.2

Bone health and immunity are important parts of health, but a reduction in mortality is always quite interesting. In this case, the reduced mortality really highlights how important immunity and bone health are. First, improved immunity can reduce death from infectious diseases. Second, when the elderly break bones, it tends to accelerate age-related diseases because you can't move around for a few months. We can't say for sure what caused the reduced mortality in these 12 systematic reviews, but a stronger immune system and stronger bones can have a positive impact.

To conclude, according to the US dietary guidelines, 90% of US adults are below the recommended vitamin D levels, and 30% and 60% of adult men and women, respectively, are below the recommended calcium intake.6 Thus, if you do not get enough sun, your bones will benefit from vitamin D and calcium supplementation, and you might get immunity benefits too. Dive into the research, below.

Research benefits

Guidelines
Positive Support
Highlights:

5 of 6 developed nation guideliens recommend calcium for the elderly, according to a review by Dai, 2021.

…

Sources: Dai, 2021 (3).

Bone Health
Positive Impact
Highlights:

In a JAMA-published systematic review of the literature, daily supplementation with calcium and vitamin D resulted in a 17% reduction in hip fractures and an 8% reduction in all fractures, using data from 6 randomized  trials.

Another systematic review also found a statistical association for calcium supplementation alone, across 20 studies. However results were inconsistent; potentially owing to the fact that vitamin d aids in calcium  absorption (10).

Sources: Yao, 2019 (9). Bolland, 2015 (10).

Immunity
Low or no impact
Highlights:

3 of 7 meta analyses of trials have shown vitamin D may reduce the risk of respiratory infection.

...

Source: Rejnmark, 2017 (2).

Harms
Risk of GI side effects
Highlights:

Source: US Preventive Services Task Force, 2018 (1).

References

    References

    1. O’Connor EA, Evans CV, Ivlev I, et al. Vitamin, Mineral, and Multivitamin Supplementation for the Primary Prevention of Cardiovascular Disease and Cancer: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2021 Jun. (Evidence Synthesis, No. 209.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK581642/
    2. Rejnmark L, Bislev LS, Cashman KD, Eiríksdottir G, Gaksch M, Grübler M, Grimnes G, Gudnason V, Lips P, Pilz S, van Schoor NM, Kiely M, Jorde R. Non-skeletal health effects of vitamin D supplementation: A systematic review on findings from meta-analyses summarizing trial data. PLoS One. 2017 Jul 7;12(7):e0180512. doi: 10.1371/journal.pone.0180512. PMID: 28686645; PMCID: PMC5501555.
    3. Dai Z, McKenzie JE, McDonald S, Baram L, Page MJ, Allman-Farinelli M, Raubenheimer D, Bero LA. Assessment of the Methods Used to Develop Vitamin D and Calcium Recommendations-A Systematic Review of Bone Health Guidelines. Nutrients. 2021 Jul 15;13(7):2423. doi: 10.3390/nu13072423. PMID: 34371932; PMCID: PMC8308557.
    4. Avenell A, Mak JC, O'Connell D. Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev. 2014 Apr 14;2014(4):CD000227. doi: 10.1002/14651858.CD000227.pub4. PMID: 24729336; PMCID: PMC7032685.
    5. Winzenberg TM, Powell S, Shaw KA, Jones G. Vitamin D supplementation for improving bone mineral density in children. Cochrane Database Syst Rev. 2010 Oct 6;(10):CD006944. doi: 10.1002/14651858.CD006944.pub2. PMID: 20927753.
    6. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov.
    7. Sabine Kuznia, Anna Zhu, Taisuke Akutsu, Julie E. Buring, Carlos A. Camargo Jr, Nancy R. Cook, Li-Ju Chen, Ting-Yuan David Cheng, Sari Hantunen, I.-Min Lee, JoAnn E. Manson, Rachel E. Neale, Robert Scragg, Aladdin H. Shadyab, Sha Sha, John Sluyter, Tomi-Pekka Tuomainen, Mitsuyoshi Urashima, Jyrki K. Virtanen, Ari Voutilainen, Jean Wactawski-Wende, Mary Waterhouse, Hermann Brenner, Ben Schöttker, Efficacy of vitamin D3 supplementation on cancer mortality: Systematic review and individual patient data meta-analysis of randomised controlled trials, Ageing Research Reviews, Volume 87, 2023, 101923, ISSN 1568-1637, https://doi.org/10.1016/j.arr.2023.101923.
    8. Cedric F. Garland, Edward D. Gorham, Sharif B. Mohr, Frank C. Garland, Vitamin D for Cancer Prevention: Global Perspective, Annals of Epidemiology, Volume 19, Issue 7, 2009, Pages 468-483, ISSN 1047-2797, https://doi.org/10.1016/j.annepidem.2009.03.021.(https://www.sciencedirect.com/science/article/pii/S1047279709001057)
    9. Yao P, Bennett D, Mafham M, et al. Vitamin D and Calcium for the Prevention of Fracture: A Systematic Review and Meta-analysis. JAMA Netw Open. 2019;2(12):e1917789. doi:10.1001/jamanetworkopen.2019.17789
    10. Bolland M J, Leung W, Tai V, Bastin S, Gamble G D, Grey A et al. Calcium intake and risk of fracture: systematic review BMJ 2015; 351 :h4580 doi:10.1136/bmj.h4580
    11. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2011;96:1911-30.
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