Who needs Calcium and Vitamin D supplement?

Calcium and vitamin D supplements needs for prevention of osteoporosis and osteoporotic fractures. There is evidence of significant benefit in people at risk of deficiency.

For individuals who cannot get enough calcium through their diets, supplements may be beneficial. These should be limited to 500-600 mg per day and it is generally recommended that they be taken combined with vitamin D. Calcium is absorbed best when taken in amounts of 500 – 600 mg or less.

Vitamin D deficiency is very common. Without sufficient vitamin D, calcium will not be absorbed and benefit the body.

Women who have premature menopause.
People who spend little time in the sun or those who regularly cover up when outdoors.
People living in nursing homes or other institutions or who are homebound.
People with certain medical conditions such as Celiac disease and inflammatory bowel disease.
People taking medicines that affect vitamin D levels such as certain anti-seizure medicines.
People with very dark skin.
Obese or very overweight people.
Older adults with certain risk factors.
Vegetarians who do not eat dairy.

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When patients need to be referred to specialists?

Evidence statement

Referral to specialists (eg endocrinologist, rheumatologist, orthopedic & physical medicine specialist) is important for specific conditions.

Circumstances depend on a combination of factors including severity of the condition, response to available treatment, availability of resources and general practitioner (GP) expertise and support.

In specific situations GPs should refer patients to a Specialist. The following are strong indicators for referral in postmenopausal women and men over 50 years of age depending on individual circumstances:

Lack of access to appropriate bone densitometry service
Osteoporosis is unexpectedly severe or has unusual features at the time of initial assessment
Inadequate response to therapy, despite good adherence
Contraindications to standard therapies
Presence of other complex medical conditions
Experiencing serious or unacceptable adverse effects with treatment
Continuing to fracture despite normal bone mineral density (BMD)
Fracture or significant ongoing loss of BMD while on first-line therapy, despite good adherence
Secondary cause that is identified or suspected and are outside the scope of general practice