Toshihiro Sugiyama, MD, PhD
Potential Conflicts of Interest: None disclosed.
Sugiyama T. Vitamin D and Calcium Supplementation to Prevent Fractures in Adults. Ann Intern Med. 2013;159:856. doi: 10.7326/0003-4819-159-12-201312170-00014
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Published: Ann Intern Med. 2013;159(12):856.
TO THE EDITOR:
The guideline from the U.S. Preventive Services Task Force (USPSTF) (1) concludes that the current evidence about calcium and vitamin D supplementation to prevent fractures in adults is essentially insufficient. This statement may be partly based on the limited efficacy of calcium and vitamin D supplementation in preventing fractures from skeletal adaptation to mechanical loading, although vitamin D promotes calcium absorption in the gut and supports bone mineralization that is essential for skeletal stiffness.
Bone responds to the local mechanical environment at each skeletal site, as evidenced by marked bone gain in the dominant arms of professional tennis players or rapid bone loss in the weight-bearing sites of astronauts during space flight; it has been considered that the skeleton adapts to mechanical stimulation through control of bone strength by resulting elastic deformation (strain) of bone. This feedback control system related to mechanical strain is known as the Harold Frost mechanostat.
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