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Annals of Internal Medicine Tip Sheet
October 26, 2016


Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.


1. The National Osteoporosis Foundation and American Society for Preventive Cardiology publish clinical guideline on calcium and vitamin D supplementation

No clear link between calcium with or without vitamin D supplementation and cardiovascular disease in generally healthy adults

Guideline (free): http://www.annals.org/article.aspx?doi=10.7326/M16-1743
Evidence review (free): http://www.annals.org/article.aspx?doi=10.7326/M16-1165

A new evidence-based clinical guideline from the National Osteoporosis Foundation (NOF) and the American Society for Preventive Cardiology (ASPC) says that calcium with or without vitamin D intake from food or supplements that does not exceed the tolerable upper level of intake (2,000 to 2,500 mg/d) should be considered safe from a cardiovascular standpoint. Obtaining calcium from food sources is preferred, but supplements can be used to address dietary shortfalls. The guideline is published in Annals of Internal Medicine.

Calcium supplements have been recommended for persons who do not consume adequate calcium from their diet as a standard strategy for preventing osteoporosis-related fractures. Conflicting reports have suggested that calcium intake, particularly from supplements, may have either beneficial or harmful effects on cardiovascular outcomes. To update the evidence on calcium and vitamin D, investigators from the Tufts University School of Medicine reviewed randomized trials and prospective cohort studies published since their last evidence report in 2009. Their findings were used to inform the joint clinical guideline from NOF and ASPC.

A total of 31 studies were included in the review. Of the four randomized trials reviewed, none found a statistically significant difference in risk for cardiovascular events or mortality between groups receiving supplements of calcium alone or calcium plus vitamin D compared to those receiving placebo. None of the 27 cohort studies included in the review conclusively linked total, dietary, or supplemental calcium intake levels to cardiovascular disease and cerebrovascular disease, mortality, or all-cause mortality. Because excessive calcium intake is nearly impossible to achieve via diet, safety of supplementation had been an area of concern. Of the three supplementation-specific trials included in the review, none found a statistically significant effect of calcium supplementation on cardiovascular disease outcomes. Based on this moderate-quality evidence, the review team concluded that calcium intake from food or supplement sources at levels within the recommended tolerable range should be considered safe for generally healthy adults.

2. Noninvasive fecal test an ‘excellent alternative to colonoscopy’ for cancer prevention

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M16-2341

The U.S. Multi-Society Task Force, a group comprised of the major U.S. gastroenterological professional associations, recently released a consensus statement on the use of the noninvasive fecal immunochemical test (FIT) for colorectal cancer screening in average risk populations. A group of colorectal cancer experts say their statement offers strong evidence for FIT as an excellent alternative for colorectal cancer prevention and, as such, should be promoted with the same enthusiasm as colonoscopy. Their commentary is published in Annals of Internal Medicine.

Colonoscopy accounts for 60 percent of all colorectal cancer screening in the U.S., despite its greater expense and risk of complications compared with other options. In addition, unlike fecal occult blood testing or flexible sigmoidoscopy, no controlled studies have shown that colonoscopy reduces colorectal cancer incidence or mortality. Still, given the preference for colonoscopy screening in the U.S., strong evidence would be required to shift this norm. While clinicians await the results of trials comparing colonoscopy with stool blood-based screening methods, the authors point to several characteristics that make FIT a more attractive primary screening method.

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