[Calcium and Vitamin D in the treatment and prevention of osteoporosis: the actual dilemma].

Calcium lowers the fracture risk when given together with vitamin D. In many patients the Calcium intake is lower than the recommended amount, because the mean value reported in several studies corresponds just to the recommended intake, which means that half of the population is below. The American Institute of Medicine (IOM) recommends 1200 mg per day. But 1000 mg should be enough in the presence of vitamin D sufficieny, particularly because 800 mg are the lowest limit for avoiding bone loss. In general, higher doses are harmless. When the Calcium intake ca not be increased by nutrition, supplements are indicated. It is not proven that they increase the cardiovascular risk, which anyway was not reported in the combination with vitamin D, neither with nutritional Calcium. Therefore, Calcium hast to be prescribed in the treatment of osteoporosis, after meal. Vitamin D too is deficient in most of the patients with osteoporosis, especially in advanced age, and should be prescribed together with Calcium, because it hardly can be delivered by food. Although there is no toxicity up to 10'000 IU par day, the IOM proposes only 600 IU per day, and by that neglects the fact that this dose hardly leads to a blood level of 25-OH vitamin D which goes along with lower fracture risk, and wich leaves a large part of the patients vitamin D deficient, unfit for optimal reaction to treatment. Swiss, German and American specialists too recommend 800 - 2000 IU per day.