Risks and Harms of Implementing this Recommendation
Calcium and vitamin D supplements are generally safe with few side effects. Some studies show that supplemental calcium in adults aged 65 or older is associated with an increased risk of constipation or nephrolithiasis.
Further placebo controlled randomized clinical trials controlling for non-compliance are needed to clarify benefits and risks of calcium and vitamin D supplementation in patients 65 and older, as well as to identify target levels to achieve optimal benefits as there appears to be a dose dependent relationship in outcomes. Measurement of the serum calcium, albumin, 25-hydoxyvitamin D, and creatinine levels may reveal secondary causes of osteoporosis (e.g. hyperparathyroidism, malignancy, vitamin D deficiency or chronic kidney disease) and could guide use of calcium, vitamin D, or nutritional supplements which may improve outcomes.
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