Good bone health relies on calcium and vitamin D working in combination

14 October 2013

Return to Media Release Index

14 October 2013 - The systematic review and meta-analysis of the effect of vitamin D supplements on bone mineral density conducted by the University of Auckland should not discourage Australians from taking a preventative approach to osteoporosis, the Australian Self Medication Industry (ASMI) said today.

ASMI has urged caution in interpreting the research results, noting that the average population studied in the meta-analysis was neither deficient in calcium nor vitamin D, and that only five of the 23 studies ran for more than two years,1 the period of time that is generally required to accurately measure bone density changes.
As acknowledged by the authors, study sizes varied significantly, from 45 to 421 participants, and some studies might have used inadequate doses of vitamin D or a baseline vitamin D status of the populations studied was not low enough for the intervention to produce a significant effect.1

The variations between studies in the daily vitamin D doses that were investigated are also problematic, with daily doses ranging from 100 to 2000 IU. Some studies investigated very high once-weekly doses, and two studies looked at extremely high once-yearly intramuscular doses.1

ASMI Regulatory and Scientific Affairs Director, Steve Scarff, also highlighted the limitations associated with the review's heavy focus on the exclusive role of vitamin D in improving bone mass density.

"Calcium and vitamin D are vital nutrients which play a very important role in building and maintaining bone health; these two nutrients work in combination to provide a protective effect against osteoporosis," said Mr Scarff. "It's unlikely that the findings will have a major bearing on the way in which vitamin D supplementation is recommended here in Australia, simply because vitamin D on its own is not part of the standard preventative approach to osteoporosis."
There is a strong body of scientific evidence which shows that calcium or calcium-vitamin D supplements may be beneficial for general health as well as reducing fracture risk in people who may not be getting enough calcium through their diet.2
"ASMI's recommendation is for people who are at-risk to speak to a qualified healthcare professional. If they are found to be calcium or vitamin D deficient, supplementation may be recommended as preventative action," Mr Scarff continued. "What we don't want to see is people, now and in the future, cutting vitamin D out of their supplement routine and potentially making themselves vulnerable to future fractures."
At-risk populations include:2,3

  • People with naturally very dark skin
  • People with little or no sun exposure - e.g. people who hospitalised, living in an aged care facility or working jobs that prevent sun exposure such as shift workers, miners, or even office workers working particularly long hour
  • People who cover up with long robes and head coverings because of religious or cultural reasons
  • Breastfed babies of mothers who have low vitamin D levels
  • People with a malabsorption conditions
  • Older adults who, due to age, can not synthesise vitamin D as efficiently
  • People who are overweight or obese

Osteoporosis is one of Australia's most debilitating and costly health problems, with approximately 1.2 million people affected.2 For people who aren't obtaining adequate calcium or vitamin D from natural sources, supplementation is known to be a highly effective way to fill the gap.3

A 2007 Australian study published in The Lancet found that calcium, and calcium in combination with Vitamin D, was associated with a 12% reduction in fractures of all types including hip, vertebrae and wrist.4 In instances where there was a higher compliance rate, the treatment was associated with a much higher 24% reduction in fractures.4

In Australia and New Zealand, the recommended daily intake of calcium is between 1000 and 1300 mg per day for adults. For vitamin D, the National Health & Medical Research Council (NHMRC) considers that doses of up to 80 mcg* are safe.5 Most supplements that are available in Australia are 25 mcg or less.
Media contact: Michelle Sollitt-Davis - ASMI PR Manager
Ph: 02 9923 9410 | M: 0422 084 951 | Email:

About ASMI: The Australian Self-Medication Industry (ASMI) is the peak industry body for the Australian self care industry representing consumer healthcare products including over-the-counter medicines and complementary medicines. ASMI's mission is to promote better health through responsible self-care. This means ensuring that safe and effective self-care products are readily available to all Australians at a reasonable cost. ASMI works to encourage responsible use by consumers and an increasing role for cost-effective self-medication products as part of the broad national health strategy.

1. Ian R Reid, Mark J Bolland, Andrew Grey. Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. The Lancet. Published online October 11, 2013.
2. Peter R Ebeling et al. Building healthy bones throughout life: an evidence-informed strategy to prevent osteoporosis in Australia. MJA Open 2 Suppl 1. 4 February 2013.
3. Steven Boyages and Kellie Bilinski 2012: Seasonal reduction in vitamin D level persists into spring in NSW Australia: implications for monitoring and replacement therapy. Clinical Endocrinology (2012) 77, 515-523.
4. Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007 Aug 25;370(9588):657-66.
5. National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes. 2006.