Calcium and vitamin d in the prevention and treatment of osteoporosis.

An increasing prevalence of calcium and/or vitamin D deficiency in the general population (especially, but not only, in elderly subjects) has been emphasized in recent epidemiologic studies. These deficiencies could be responsible for accelerated bone loss mediated by secondary hyperpara-thyroidism and increased bone turnover and could explain the dramatic increase of the incidence of osteoporotic fractures with age. High calcium intake in prepubertal girls seems to be associated with higher peak bone mass in late adolescence. Calcium supplementation could slow bone turnover and bone loss in particular subsets of patients, including calcium-deficient postmenopausal women and elderly patients. A specific antif-racture effect of calcium supplementation in postmenopausal osteoporotic patients has not been established, but a calcium-plus-low-dose-vitamin D3 supplementation has been suggested to decrease the peripheral fracture incidence (especially hip fracture) in elderly institutionalized women. After a critical review of these data, some practical recommendations are suggested.