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Back to Experts' Summaries

Institute of Medicine's DRIs for Calcium and Vitamin D

Stephanie A. Atkinson Stephanie A. Atkinson, PhD, FCAHS

Professor and Associate Chair (Research), Department of Pediatrics, McMaster University

Following a comprehensive review of the scientific literature, the Institute of Medicine (IOM) issued recommendations for intakes of calcium and vitamin D based on their key role in skeletal health, consistent with a cause-and-effect relationship.

Highlights:

  • Scientific evidence indicates that calcium and vitamin D play a key role in bone growth and maintenance.
  • A serum 25(OH)D of 50 nmol/L is deemed sufficient for bone health but controversy exists.
  • The frequency of vitamin D-fortified milk consumption appears to be positively related to serum 25(OH)D status.
  • Further research is needed to clarify the benefits of calcium and vitamin D beyond bone health and the optimal serum 25(OH)D associated with other health outcomes.

A review of nearly 1,000 published studies including two systematic reviews led to the new Dietary Reference Intakes (DRIs) for calcium and vitamin D based on intakes that support skeletal growth and maintenance and avoid risk of poor bone health, as well as on adverse effects of excess intakes.1,2

The Recommended Dietary Allowances (RDA) and Tolerable Upper Intakes (UL) are summarized in the Table. Of note, the RDA for calcium for women in the postmenopausal years is slightly more than that for men, while for all other ages there are no gender differences.

Vitamin D status

The recommendation for vitamin D was based on achieving a serum 25-hydroxyvitamin D [25(OH)D] of 50 nmol/L to support optimum bone health, assuming little or no sun exposure. Although some experts recommend a higher target for serum 25(OH)D (i.e., closer to 75-100 nmol/L),3 the IOM concluded that a serum 25(OH)D of 50 nmol/L was sufficient for bone health and this target would be achieved at the RDA intakes across all age groups. In terms of other outcomes, including cancer, cardiovascular disease, diabetes, and autoimmune disorders, the evidence was deemed to be inconclusive with respect to causality and insufficient to be translated into nutrient recommendations.

According to a national survey of vitamin D status, the mean serum 25(OH)D among Canadians aged 6 to 79 years was 67.7 nmol/L.4 The factors related to low serum 25(OH)D levels included winter season, racial background other than white, and less frequent consumption of milk.4

Upper limits of tolerance (UL)

The goal for setting the UL for vitamin D (see Table) was to not surpass 125-150 nmol/L for sustained serum concentration. While these values vary somewhat by age, the UL for vitamin D is set at 4,000 IU/day, while for calcium it is 2,500 mg/day for adults 19-50 years and 2000 mg/day for those 51 and over.1,2 The ULs for calcium for adults are based on the risk of kidney stones, derived largely from work conducted with postmenopausal women taking calcium supplements.1

Adapted from Ross et al.2

References

  1. Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington, DC: The National Academics Press, 2011.
  2. Ross C et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: What clinicians need to know. J Clin Endocrinol Metab 2011;95:53-58.
  3. Heaney RP, Holick MF. Why the IOM recommendations for vitamin D are deficient. J Bone and Min Res 2011;doi: 10.1002/jbmr.328.
  4. Langlois K et al. Vitamin D status of Canadians as measured in the 2007 to 2009 Canadian Health Measures Survey. Statistics Canada 2010; catalogue no. 82-003-X.

Keywords: calcium , vitamin D , bone health , recommendations , Institute of Medicine


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