Prevalence, determinants, and inappropriateness of calcium supplementation among men and women in a Spanish Mediterranean area: Cross-sectional data from the ESOSVAL cohort

Abstract

Recently, safety concerns about calcium supplementation have arisen. In this situation, ensuring appropriateness of use is highly important. We aimed to describe the use of calcium and vitamin D supplements, the factors related to it, and to assess the appropriateness of calcium prescription among men and women aged 50 years or older. We performed a cross-sectional study in 2009-2010 including 11,035 adults who belong to the ESOSVAL cohort and attend 272 primary healthcare centers in the Valencia region of Spain. Criteria for the inappropriateness of calcium prescription, based on guidelines and recent evidence, were: excessive or insufficient daily total intake (diet plus supplements), excessive single doses of supplements, excessive or insufficient association with vitamin D, and overall inappropriateness. Calcium and/or vitamin D were prescribed to about 17% of the population. Older age, antiosteoporotic treatment, use of glucocorticoids, and a diagnosis of osteoporosis were related to prescription. The presence of other secondary causes of osteoporosis determined supplementation only in men. Calcium dietary intake was not related to the prescription of supplements. Among calcium users, 85.8% met at least one criterion of inappropriate prescription; 29% had an inappropriate daily total intake mainly resulting from excessive consumption (>2000 mg/day); 53.8% of patients were given calcium supplements in quantities higher than 500 mg per dose; and 38.9% of individuals receiving calcium supplements had inappropriate (absent or below 800 UI/day) vitamin D supplementation (all of them at high risk). In conclusion, we found high inappropriateness of calcium supplementation, mainly because of calcium overdosing, and also to undertreatment and underdosing of vitamin D in high-risk patients. Physicians should be encouraged to assess calcium dietary intakes before supplementation, recommending intake from food whenever possible, and to prescribe low calcium doses and high vitamin D doses when given in fixed-dose combinations, or vitamin D alone when calcium is not necessary.

Determinants of vitamin D supplementation prescription in nursing homes: a survey among general practitioners

“…However, our survey did not assess the 25(OH)D threshold value below which doctors prescribe vitamin D to their institutionalized patients. Although doctors often prescribe vitamin D based on a blood test, the trend of paying agencies and the HAS (BHaute Autorité de Santé^) is rather to reduce [30][31][32]. Despite the growing scientific interest in the benefits of vitamin D in the literature [27], a surprising determinant, highlighted in our study, was that 16 physicians (31.4 %) only prescribe vitamin D when they think of it.…”

A join point regression analysis of trends in mortality due to osteoporosis in Spain

“…Since the introduction of generic bisphosphonates, reports have consistently concluded that its adherence is poorer than the original brand 32–34 , which could eventually lead to higher rates of gastro-intestinal intolerance 35 , lower increase of lumbar spine and total hip bone mineral density 36,37 . In addition, age group 50–64 years present high level of treatment and low prevalence of risk factors 38,39 . In Spain, primary treatment has been associated with lower adherences than secondary treatment 27 .…”

Impact of Drug Safety Warnings and Cost-Sharing Policies on Osteoporosis Drug Utilization in Spain: A Major Reduction But With the Persistence of Over and Underuse. Data From the ESOSVAL Cohort From 2009 to 2015

“…The ESOSVAL cohort, designed to develop a risk fracture assessment tool for the European Mediterranean population with a prevision of 10 years of follow-up, has been fully described elsewhere (Sanfélix-Genovés et al, 2010; Sanfélix-Genovés et al, 2013; Sanfélix-Gimeno et al, 2013; Hurtado et al, 2014) and was composed of about 11,000 people aged 50 years and over attending 272 primary healthcare centers in the Valencia Health System (VHS) for any health problem between November 2009 and September 2010. Participants were recruited by 600 general practitioners and primary care nurses collaborating for free in the ESOSVAL study and following predefined criteria attempting to obtain a similar number of men and women, and with an age distribution as close as possible to the distribution of the region’s population.…”