Orthopaedics  |  Fragility Fractures Pathway - Calcium and Vitamin D


Fragility Fractures Pathway - Calcium and Vitamin D

Calcium and vitamin D advice differs depending on the target population. The following recommendations apply to patients with osteoporotic fracture.


There has been a progressive decrease up until recently in recommended calcium intake over recent years, especially in the context of people having additional Vitamin D. A dietary calcium intake of 1,000 to 1,300mg/day elemental calcium has been recommended although a target of 500mg - 1,000mg is adequate for most. Dairy products not only provide calcium but also many other beneficial components such as protein, fluid, phosphate, leucine for muscle replenishment and factors for bone growth. Calcium-enhanced milk ("yellow-top") contains approximately 500mg of calcium per 250ml. Dietary intake is far preferable to supplementation but if this is not possible, consider supplementation with 500mg once a day preferably with the evening meal (500mg elemental calcium = 1250mg calcium carbonate).

Vitamin D:

The recommended vitamin D intake for patients with established osteoporosis is at least 1000 IU per day. Most people will need supplementation to achieve this. There is no need to measure Vitamin D levels.

  • Dose recommendations vary; prescribe a loading dose of colecalciferol (VitD3 1.25mg = 50,000IU).  Prescribe ONE capsule followed by another tablet two to three days later. This is then followed by a maintenance dose of ONE capsule ONCE a month only.
  • Obese patients may need higher doses.
  • Patients with hypercalcaemia should be referred for specialist advice. Some of these patients can have vitamin D with monitoring but without a calcium enhanced diet.


Vitamin D for Zoledronic acid (Aclasta) infusion:

Vitamin D stores must be adequate before administering IV zoledronic acid (Aclasta®) and serum calcium must be in the normal range. There is no need to measure Vitamin D levels. If not already receiving vitamin D (colecalciferol), give one tablet of 1.25mg  (total 50,000IU) colecalciferol (VitD3) in the week prior to infusion.  Continue vitamin D supplementation by prescribing one tablet of 1.25mg (50,000IU) colecalciferol once a month as maintenance therapy.

Last updated : Tuesday, November 21, 2017
Next review date : Wednesday, November 21,2018

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