IOF statement on new IOM dietary reference intakes for calcium and vitamin D

On November 30, 2010, the Institute of Medicine of the National Academy of Sciences (IOM) in the US released new recommendations on daily reference intakes for vitamin D and calcium across all ages. The report is based on available evidence in the literature, with higher quality studies, supporting the role of these nutrients on bone health. Vitamin D deficiency is an important health issue to address as it has been linked to the pathogenesis of osteoporosis and hip fractures as well as other skeletal and non-skeletal disorders.

The IOM recommendations for the daily reference intakes on vitamin D have increased since their last recommendations in 1997, and the International Osteoporosis Foundation (IOF) commends IOM for their effort in helping to reduce the burden of vitamin D deficiency, by increasing their reference values.

In April this year, IOF published global recommendations for vitamin D in older adults*, which advised higher daily intakes in this age category of 800 to 1000 IU/day. It is worth noting that the repletion dose will vary among individuals according to their starting level, their BMI, their effective sun exposure, and other unidentified factors. These recommended intakes fall well below the upper safe boundaries for vitamin D intake indicated by the IOM of 4000IU/day for this age group.

Importantly, although the IOM vitamin D recommendations may be adequate for most average risk seniors, they will not likely cover the needs of high risk seniors. These include obese individuals, those with osteoporosis, those with limited sun exposure (institutionalized, homebound), those experiencing malabsorption, those residing in regions known to be at high risk for vitamin D deficiency such as the Middle East and South Asia, and immigrants from such regions living in Europe. To ensure that vitamin D need is met in high-risk elders, IOF recommends measuring their 25OHD level, supplementing with the amount estimated to bring their level up to 75nmol/L, then remeasuring to verify that the individual is vitamin D replete.

The statement is authored by Professor Bess Dawson-Hughes and Professor Cyrus Cooper
on behalf of the International Osteoporosis Foundation.

* IOF position statement: vitamin D recommendations for older adults
B. Dawson-Hughes, et al. (2010) Osteoporosis International Jul;21(7):1151-4