Osteoporosis International

, Volume 15, Issue 7, pp 511–519 | Cite as

The need for clinical guidance in the use of calcium and vitamin D in the management of osteoporosis: a consensus report

  • S. BoonenEmail author
  • R. Rizzoli
  • P. J. Meunier
  • M. Stone
  • G. Nuki
  • U. Syversen
  • M. Lehtonen-Veromaa
  • P. Lips
  • O. Johnell
  • J.-Y. Reginster


A European Union (EU) directive on vitamins and minerals used as ingredients of food supplements with a nutritional or physiological effect (2002/46/EC) was introduced in 2003. Its implications for the use of oral supplements of calcium and vitamin D in the prevention and treatment of osteoporosis were discussed at a meeting organized with the help of the World Health Organization (WHO) Collaborating Center for Public Health Aspects of Rheumatic Diseases (Liège, Belgium) and the support of the WHO Collaborating Center for Osteoporosis Prevention (Geneva, Switzerland). The following issues were addressed: Is osteoporosis a physiological or a medical condition? What is the evidence for the efficacy of calcium and vitamin D in the management of postmenopausal osteoporosis? What are the risks of self-management by patients in osteoporosis? From their discussions, the panel concluded that: (1) osteoporosis is a disease that requires continuing medical attention to ensure optimal therapeutic benefits; (2) when given in appropriate doses, calcium and vitamin D have been shown to be pharmacologically active (particularly in patients with dietary deficiencies), safe, and effective for the prevention and treatment of osteoporotic fractures; (3) calcium and vitamin D are an essential, but not sufficient, component of an integrated management strategy for the prevention and treatment of osteoporosis in patients with dietary insufficiencies, although maximal benefit in terms of fracture prevention requires the addition of antiresorptive therapy; (4) calcium and vitamin D are a cost-effective medication in the prevention and treatment of osteoporosis; (5) it is apparent that awareness of the efficacy of calcium and vitamin D in osteoporosis is still low and further work needs to be done to increase awareness among physicians, patients, and women at risk; and (6) in order that calcium and vitamin D continues to be manufactured to Good Manufacturing Practice standards and physicians and other health care professionals continue to provide guidance for the optimal use of these agents, they should continue to be classified as medicinal products.


Calcium Fracture prevention Osteoporosis drugs Vitamin D 



This paper reports the conclusions from an international expert meeting organized in Barcelona on 10 November 2002, under the auspices of the World Health Organization Collaborating Center for Public Health Aspects of Rheumatic Diseases (Liège, Belgium) and supported in part by an unrestricted educational grant from Nycomed, Novartis, Shire and Orion Pharma. Dr S. Boonen is senior clinical investigator of the Fund for Scientific Research, Flanders, Belgium (F.W.O–Vlaanderen).


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004

Authors and Affiliations

  • S. Boonen
    • 1
    Email author
  • R. Rizzoli
    • 2
  • P. J. Meunier
    • 3
  • M. Stone
    • 4
  • G. Nuki
    • 5
  • U. Syversen
    • 6
  • M. Lehtonen-Veromaa
    • 7
  • P. Lips
    • 8
  • O. Johnell
    • 9
  • J.-Y. Reginster
    • 10
  1. 1.Leuven University Centre for Metabolic Bone Diseases & Division of Geriatric MedicineUniversity Hospital LeuvenLeuvenBelgium
  2. 2.University HospitalGenevaSwitzerland
  3. 3.Hôpital Edouard HerriotLyonFrance
  4. 4.Llandough HospitalPenarthUK
  5. 5.University of EdinburghEdinburghUK
  6. 6.St Olavs Hospital HFTrondheimNorway
  7. 7.University of TurkuTurkuFinland
  8. 8.VU Medical CentreAmsterdamThe Netherlands
  9. 9.Malmö HospitalUniversity of MalmöMalmöSweden
  10. 10.Unité d’Exploration de l’Os et du CartilageLiègeBelgium

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