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26 February 2013 Annals of Internal Medicine Tip Sheet

Below is information about an article being published in the February 26 issue of Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage. For an embargoed copy of a study, contact Megan Hanks at mhanks@acponline.org or 215-351-2656 or Angela Collom at acollom@acponline.org or 215-351-2653.

1. Panel Recommends Against Daily Vitamin D and Calcium Supplementation for the Primary Prevention of Fractures in Postmenopausal Women

The United States Preventive Services Task Force recommends against daily supplementation with doses of vitamin D = 400 IU and calcium = 1,000 mg for the primary prevention of fractures in postmenopausal women living in the community setting. The Task Force found insufficient evidence to assess the benefits and harms of daily supplementation with higher doses in this population. Evidence also was insufficient to recommend for or against daily vitamin D and calcium supplementation to prevent fractures in premenopausal women or in men. Fracture prevention in older patients is important because fractures (especially hip fractures) are associated with chronic pain, disability, and increased mortality. One half of all postmenopausal women will have an osteoporosis-related fracture in their lifetime. Vitamin D and calcium supplements are inexpensive and readily available without a prescription. To form a recommendation, the Task Force commissioned two systematic evidence reviews and a meta-analysis on vitamin D supplementation with or without calcium. Researchers reviewed the evidence to assess the effects of vitamin D and calcium on bone health outcomes in community-dwelling adults and the adverse effects of supplementation. Based on the evidence, researchers concluded with moderate certainty that daily supplementation with doses of vitamin D = 400 IU and calcium = 1,000 mg has no net benefit for the primary prevention of fractures, and that it increases the incidence of kidney stones. The recommendation applies to nonistitutionalized, asymptomatic adults without previous history of fractures. In previous recommendations related to fracture prevention, the Task Force recommended screening for osteoporosis in women age 65 or older and in younger women at high risk for fracture. The Task force also recommends vitamin D supplementation to prevent falls in community-dwelling adults age 65 and older who are at increased risk for falls. Task force evidence reviews and recommendation statements can be found at www.annals.org.

2. HIV Accelerates the Biologic Affects of Aging for patients Co-infected with Hepatitis C

Patients infected with HIV and hepatitis C virus (HCV) seem to have liver fibrosis stages similar to HIV-uninfected people who are almost a decade older. Even when treated with antiretroviral therapy (ART), HIV-infected persons are more likely to develop or die of cardiovascular disease, liver disease, and some cancers than those without HIV who are the same age range and gender. Since the incidence and rates of these conditions increase with age, one explanation of these findings is that HIV accelerates the biologic effects of aging. However, other modifiable behaviors, such as being overweight or excessive alcohol use, can also contribute to these illnesses. Researchers studied 1,176 HCV-infected patients to determine whether HIV-infected persons develop HCV-related liver disease at a younger age than comparable HIV-negative persons. Thirty-four percent of patients enrolled in the study also had HIV. Every six months from 2006 to 2011, all patients were assessed for liver fibrosis. The researchers found that HCV-infected patients co-infected with HIV had liver fibrosis measures equivalent to HCV-infected patients without HIV who were about 9.2 years older. The researchers conclude that these finding support the hypotheses that both HIV infection and older age promote HCV-related liver disease progression.