Calcium-rich foods such as dairy products contain additional nutrients that may also contribute to bone health [141]. The Recommended Nutrient Intakes (RNI) are at least 1,000 mg of calcium and 800 IU of vitamin D per day in men and women over the age of 50 years [142]. As calcium is mainly provided in dairies, calcium- and vitamin D-fortified dairy products (yoghurt, milk) providing at least 40 % of the RNI of calcium (400 mg) and 200 IU of vitamin D per portion are valuable options (e.g. yoghurt, such

as Danone Densia/Danaos, check details or milk, such as Valio Plus Hyla) that are likely to improve long-term adherence. There is a high prevalence of calcium, protein and vitamin D insufficiency in the elderly. Combined calcium and vitamin D supplements in a daily dose of 0.5–1.2 g and 400–800 IU, respectively, are generally recommended in patients receiving bone protective therapy, since most randomised controlled trial evidence for the efficacy of interventions is based on co-administration of the agent with calcium and vitamin D supplements [13]. Calcium and vitamin D supplements decrease secondary hyperparathyroidism BIX 1294 supplier and reduce the risk of proximal femur fracture, particularly in the elderly living in nursing homes. Intakes of at least 1,000 mg/day

of calcium, 800 IU of vitamin D and of 1 g/kg body weight of protein can be recommended in the general management of patients with osteoporosis [140, 143]. Vitamin D supplements alone may reduce the risk of fracture and of falling provided the daily dose of vitamin D is greater than 700 IU [144]. In contrast, studies with large annual doses of vitamin D have reported an increased risk of hip CYTH4 fracture and, in one study, also of falls [145, 146]. Meta-analyses also indicate that vitamin D may have a small beneficial

effect on cardiovascular risk and Selleck Tubastatin A mortality [147, 148]. In contrast, a recent meta-analysis concluded that calcium supplements without co-administered vitamin D were associated with an increase in the risk of myocardial infarction by around 30 % [149]. Cardiovascular outcomes were not primary endpoints in any of the studies, and the association remains the subject of some controversy [150–156]. Whereas a gradual decline in caloric intake with age can be considered as an appropriate adjustment to the progressive reduction in energy expenditure, the parallel reduction in protein intake may be detrimental for maintaining the integrity and function of several organs or systems, including skeletal muscle and bone. Sufficient protein intakes are necessary to maintain the function of the musculoskeletal system, but they also decrease the complications that occur after an osteoporotic fracture.