The study attempts to assess the public health and economic impact of fortified dairy products given to the general elderly population. Researchers estimated that all osteoporosis fractures amounted to 2.7 million in men and women in Europe. In 2010, the direct costs of osteoporosis fractures in the five largest EU countries were evaluated at €29 billion and at €38.7 billion in the 27 countries.
This high societal and personal burden poses challenges to public health and physicians as there is a high prevalence of vitamin D insufficiency in the elderly and dietary calcium is low in many postmenopausal osteoporosis women.
“The cost of calcium and vitamin D, while relatively limited, is definitely one of the reasons why elderly people are not systematically supplemented,” Dr Jean-Yves Reginster, co-author of the study told us. “There is also a relatively low adherence to calcium and vitamin D, as it is the case for all types of medications in chronic silent disorders.”
A population-based model was adopted to forecast the potential health outcomes and medical effectiveness of the daily administration of dairy supplements. These supplements contained 0.02mg (800 IU) of vitamin D and 1g of calcium and were given to subjects of both genders, aged 50, 60, 70 and 80 years. Annual costs of dairy products were tested at €150, €250 and €350.
In total, the daily intake of vitamin-D rich dairy products reduced the number of osteoporotic fractures in women and men by 30,376 and 16,105 events respectively. The researchers also estimated a gain of 6605 and 6144 life-years, in women and men respectively. More significantly, this intervention was cost-effective from 70 years on in the general population and from 60 years on in patients at increased risk of osteoporotic fractures.
Dairy: friend to the elderly
The results echo current studies that identify vitamin D and calcium as not only an aid to stronger bones in the elderly, but as nutrients vital to the well-being of the general public. Data, published in BMC Medicine, found that consumption of one 28g serving of yogurt per day was associated with an 18 per cent lower risk of type 2 diabetes.
Likewise, research featured in the Journal of the Academy of Nutrition and Dietetics found that elderly women that consume “higher” levels of milk, yogurt and cheese are at less risk of a fall. The study found that elderly female participants that consumed more than 2.2 servings of dairy per day typically had greater body mass and better physical performance.
This selection of study findings suggest dietary sources of nutrients are the preferred option and pharmacological supplementation should only be targeted to those individuals who do not get sufficient calcium from their diet and who are at increased risk for osteoporosis.
Recent European agreement by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) recommended adequate vitamin D intake of 0.02mg (800 IU/day) as well as calcium intake of 1000mg/day (IU/day). Elderly subjects who were at elevated risk for falls and fracture, were instructed to maintain a minimal vitamin D level of 75 nmol/L (30 ng/mL), for the greatest impact on fracture.
In the new study, the potential population health outcomes and medical costs were studied following an appropriate daily intake of calcium/vitamin D in Belgium.
Appropriate daily intake was determined of a daily dairy supplementation containing 1000mg of calcium and 800IU of vitamin D. In total, 30,376 osteoporosis-related fractures would be avoided and 6605 life-years would be gained in the women. In men, the number of osteoporosis-related fractures avoided and life-years gained amounted to 16,105 and 6144, respectively.
The cost-per-osteoporosis-related fracture avoided was below €60,000 in women and below €90,000 in men. In both genders, the cost-per-osteoporosis-related fracture avoided declined markedly with age and baseline risk of osteoporosis-related fracture.
The cost-per-life-years gained (cost-effectiveness) was above €100,000 in the 50 years age group for both women and men. In all instances, the cost-per-life-years gained tended to be more favourable (i.e. lower) in older and riskier age groups.
“Several studies have documented the link between low intake of dairy foods and decreased bone mineral density or increased osteoporosis-related fracture risk,” the researchers commented.
“Dairy food has been shown to be an appropriate vehicle to provide calcium, with good compliance compared to pharmacological supplements, which might have a
positive effect on the effectiveness of our approach."
Different studies have suggested that calcium and vitamin D supplementation have other health benefits from the risk reduction of breast cancer and colon to vitamin D’s small beneficial effect on cardiovascular risk and mortality.
“Dietary sources of nutrients are recommended as appropriate to ensure adequate calcium and vitamin D repletion. This recommendation, widely claimed to be justified in terms of efficacy, is also supported by our public health impact and health economics analyses,” the study concluded.
“Based on the outcomes of the study, I believe that there are two immediate advantages that can be considered. First, a campaign to increase the awareness of calcium and vitamin D benefits in elderly subjects,” said Reginster.
“Alternatively or in addition, policy makers might consider the reimbursement of calcium and vitamin D in subjects with an increased risk of bone and muscle wasting."
Source: Archives of Public Health. The official journal of the Belgian Public Health Association 2015, 73:48
Published: DOI: 10.1186/s13690-015-0099-3
“Public health impact and cost-effectiveness of dairy products supplemented with vitamin D in prevention of osteoporotic fractures.”
Authors: Olivier Ethgen, Mickaël Hiligsmann, Nansa Burlet and Jean-Yves Reginster