The optimal intake of calcium and vitamin D is uncertain. The Institute of Medicine recommends that adults maintain a daily calcium intake of 1000 to 1200 mg for preventing osteoporosis and reducing fracture risk. However, the average daily intake of calcium in the population is 700 to 900 mg. A meta-analysis of 59 randomised controlled trials that Increasing dietary calcium intake by 250–3320 mg per day or taking calcium supplements (250–2500 mg daily) increased bone mineral density by 0.6 to 1.4 at one year. This finding is statistically but not clinically significant.

The Scientific Advisory Committee on Nutrition states that the risk of poor musculoskeletal health is increased at serum 25-hydroxyvitamin D (25(OH) D) concentrations below 25 nmol/L. It also advises adults, young people and children over 4 years should consider taking a daily supplement containing 10 micrograms (400 units) of vitamin D between October and early March because people do not make enough vitamin D from sunlight in these months and all year round if they have little or no sunshine exposure. There is no need for screening the public for vitamin D deficiency.

Adequate calcium and vitamin D is not effective in reducing fracture risk but is necessary for all pharmacologic therapy in patients with osteoporosis. Calcium (1000-1200mg) is best provided through dietary means. Supplements are added if necessary. Vitamin D, 400-600 iu per day, needs to be maintained mostly with supplements.

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