Supplementation for over 55s offers significant healthcare savings

Calcium plus vitamin D could save European healthcare nearly €4 billion

By Nathan Gray

- Last updated on GMT

Calcium plus vitamin D could save European healthcare nearly €4 billion

Related tags Food supplements europe Osteoporosis

Fortification or supplementation programmes to increase levels of calcium and vitamin D could prevent almost 200,000 fractures per year in Europe – saving €3.96 billion in avoidable healthcare costs.

A new report from Frost & Sullivan has found that higher intakes of calcium and vitamin D for a target population of over 55s could save €19.8 billion in healthcare costs over five years, and provide a return of €3.47 in savings for every €1 spent on supplements or fortification.

The new report – commissioned by Food Supplements Europe but carried out independently – provides analysis of the costs and savings that the use of a 1,000 mg calcium plus 15 µg vitamin D supplements could bring to European Union Member States when targeted to the ‘at risk’ over 55’s population, where there is an increased possibility of fractures and associated costly medical treatment.

It noted that recent evidence has shown the combination of calcium and vitamin D can reduce the incidence of osteoporosis-related fractures by around 15% - with an EFSA approved risk reduction claim on the loss of bone mineral density, “which may contribute to a reduction in the risk of osteoporotic bone fracture”​ relating to an intake of at least 1200 mg of calcium and 800 I.U. [20 µg/day] of vitamin D from all sources.

“Over several decades, a significant amount of clinical research has been conducted showing that the daily use of calcium and vitamin D food supplements is highly correlated to a lower risk of experiencing an osteoporosis-attributed fracture,”​ said Ingrid Atteryd, chair of Food Supplements Europe. “This new analysis, for the first time, demonstrates that more widespread supplementation with these nutrients could also save many billions of euros in avoidable healthcare costs.”

“The EU’s population is ageing and without taking action the number of bone fractures attributed to osteoporosis will almost certainly rise. As such it has never been more important to leverage the substantiated benefits of calcium and vitamin D to help minimise the financial burden of this disease on healthcare systems across Europe,” ​she added.

The new Frost & Sullivan study is the second in-depth analysis commissioned by Food Supplements Europe to examine the positive impact of supplementation on EU healthcare costs. Last year, its first report highlighted possible €12.9 billion a year savings​ on spending for cardiovascular disease through more widespread consumption of omega 3 EPA+DHA supplements by people aged 55 or over.

The figures behind the facts 

Screen Shot 2017-02-21 at 13.33.17
Country-by-country breakdown of expected healthcare savings, expected supplementation costs, and net healthcare savings. Based on 2016 data. 

The headline figure of a total potential savings of € 3.96 billion per year is calculated based on the sum total of Frost & Sullivan analysis data that worked out each EU country’s potential cost savings from avoided bone fractures among the target population of adult’s age 55 and older.

The total economic burden of osteoporosis-related bone fractures in the EU is calculated to be €26.4 billion per year – averaging at €21,231 per event for the 1.2 million fractures that happen every year.

Over five years, the total cost of fractures in the over 55s attributed to osteoporosis will amount to €132 billion – with a potential saving of almost €20 billion of healthcare costs calcium and vitamin D prevention, the report said.

According to the country-by-country data, Luxembourg has the lowest potential savings (€2.1 million per year) followed by Malta (€2.3 million per year). Meanwhile Germany has the highest potential savings of €1.09 bn.

“Overall, the five largest EU countries (France, Germany, Italy, Spain, and the UK) combined can expect potential cost savings in excess of €200 million per country per year if the entire target population of adults age 55 and older used calcium and vitamin D on a daily basis,” ​the report states.

“Thus, a targeted calcium + vitamin D supplement regimen is recommended as a means to help control rising societal healthcare costs and as a means for high-risk individuals to minimise the chance of having to deal with potentially detrimental disease-attributed events.”

Total net savings by country: Healthcare cost savings excluding expected cost of supplements. All results in € million. Annualised averages for 2016-2020.


Speaking with NutraIngredients before the release of the report, Patrick Coppens, director of regulatory and scientific affairs at Food Supplements Europe said that even when the additional costs of supplementation or fortification are factored in to the analysis, a net saving of € 2.82 billion can still be achieved within the EU.

He added that while it is known that adequate intake of calcium and vitamin D in younger life stages is important in laying foundations for the prevention of osteoporotic fractures, the data used in the report focuses on supplementation in later life stages – which can only counteract or slow down a decline of the status that has been built up in earlier ages.

“The age cohort threshold of 55 and older was adopted for this case study in order to provide a conservative assessment of the health and economic benefits to current and potential users,”​ said the report. 

Total return by country: Gains in healthcare cost savings per €1 spent on supplementation. Annualised averages for 2016-2020.

On average, the report finds that for every € 1.00 spent on a calcium + vitamin D food supplement, there would be a certainty equivalent return of €3.47 to users and society as a whole in the form of avoided healthcare expenditures attributed to osteoporosis.

In a country-by-country analysis of these benefits, Denmark, Germany and Sweden come with the biggest returns, while Poland, Romania and the Netherlands stand the least to gain (with a return of between €1.3 and €1.4 savings per €1 spent).

“There would be a significant portion of cost savings to the primary payers of healthcare costs, which include governments and insurance companies,”​ said the report. “In fact, all 28 EU countries have benefit cost ratios greater than € 1.00 which is an indication of cost effectiveness.”



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Too narrow

Posted by Larsen James,

I think the issue re osteoporosis is that the bulk of research has focused on calcium and vit D doses and created the impression that calcium and D solve the problem.

The concept that you should screen and treat osteoporosis at 65 is flawed:

"Osteoporosis is a disease with its roots in childhood, as bone size, strength, and mineralization peak in one's 20s. Since bone mass declines with advancing age and menopause, individuals who attain optimal peak bone mass during their younger years will have an advantage as they get older. Although it is largely genetically predetermined, peak bone mass is not always attained due to inadequate calcium and vitamin D intakes, poor overall nutrition, lack of physical activity, and other factors such as smoking.1 “

Brown JP et al. Canadian Consensus Conference on osteoporosis, 2006 update. J Ostete Gynaecol Can 2006;28(2 Suppl 1):S95-S112.

Since peak bone mass is built by age 20, you should be screening in the late teens.

The second issue is treating osteoporosis. Bones are living tissue that act like an organ by making blood components and respond like a muscle to weight-bearing exercise. Bones need 20+ nutrients.

If you look at the NASA research, bones need both nutrients and exercise.

"Bone can be imagined as being somewhat like a sponge made of living protein upon which mineral crystals are embedded. By volume, roughly half of bone is comprised of protein. When a fracture occurs, the body is called upon to gather protein building blocks together to synthesize a new structural bone protein matrix. In addition, protein supplementation increases growth factors like insulin‐like growth factor‐1 (IGF‐1), a polypeptide that exerts a positive effect on skeletal integrity, muscle strength, immune response, and bone renewal.4 Protein malnutrition or under‐nutrition leads to a “rubbery” callus, compared to the rigid calluses of those with adequate or high protein intake. Numerous studies document the acceleration of fracture healing with even a modest 10‐ to 20‐gram increase in protein intake. The benefits of supplemental protein are important to everyone and especially important to those with malnutrition or low baseline protein intake. In fact, among elderly hip fracture patients, poor protein status at the time of fracture predicts fracture outcome. Those with low protein status take longer to heal, and have more complications, including death.5 “

4 Bonjour, JP, Schurch, MA, and Rizzoli, R. 1996. Nutritional aspects of hip fractures, Bone, 18:139S-144S; Schurch, MA, Rizzoli, R, Slosman, D, Vadas, L, Vergnaud, P, and Bonjour, JP. 1998. Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture, Ann Intern Med, 128(10):801-809.
5 Koval, KJ, Maurer, SG, Su, ET, Aharonoff, GB, and Zuckerman, JD. 1999. The effects of nutritional status on outcome after hip fracture, J Ortho Trauma, 13(3):164-169; New, SA. 2002. The role of the skeleton in acid-base homeostasis,

Methodologically, even if you were accepting calcium was one of 2 variables, food-based calcium and supplement-based calcium varies widely in bioavailability. So, how do you set the dose?

Dr. Lappe conducted a calcium-D research study on Navy female recruits using 2,000 mg calcium and 800 IU D. Stress fractures were reduced by 20%. The calcium dose BTW was based on earlier Klesges research on calcium sweat losses in athletes.

Dr. Lappe also did a study of bone status in 4,000+ young women in the Army. At least a fifth of them had poor bone status.

The US AF recently conducted a program to diagnose iron anemia and treat it. Roughly 25% of young women and 9% of men were anemic. Correcting anemia and issuing a daily multi to women lowered injuries by 50%.

BTW research also suggests that healthy bones need serum D levels of at leas t32 ng/ml (Heaney) and likely 40 ng/ml. 600 IU will rarely achieve those levels.

The totality of research across variables suggests that osteoporosis is primarily a malnutrition disease compounded by lack of exercise. Therefore we need complete nutritional interventions (not just calcium & D) and rehabilitation.

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Beware calcium, but soak up the sun for vitamin D

Posted by Marc,

Food usually contains plenty of calcium of human health, and supplementation with calcium has been shown in at least two studies to increase the risk of cardiovascular disease(CVD). Sun exposure itself is the best way to prevent the fractures caused by osteoporosis. A scientific investigation showed that women who actively sought the sun had only 1/11 the risk of fracture compared to women who avoided the sun. Sun exposure is vital for human health. Here are a few examples:
•A 20-year Swedish study shows that sun avoidance is as bad for the health as cigarette smoking.
•Men who work outdoors have half the risk of melanoma as those who work indoors.
•Women who totally avoid the sun have 10-times the risk of breast cancer as those who embrace the sun.
•Women who sunbathe regularly have half the risk of death during a 20-year period compared to those who stay indoors.
•Sun exposure increases nitric oxide production, which leads to a decrease in heart attack risk.
•Vitamin D, the sunshine vitamin, is essential to human survival, and sun exposure is the only natural way to obtain it. Sunbathing can produce 20,000 units of vitamin D in 20 minutes of whole-body exposure.
•Sun exposure dramatically improves mood through the production of serotonin and endorphin.
•Beyond vitamin D, sun exposure also stimulates the production of endorphin, nitric oxide and BDNF, all of which are vital to human health.
•Regular sun exposure also reduces high blood pressure, heart disease, psoriasis and multiple sclerosis (MS).
•As sunscreen use has increased dramatically, melanoma has INCREASED exponentially.
For the scientific references and articles for the above statements, visit

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Calcium supplementation can backfire

Posted by Anders Struksnes,

A resent large study has shown that calcium supplementation increases the risk for CVD with up to 30%. the reason is that the EU population lacks Vitamin K2/MK7, and K2 is key in order to direct the calcium to the bones, and not the arteries.
It does not help to supplement with calcium to reduce osteoporosis if more people gets CVD as consequence.

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