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[2008 updates are highlighted in red]
| Description: |
Vitamin D and calcium have multiple actions in the body, including an important role in maintaining bone density. Vitamin D and calcium are relevant to people with MS for two reasons. First, people with MS are at risk for developing osteoporosis and a less severe form of decreased bone density known as osteopenia. In addition, vitamin D and calcium have effects on immune system function. |
| Rationale: |
People with MS are prone to decreased bone density, and vitamin D and calcium are important in maintaining bone density. In addition, vitamin D mildly suppresses immune system function in a way that could be therapeutic for people with MS. |
| Evaluation: |
A possible therapeutic effect for vitamin D in MS is suggested by several studies. In the animal model of MS, disease severity is worsened by vitamin D deficiency and improved by vitamin D supplementation. Epidemiologic studies indicate that the use of vitamin D supplements is associated with a decreased risk of developing MS. Unfortunately, there is very limited clinical trial information about vitamin D and MS. A preliminary report of a small, short-term study of 11 people with MS found that treatment with “19-nor,” a form of vitamin D, did not produce significant benefits on the basis of clinical tests and magnetic resonance imaging (MRI) measures. In another small study of 15 people with MS, the active form of vitamin D, “calitriol,” was safe and well tolerated for up to one year. |
| Risks: |
In reasonable doses, vitamin D and calcium are usually well tolerated. Calcium may interfere with the absorption of some medications (antibiotics, thyroid medication, osteoporosis medication) and minerals (iron, magnesium, zinc). In high doses, vitamin D and calcium may cause multiple side-effects. |
| Costs: |
Vitamin D and calcium are inexpensive. |
| Committee opinion: |
In the opinion of the Committee, vitamin D and calcium are low-cost, generally safe therapies. Treatment with these supplements should be considered in people who are at risk for low bone density or have known decreased bone density. There are suggestive studies that vitamin D and calcium could have a therapeutic effect on the disease course in MS, but additional studies are needed to determine if there is any definite effect. |
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