The USPSTF recommends screening for osteoporosis in women 65 years or older and in younger women at increased risk. The USPSTF recommends exercise interventions to prevent falls in community-dwelling older adults at increased risk for falls multifactorial interventions may also be effective in some persons as well. The USPSTF recommends against vitamin D supplementation to prevent falls in community-dwelling adults 65 years or older. If future evidence shows a benefit, the magnitude of that benefit will need to be weighed against the magnitude of harms caused by supplementation (kidney stones). More studies are needed to more clearly determine if supplementation with vitamin D, calcium, or both consistently prevents fractures. Evidence on the effect of supplementation on fractures at higher doses is conflicting, with some studies showing a reduction in certain fractures at higher doses and others showing no reduction or even an increase. The recommendation against supplementation at lower doses was based on an overall assessment that supplementation at low doses provides no benefit. Absolute fracture risk is very low in premenopausal women compared with postmenopausal women. Other risks factors for low bone mass and fractures include female sex, smoking, use of glucocorticoids, and use of other medications that impair bone metabolism (eg, aromatase inhibitors). Low bone mass, older age, and history of falls are major risk factors for incident osteoporotic fractures. Grade: I statement (insufficient evidence) ≤400 IU of vitamin D and ≤1000 mg of calcium in postmenopausal women >400 IU of vitamin D and >1000 mg of calcium in postmenopausal women
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