3 Supplementation For Primary Prevention of Fractures
A Review of the Literature

Ryan Foster, MD, Department of Medicine, University of Toronto, Toronto, ON.

Matthew T. Oughton, MD, Department of Medicine, McGill University, Montreal, PQ.

Shabbir M.H. Alibhai, MD, MSc, FRCP(C), Staff Physician, Department of Medicine, University Health Network, Toronto, ON.

Fractures are a significant cause of morbidity and mortality in older adults. Previous studies indicated that fracture prevention with vitamin D supplementation, with or without calcium, was achievable only in limited populations. The most recent trial in this field, a randomized, placebo-controlled study by Trivedi, et al., found that large vitamin D doses given every four months are effective for primary prevention of fractures in the community-based older population. This study is critically reviewed in the context of previous studies, and recommendations are made about the role of calcium and vitamin D supplementation in fracture prevention.
Key words: osteoporosis, fracture prevention, vitamin D, calcium, supplementation.

Sohel Somani, MD, Senior Resident, Department of Ophthalmology, University of Toronto, Toronto, ON.

Age-related macular degeneration (ARMD) is a progressive disease affecting the central vision of patients older than 55 years. Typically, ARMD patients are classified into dry and wet forms based on clinical characteristics. This has important implications with respect to their clinical presentation, prognosis and management options. Important risk factors in the progression of disease include age, smoking and drusen characteristics. The promising results of a new study on vitamin supplementation provide direction for treatment and prevention, as well as the understanding of the role of antioxidants in ARMD pathogenesis. High-dose vitamins (beta- carotene, vitamins C and E and zinc) should be considered in certain patients with ARMD.
Key words: macular degeneration, vitamins, low vision, supplementation, Amsler grid.