OTC Case Studies: Supplements for Aging

Case 1: Vitamin D

KJ is a 72-year-old woman presenting after her annual checkup with her physician. She lives in a northern climate, spends most of the winter indoors, and was found to have osteopenia on her most recent bone density scan. Her physician recently informed her that her vitamin D level is low, and she wants to know whether vitamin D supplementation would be beneficial. What recommendations do you have for KJ?

A: Vitamin D supplementation is a well-supported intervention for older adults with low vitamin D levels. Because vitamin D is primarily synthesized in the skin upon exposure to sunlight, individuals like KJ, who live in Northern regions and spend limited time outdoors, are at higher risk for deficiency. In her case, supplementation is appropriate to maintain optimal vitamin D status. For adults older than 70 years, a daily intake of 600 IU to 800 IU of vitamin D is generally recommended; however, some individuals may require higher doses based on laboratory results and medical supervision. It is important to achieve balance because too little vitamin D can lead to bone loss and fractures and excessive supplementation may cause toxicity. Her health care provider should monitor her levels regularly and adjust the dosage as needed.¹

Case 2: Calcium

LS is a 70-year-old woman who presents for her annual physical exam. She reports avoiding dairy due to mild lactose intolerance and eating a limited variety of foods. Her recent bone density scan showed evidence of osteopenia. She is concerned about her bone health and asks whether taking a calcium supplement would be helpful. What recommendations do you have for LS?

A: Calcium supplementation is an important consideration for older adults, especially for those with low dietary intake or bone loss due to osteopenia or osteoporosis. Older adults are at higher risk for calcium deficiency due to reduced absorption and changes in dietary patterns. For women older than 50 years and men older than 70 years, the recommended daily calcium intake is 1200 mg from both food and supplements combined. LS should aim to meet most of her calcium needs through dietary sources such as fortified nondairy milk, yogurt, cheese, leafy green vegetables, and calcium-fortified cereals. If her diet does not provide enough calcium, a supplement may be beneficial. Calcium carbonate and calcium citrate are the 2 main forms; calcium citrate is often preferred for older adults because it is better absorbed, especially when taken without food. It is important not to exceed the recommended dose because excessive calcium can lead to kidney stones or other complications.²

Case 3: Melatonin

AT is a 68-year-old man who comes in for a routine visit. He reports trouble falling asleep and says he frequently wakes up during the night. He does not nap during the day and limits caffeine, but his sleep issues have persisted for several months. He has heard that melatonin might help him sleep and wants to know whether it is safe and effective for someone his age. What recommendations do you have for AT?

A: Melatonin supplementation can be a useful option for older adults experiencing sleep difficulties, particularly related to insomnia or disrupted sleep-wake cycles. As people age, natural melatonin production tends to decline, which may contribute to difficulty falling or staying asleep. For individuals like AT, short-term melatonin use may help improve sleep onset and quality. For older adults, the recommended starting dose is 0.5 mg to 3 mg taken 30 to 60 minutes before bed. Starting with the lowest effective dose is best to minimize potential adverse events such as morning grogginess, vivid dreams, or dizziness. Melatonin is generally considered safe for short-term use; however, long-term safety data are limited. AT should discuss melatonin use with his health care provider, especially if he takes other medications that may interact with it.³

Case 4: Multivitamin

VP is a 74-year-old woman who comes in for an annual wellness visit. She eats small meals and admits that her diet is not always balanced, saying that some days she skips fruits and vegetables or eats very little protein. She takes several prescription medications and wonders whether she should start a daily multivitamin “just to be safe.” What recommendations do you have for VP?

A: A daily multivitamin may be beneficial for older adults like VP who experience dietary gaps or decreased nutrient absorption. Multivitamins are formulated to provide modest amounts of a broad range of nutrients to help meet daily nutritional requirements. For most older adults, a standard once-daily multivitamin providing approximately 100% of the Recommended Dietary Allowance for essential vitamins and minerals is sufficient. Many manufacturers offer specialized formulations for older adults, which may be more beneficial for addressing age-related nutrient needs. Although a multivitamin can help fill nutritional gaps, it should not replace a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. VP should review the supplement label with her health care provider or pharmacist to ensure it appropriately complements her diet, medications, and overall health needs.⁴

REFERENCES

1.Dodd K. Nutrition needs for older adults: vitamin D. The National Resource Center on Nutrition and Aging. Accessed November 14, 2025. https://acl.gov/sites/default/files/nutrition/Nutrition-Needs_Vitamin-D_FINAL_508.pdf

2. Calcium: calcium recommendations. International Osteoporosis Foundation. Accessed November 14, 2025. https://www.osteoporosis.foundation/educational-hub/topic/calcium/calcium-recommendations

3. Neher JO, Goebel A Louden DKN. Melatonin to treat insomnia in older adults. Am Fam Physician. 2021;104(3):297-298.

4. Vitamins and minerals for older adults. National Institute on Aging. Updated January 2, 2021. Accessed November 14, 2025. https://www.nia.nih.gov/health/vitamins-and-supplements/vitamins-and-minerals-older-adults