Fracture prevention: meta-analysis supports vitamin D plus calcium

  • Yao P & al.
  • JAMA Netw Open
  • 2 Dec 2019

  • International Clinical Digest
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Takeaway

  • The combination of vitamin D and calcium, but not vitamin D alone, is associated with reduced risk for any fracture and hip fracture, according to a meta-analysis of observational studies and randomized controlled trials (RCTs).

Why this matters

  • Findings support recommendations favoring vitamin D and calcium supplements to prevent fracture.

Study design

  • Meta-analysis of 11 observational studies (n=39,141) and 17 RCTs.
  • Observational studies were required to involve at least 200 fracture events, and RCTs must have enrolled ≥500 participants.
  • Primary outcomes: any fracture and hip fracture.
  • Funding: Sino-British Fellowship Trust.

Key results

  • Observational studies:
    • Each increase of 10.0 ng/mL vitamin D was associated with reduction in:
      • Any fracture: adjusted rate ratio [aRR]: 0.93 (95% CI, 0.89-0.96).
      • Hip fracture: aRR, 0.80 (95% CI, 0.75-0.86).
  • 11 RCTs of vitamin D alone (n=34,243):
    • No reduced risk for:
      • Any fracture: RR, 1.06 (95% CI, 0.98-1.14).
      • Hip fracture: RR, 1.14 (95% CI, 0.98-1.32).
  • 6 RCTs of vitamin D plus calcium (n=49,282):
    • Reduced risk for:
      • Any fracture: RR, 0.94 (95% CI, 0.89-0.99).
      • Hip fracture: RR, 0.84 (95% CI, 0.72-0.97).

Limitations

  • Vitamin D-only studies were constrained by small sample size, short treatment duration, and high risk for bias.