Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis
Zhao JG, Zeng XT, Wang J, Liu L
JAMA · 388 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Meta-analysis (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Funding not disclosed
Publication
- Published
- 2017-12-26 · JAMA · vol. 318 · issue 24 · p. 2466
- Publisher
- American Medical Association
- Cited
- 545 citations · more than 100% of similar papers · 40.3× the field average
- Impact
- Top 10% most cited in its field
- References
- 80 works
- Access
- Free to read
- Research areas
- Vitamin D Research Studies · Bone health and osteoporosis research · Nutrition and Health in Aging
- Keywords
- Medicine, Vitamin D and neurology, Randomized controlled trial, Incidence (geometry), Placebo, Meta-analysis, Osteoporosis, Internal medicine, Relative risk, Calcium, Cochrane Library, Physical therapy, Confidence interval, Alternative medicine, Pathology
- MeSH
- humans, hip fractures, calcium, vitamins, vitamin d, drug therapy, combination, incidence, risk, dietary supplements, aged, middle aged, fractures, bone, randomized controlled trials as topic, independent living
4 authors
From CN
- Jia‐Guo Zhao · correspondingTianjin Hospital
- Xiantie ZengTianjin Hospital
- Jia WangTianjin Hospital
- Lin Liu
Abstract
Importance
The increased social and economic burdens for osteoporosis-related fractures worldwide make the prevention of such injuries a major public health goal. Previous studies have reached mixed conclusions regarding the association between calcium, vitamin D, or combined calcium and vitamin D supplements and fracture incidence in older adults.
Objective
To investigate whether calcium, vitamin D, or combined calcium and vitamin D supplements are associated with a lower fracture incidence in community-dwelling older adults.
Data sources
The PubMed, Cochrane library, and EMBASE databases were systematically searched from the inception dates to December 24, 2016, using the keywords calcium, vitamin D, and fracture to identify systematic reviews or meta-analyses. The primary randomized clinical trials included in systematic reviews or meta-analyses were identified, and an additional search for recently published randomized trials was performed from July 16, 2012, to July 16, 2017.
Study selection
Randomized clinical trials comparing calcium, vitamin D, or combined calcium and vitamin D supplements with a placebo or no treatment for fracture incidence in community-dwelling adults older than 50 years.
Data extraction and synthesis
Two independent reviewers performed the data extraction and assessed study quality. A meta-analysis was performed to calculate risk ratios (RRs), absolute risk differences (ARDs), and 95% CIs using random-effects models.
Main outcomes and measures
Hip fracture was defined as the primary outcome. Secondary outcomes were nonvertebral fracture, vertebral fracture, and total fracture.
Results
A total of 33 randomized trials involving 51 145 participants fulfilled the inclusion criteria. There was no significant association of calcium or vitamin D with risk of hip fracture compared with placebo or no treatment (calcium: RR, 1.53 [95% CI, 0.97 to 2.42]; ARD, 0.01 [95% CI, 0.00 to 0.01]; vitamin D: RR, 1.21 [95% CI, 0.99 to 1.47]; ARD, 0.00 [95% CI, -0.00 to 0.01]. There was no significant association of combined calcium and vitamin D with hip fracture compared with placebo or no treatment (RR, 1.09 [95% CI, 0.85 to 1.39]; ARD, 0.00 [95% CI, -0.00 to 0.00]). No significant associations were found between calcium, vitamin D, or combined calcium and vitamin D supplements and the incidence of nonvertebral, vertebral, or total fractures. Subgroup analyses showed that these results were generally consistent regardless of the calcium or vitamin D dose, sex, fracture history, dietary calcium intake, and baseline serum 25-hydroxyvitamin D concentration.
Conclusions and relevance
In this meta-analysis of randomized clinical trials, the use of supplements that included calcium, vitamin D, or both compared with placebo or no treatment was not associated with a lower risk of fractures among community-dwelling older adults. These findings do not support the routine use of these supplements in community-dwelling older people.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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