Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation

Abstract

SummaryThe aim was to meta-analyze randomized controlled trials of calcium plus vitamin D supplementation and fracture prevention. Meta-analysis showed a significant 15 % reduced risk of total fractures (summary relative risk estimate [SRRE], 0.85; 95 % confidence interval [CI], 0.73–0.98) and a 30 % reduced risk of hip fractures (SRRE, 0.70; 95 % CI, 0.56–0.87).IntroductionCalcium plus vitamin D supplementation has been widely recommended to prevent osteoporosis and subsequent fractures; however, considerable controversy exists regarding the association of such supplementation and fracture risk. The aim was to conduct a meta-analysis of randomized controlled trials [RCTs] of calcium plus vitamin D supplementation and fracture prevention in adults.MethodsA PubMed literature search was conducted for the period from July 1, 2011 through July 31, 2015. RCTs reporting the effect of calcium plus vitamin D supplementation on fracture incidence were selected from English-language studies. Qualitative and quantitative information was extracted; random-effects meta-analyses were conducted to generate summary relative risk estimates (SRREs) for total and hip fractures. Statistical heterogeneity was assessed using Cochran’s Q test and the I2 statistic, and potential for publication bias was assessed.ResultsOf the citations retrieved, eight studies including 30,970 participants met criteria for inclusion in the primary analysis, reporting 195 hip fractures and 2231 total fractures. Meta-analysis of all studies showed that calcium plus vitamin D supplementation produced a statistically significant 15 % reduced risk of total fractures (SRRE, 0.85; 95 % confidence interval [CI], 0.73–0.98) and a 30 % reduced risk of hip fractures (SRRE, 0.70; 95 % CI, 0.56–0.87). Numerous sensitivity and subgroup analyses produced similar summary associations. A limitation is that this study utilized data from subgroup analysis of the Women’s Health Initiative.ConclusionsThis meta-analysis of RCTs supports the use of calcium plus vitamin D supplements as an intervention for fracture risk reduction in both community-dwelling and institutionalized middle-aged to older adults.

Vitamin D, bones and muscle: myth versus reality

“…However, a beneficial effect from increased dietary calcium intake cannot be excluded. Conversely, an alternative meta-analysis found calcium plus vitamin D supplementation produced a significant 15% reduction in risk for total fractures and a 30% reduced risk for hip fracture [7]. Overall, the benefit of oral vitamin D supplementation was independent of additional calcium supplementation among seniors age 65 and older -in both institutionalised and community-dwelling seniors [8].…”

Calcium supplementation in osteoporosis: useful or harmful?

“…all community dwelling, this study suggests that this type of supplementation is efficacious even in the freeliving setting. Similarly, in the trial data meta-analysis performed by the US National Osteoporosis Foundation (NOF), which included 8 studies (about 31000 subjects), a 15% reduction of overall fracture risk and a 30% reduction of hip fracture risk was found (7). These data are similar to those previously published in the meta-analysis of Tang and coauthors, who found a statistically significant reduction of all fractures (RR 0.99) and hip fractures (0.87) in participants taking calcium with concomitant vitamin D supplements (50).…”

“…However, in recent years the usefulness of calcium supplementation (alone and with concomitant vitamin D supplementation) has been questioned, since some studies reported only weak efficacy of these supplementations in reducing fragility fracture risk (6)(7)(8). Concomitantly, besides the known gastrointestinal side effects of calcium supplements and the risk of kidney stones related to use of coadministered calcium and vitamin D supplements, other evidence suggested potential adverse cardiovascular effects from calcium supplementation (9)(10)(11).…”

Erratum and additional analyses re: Calcium plus vitamin D supplementation and the risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation

“…Bolland, Avenell, Grey, and Reid [1], we offer the following additional data and analyses. We apologize for several errors in Table 1 of the original publication [2]; the updated table is reproduced here (Table 1). We also offer the following method clarifications:…”

“…These data could further suggest that calcium with vitamin D supplementation may have a greater impact on preventing hip fractures than originally described. We also apologize for a typographical error in the original text [2]. The dataset contains 192 hip fractures, as listed in the original publication's table (not 195).…”