Prevention of Nonvertebral Fractures With Oral Vitamin D and Dose Dependency

Self Cite

121

Milk contains calcium, phosphorus, and protein and is fortified with vitamin D in the United States. All these ingredients may improve bone health. However, the potential benefit of milk on hip fracture prevention is not well established. The objective of this study was to assess the association of milk intake with risk of hip fracture based on a meta-analysis of cohort studies in middle-aged or older men and women. Data sources for this study were English and non-English publications via Medline (Ovid, PubMed) and EMBASE search up to June 2010, experts in the field, and reference lists. The idea was to compare prospective cohort studies on the same scale so that we could calculate the relative risk (RR) of hip fracture per glass of milk intake daily (approximately 300 mg calcium per glass of milk). Pooled analyses were based on random effects models. The data were extracted by two independent observers. The results show that in women (6 studies, 195,102 women, 3574 hip fractures), there was no overall association between total milk intake and hip fracture risk (pooled RR per glass of milk per day ¼ 0.99; 95% confidence interval [CI] 0.96-1.02; Q-test p ¼ .37). In men (3 studies, 75,149 men, 195 hip fractures), the pooled RR per daily glass of milk was 0.91 (95% CI 0.81-1.01). Our conclusion is that in our meta-analysis of cohort studies, there was no overall association between milk intake and hip fracture risk in women but that more data are needed in men. ß

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 90%

Milk intake and risk of hip fracture in men and women: A meta-analysis of prospective cohort studies

Bischoff‐Ferrari

Dawson‐Hughes

Baron

et al. 2010

Self Cite

121

“…(3) The recommendations by the International Osteoporosis Foundation (IOF) and the Endocrine Society are based on two meta-analyses of double-blind randomized controlled trials that suggested fall reduction required a threshold of at least 24 ng/mL (4) and fracture reduction a threshold of at least 30 ng/mL. (5) Regarding general health endpoints, the Endocrine Society states that while evidence from randomized controlled trials is lacking, numerous epidemiological studies have suggested that a 25(OH)D blood level of 30 ng/mL and above may have additional health benefits in reducing the risk of common cancers, autoimmune diseases, type 2 diabetes, cardiovascular disease, and infectious diseases. (6)(7)(8)(9)(10) In contrast, the IOM concludes that there is no evidence that a 25(OH)D threshold greater than 20 ng/mL has any benefit to health.…”

Section: Esirable Thresholds For 25(oh)d Have Been Discussedmentioning

confidence: 99%

Oral supplementation with 25(OH)D3 versus vitamin D3: Effects on 25(OH)D levels, lower extremity function, blood pressure, and markers of innate immunity

Bischoff‐Ferrari

Dawson‐Hughes

Stöcklin³

et al. 2011

Self Cite

162

176

To test the effect of 25(OH)D 3 (HyD) compared to vitamin D 3 on serum 25-hydroxyvitamin D levels (25(OH)D), lower extremity function, blood pressure, and markers of innate immunity. Twenty healthy postmenopausal women with an average 25(OH)D level of 13.2 AE 3.9 ng/mL (mean AE SD) and a mean age of 61.5 AE 7.2 years were randomized to either 20 mg of HyD or 20 mg (800 IU) of vitamin D 3 per day in a double-blind manner. We measured on 14 visits over 4 months, 25(OH)D serum levels, blood pressure, and seven markers of innate immunity (eotaxin, interleukin [IL]-8, IL-12, interferon gamma-induced protein 10 kDa , monocyte chemotactic protein-1 [MCP-1], macrophage inflammatory protein beta , and ''Regulated upon Activation, Normal T-cell Expressed, and Secreted'' [RANTES]). At baseline and at 4 months, a test battery for lower extremity function (knee extensor and flexor strength, timed up and go, repeated sit-to-stand) was assessed. All analyses were adjusted for baseline measurement, age, and body mass index. Mean 25(OH)D levels increased to 69.5 ng/mL in the HyD group. This rise was immediate and sustained. Mean 25(OH)D levels increased to 31.0 ng/mL with a slow increase in the vitamin D 3 group. Women on HyD compared with vitamin D 3 had a 2.8-fold increased odds of maintained or improved lower extremity function (odds ratio [OR] ¼ 2.79; 95% confidence interval [CI], 1.18-6.58), and a 5.7-mmHg decrease in systolic blood pressure ( p ¼ 0.0002). Both types of vitamin D contributed to a decrease in five out of seven markers of innate immunity, significantly more pronounced with HyD for eotaxin, IL-12, MCP-1, and MIP-1 b. There were no cases of hypercalcemia at any time point. Twenty micrograms (20 mg) of HyD per day resulted in a safe, immediate, and sustained increase in 25(OH)D serum levels in all participants, which may explain its significant benefit on lower extremity function, systolic blood pressure, and innate immune response compared with vitamin D 3 . ß

“…(3) The fact that other trials, with less good compliance, failed to reproduce that effect does not negate the evidence of a well-conducted trial. Second, there are the many meta-analyses of Bischoff-Ferrari and colleagues (4,5) demonstrating that, taken overall, fracture reduction with vitamin D does not occur reproducibly below serum 25(OH)D PERSPECTIVE J JBMR levels of 30 ng/mL and for some fractures even 40 ng/mL. Finally, there is the demonstration, in a large German autopsy series (strangely misinterpreted by the panel), that osteoid seam width-the histologic hallmark of vitamin D deficiency-does not reach fully normal values until serum 25(OH)D levels are above 30 ng/mL.…”

Section: Introductionmentioning

confidence: 99%

Why the IOM recommendations for vitamin D are deficient

Heaney¹,

Holick²

2011

328

237