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Calcium, vitamin D supplements do not lower risk of fractures in elderly

Tristan Manalac
04 Jan 2018

In community-dwelling elderly adults, supplementation with vitamin D, calcium, or both does not appear to prevent or reduce the risk of fractures, a recent study has shown.

The results of the present study showed that “calcium, calcium plus vitamin D, and vitamin D supplementation alone were not significantly associated with a lower incidence of hip, nonvertebral, vertebral, or total fractures in community-dwelling older adults,” said researchers.

The research team performed a systematic review and meta-analysis of 33 randomized clinical trials corresponding to 51,145 participants >50 years of age. A pooled analysis of 14 trials showed that compared with placebo, calcium supplements did not significantly affect the risk of hip fractures (risk ratio [RR], 1.53; 95 percent CI, 0.97–2.42; p=0.07; absolute risk difference [ARD], 0.01; 0.00–0.01). [JAMA 2017;318:2466-2482]

Calcium supplements also did not significantly reduce the risk of nonvertebral fractures (RR, 0.95; 0.82–1.11; p=0.54; ARD, -0.01; -0.02–0.01), vertebral fractures (RR, 0.83; 0.66–1.05; p=0.13; ARD, -0.01; -0.03–0.01), and total fractures (RR, 0.88; 0.75–1.03; p=0.12; ARD, -0.02; -0.03 to -0.01).

Vitamin D supplementation was examined in 17 trials. Compared with placebo or no treatment, vitamin D supplements showed no significant advantage in lowering the risk of hip fractures (RR, 1.21; 0.99–1.47; p=0.06; ARD, 0.00; -0.00–0.01).

There was also no benefit with vitamin D in terms of nonvertebral fractures (RR, 1.10; 1.00–1.21; p=0.05; ARD, 0.01; -0.00–0.01), vertebral fractures (RR, 0.97; 0.54–1.77; p=0.93; ARD, 0.00; -0.00–0.01), and total fractures (RR, 1.01; 0.87–1.17; p=0.87; ARD, 0.00; -0.01–0.01).

Notably, while the effect of either calcium or vitamin D supplementation on fracture risk did not reach statistical significance, the risk of hip fractures was nominally raised with calcium supplements. This indicates “the possibility of a significant association of calcium supplementation with increased fracture incidence,” said researchers.

“However, the reason for this association is unclear. Overall, results reported here suggest that calcium should not be routinely recommended for fracture prevention,” they added.

The effect of the combination of calcium and vitamin D supplements on the risk of fractures was investigated in 13 studies. The meta-analysis showed no significant effect of the combination on the risk of hip fracture (RR, 1.09; 0.85–1.39; p=0.50; ARD, 0.00; -0.00–0.00). Likewise, the risk of nonvertebral fractures (RR, 0.88; 0.77–1.03; p=0.10; ARD, -0.01; -0.02–0.00), vertebral fractures (RR, 0.63; 0.29–1.40; p=0.26; ARD, -0.00; -0.00–0.00), and total fractures (RR, 0.90; 0.78–1.04; p=0.16; ARD, -0.01; -0.01–0.00) was not significantly affected.

Overall, the findings of the present study “do not support the routine use of these supplements in community-dwelling older people,” the researchers said.

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