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

C. M. Weaver, D. D. Alexander, C. J. Boushey, B. Dawson-Hughes, Joan M. Lappe, M. S. LeBoff, S. Liu, A. C. Looker, T. C. Wallace, D. D. Wang

Research output: Contribution to journalArticle

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Abstract

Summary: The 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). Introduction: Calcium 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. Methods: A 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. Results: Of 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. Conclusions: This 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.

Original languageEnglish
Pages (from-to)367-376
Number of pages10
JournalOsteoporosis International
Volume27
Issue number1
DOIs
StatePublished - Jan 1 2016

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Vitamin D
Osteoporosis
Meta-Analysis
Calcium
Hip Fractures
Randomized Controlled Trials
Confidence Intervals
Independent Living
Publication Bias
Fracture Fixation
Women's Health
Risk Reduction Behavior
PubMed
Language
Incidence

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism

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Calcium plus vitamin D supplementation and risk of fractures : an updated meta-analysis from the National Osteoporosis Foundation. / Weaver, C. M.; Alexander, D. D.; Boushey, C. J.; Dawson-Hughes, B.; Lappe, Joan M.; LeBoff, M. S.; Liu, S.; Looker, A. C.; Wallace, T. C.; Wang, D. D.

In: Osteoporosis International, Vol. 27, No. 1, 01.01.2016, p. 367-376.

Research output: Contribution to journalArticle

Weaver, CM, Alexander, DD, Boushey, CJ, Dawson-Hughes, B, Lappe, JM, LeBoff, MS, Liu, S, Looker, AC, Wallace, TC & Wang, DD 2016, 'Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation', Osteoporosis International, vol. 27, no. 1, pp. 367-376. https://doi.org/10.1007/s00198-015-3386-5
Weaver, C. M. ; Alexander, D. D. ; Boushey, C. J. ; Dawson-Hughes, B. ; Lappe, Joan M. ; LeBoff, M. S. ; Liu, S. ; Looker, A. C. ; Wallace, T. C. ; Wang, D. D. / Calcium plus vitamin D supplementation and risk of fractures : an updated meta-analysis from the National Osteoporosis Foundation. In: Osteoporosis International. 2016 ; Vol. 27, No. 1. pp. 367-376.
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AU - Dawson-Hughes, B.

AU - Lappe, Joan M.

AU - LeBoff, M. S.

AU - Liu, S.

AU - Looker, A. C.

AU - Wallace, T. C.

AU - Wang, D. D.

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N2 - Summary: The 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). Introduction: Calcium 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. Methods: A 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. Results: Of 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. Conclusions: This 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.

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