What is the role of vitamin D supplementation in acute fracture patients? A systematic review and meta-analysis of the prevalence of hypovitaminosis D and supplementation efficacy.
J Orthop Trauma. 2015 Sep 22. [Epub ahead of print]
Sprague S1, Petrisor B, Scott T, Devji T, Phillips M, Spurr H, Bhandari M, Slobogean G.
1Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario
2Department of Clinical Epidemiology and Biostatistics, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario
3Graduate Entry Medicine, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland
4Department of Orthopaedics, University of Maryland School of Medicine, 6th Floor, Suite 300, 110 S. Paca St., Baltimore MD.
OBJECTIVES: The objectives of this systematic review and meta-analyses are: 1) to estimate the prevalence of hypovitaminosis D in fracture patients and 2) to summarize the available evidence on the efficacy of vitamin D supplementation in fracture patients.
DATA SOURCES: A comprehensive search of the MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases was conducted. Conference abstracts from relevant meetings were also searched.
STUDY SELECTION: We included studies that investigate vitamin D insufficiency or examine the effect of vitamin D supplementation on 25(OH)D serum levels in fracture patients.
DATA EXTRACTION: Two authors independently extracted data using a pre-designed form.
DATA SYNTHESIS: We performed a pooled analysis to determine the prevalence of post-fracture hypovitaminosis D and mean post-fracture 25(OH)D levels. We present detailed summaries of each of the studies evaluating the impact of vitamin D supplementation.
RESULTS: The weighted pooled prevalence of hypovitaminosis D was 70.0% (95% CI: 63.7-76.0%, I = 97.7).
The mean post-fracture serum 25(OH)D was 19.5 ng/ml. The studies that evaluated the efficacy of vitamin D supplementation suggest that vitamin D supplementation safely increases serum 25(OH)D levels. Only one meeting abstract showed a trend towards reduced risk of nonunion following a single large loading dose of vitamin D.
CONCLUSIONS: This review found a high prevalence of hypovitaminosis D in fracture patients and that vitamin D supplementation at a range of doses safely increases 25(OHD) serum levels. To date, only one pilot study published as a meeting abstract has demonstrated a trend towards improved fracture healing with vitamin D supplementation.
LEVEL OF EVIDENCE: Level IV.
Pages listed in BOTH the categories Falls/Fracture and Meta-analysis
- Increased risk of fracture if high level of Vitamin D (if continue to take Calcium) – umbrella analysis of meta-analyses Nov 2020
- Hip fractures not prevented by Vitamin D (800 IU daily or large quarterly or annual doses) – meta-analysis – Dec 2019
- Vitamin K (any amount and any kind) reduced bone fractures by 24 percent – meta-analysis – May 2019
- Vitamin D not help fractures and falls if not vitamin D deficient – meta-analysis Oct 2018
- Fractures not reduced by small amounts of vitamin D - meta-analysis Dec 2017
- Preventing Falls in Older Adults – Vitamin D combination is the best - JAMA Meta-analysis Nov 2017
- Hip fracture 58 percent more likely if low vitamin D – meta-analysis March 2017
- Fracture risk reduced somewhat by 800 IU of vitamin D and Calcium – meta-analysis Oct 2015
- Acute fracture patients – 70 percent were vitamin D deficient – meta-analysis Sept 2015
- Falls not prevented by vitamin D given every 3 months or less often – meta-analysis Jan 2015
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- Vitamin D and fractures – 24 meta-analyses and counting – Dec 2014
- Bone fractures reduced by a minimum of 800 IU vitamin D and Calcium – meta-meta-analysis March 2014
- Fractures reduced with any amount of vitamin D and some Calcium - Cochraine April 2014
- Fallers often had less than 20 ng of vitamin D – meta-analysis April 2014
- Hip fractures greatly reduced by sunshine, vitamin D, and vitamin K – meta-analysis Sept 2012
- Vitamin D may prevent falls and fractures without Calcium – an overview of 9 meta-analysis – Oct 2012
- Hip fractures reduced 30 percent with 800 IU of vitamin D – meta-analysis July 2012
- Vitamin D reduces falls – meta-analysis Oct 2011
- Active form of vitamin D (calcitriol) cut in half the fractures following organ transplant – meta-analysis Aug 2011
- 1000 IU minimum to decrease falls and fractures Swiss - 2009
- Meta-analysis of falls and 800+ IU of vitamin D found good results – June 2010
- 800 IU vitamin D reduces falls - Dec 2009