Centrum Silver increased facture risk (too little of Vitamin D and Calcium) - RCT Feb 2025

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Effects of Cocoa Extract Supplementation and Multivitamin/Multimineral Supplements on Self-Reported Fractures in the Cocoa Supplement and Multivitamins Outcomes Study (COSMOS) Randomized Clinical Trial

J Bone Miner Res. 2025 Feb 18:zjaf030. doi: 10.1093/jbmr/zjaf030
Carolyn J Crandall 1, Sharon Chou 2 3, Eunjung Kim 4, Dana Ratnarajah 5, Nancy R Cook 3 6 7, Allison Clar 6, Howard D Sesso 3 6 7, JoAnn E Manson 3 6 7, Meryl S LeBoff 2 3

Centrum appears to have INCREASED fractures (only 1,000 IU of Vit D, 200 mg of Calcium)

Abstract

Osteoporosis is a major public health problem among older adults. Forty percent of older U.S. adults take multivitamin/multimineral (MVM) supplementation. The effects of MVM supplementation on fractures is unclear. Preclinical and observational studies suggest that MVM and flavanols may have beneficial effects on bone. We conducted an ancillary study to COcoa Supplement and Multivitamin Outcomes Study (COSMOS; NCT05232669) designed to investigate incident fracture and injurious falls in 21 442 COSMOS participants (12 666 females aged ≥65 years and 8776 males aged ≥60 years) randomized in a 2x2 factorial design to 1 of 4 intervention groups: cocoa extract + MVM, cocoa extract + MVM placebo, cocoa extract placebo + MVM, or double placebo. The daily cocoa extract supplement contained 500 mg/d flavanols and 80 mg/d (-)-epicatechin (Mars Edge); the daily MVM supplement was Centrum Silver® (Haleon). The median (interquartile range) duration of the intervention was 3.6 (3.2-4.2) years. Annually, participants self-reported incident fractures. In intention-to-treat analyses, we examined the effects of cocoa extract and MVM on the primary outcomes of total clinical fracture (hip, upper leg, forearm/wrist, pelvis, upper arm/shoulder, spine, knee, or other), hip fracture, and nonvertebral fracture, and secondary outcomes of clinical spine, forearm/wrist, major osteoporotic, and pelvic fracture using Cox proportional hazards models. During the intervention period, 2083 incident clinical fractures occurred.
Compared with placebo, cocoa extract was not significantly associated with lower risk of incident clinical fracture (adjusted hazard ratio [aHR] 1.03, 95% CI 0.95-1.12) or nonvertebral fracture (aHR 1.05, 95% CI 0.96-1.14).

MVM supplementation was not associated with lower risk of

• total clinical fracture (aHR 1.09, 95% CI 1.00-1.19),
• hip fracture (aHR 1.06, 95% CI 0.80-1.42), or
• nonvertebral fracture (aHR 1.10, 95% CI 1.00-1.20).

These findings do not support the use of cocoa extract or MVM to decrease fracture risk in older individuals not selected for pre-existing osteoporosis.
 Download the PDF from VitaminDWiki

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Plain language summary

Osteoporosis is a major public health problem among older adults. Some studies suggest that flavanols, which are present in large quantities in cocoa, may have beneficial effects on bone. Multivitamin/multimineral (MVM) supplementation, taken by 40% of the US population, may also have beneficial effects on bone. We conducted an ancillary study to the COSMOS clinical trial. The COSMOS trial assigned 21 442 participants (12 666 females aged ≥65 years and 8776 males aged ≥60 years) to receive 2 of 4 study pills: cocoa extract + MVM, cocoa extract + MVM placebo, cocoa extract placebo + MVM, or double placebo. . After accounting for age, race/ethnicity, and sex, compared with placebo, cocoa extract supplementation was not significantly associated with the risk of clinical fractures. MVM supplementation also did not reduce risk of total clinical, hip, or nonvertebral fracture. In this large study of older men and women, cocoa extract compared with placebo supplementation given for an average of 3.6 years did not significantly affect the risk of fractures. Similarly, MVM supplement (versus placebo) did not reduce the risk of clinical fracture in older community-dwelling persons. MVM may have other health benefits, including helping to ensure adequate intake of calcium and vitamin D.

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1,000 IU of Vitamin D PLUS 1 gram of Calcium reduces risk of fracture by only 13% - Perplexity AI Feb 2025

Centrum Silver only has 1/5 gram of Calcium

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VitaminDWiki – Falls and Fractures category contains

• 260 items in FALLS and FRACTURES
• Vitamin D and Calcium cost-effectively reduce falls and fractures – April 2019
• see also Overview Seniors and Vitamin D
  • Overview Fractures and Falls and Vitamin D
  • Overview Fractures and vitamin D
  • Muscles and Vitamin D - many studies

Falls

• Fall prevention - Vitamin D is one of the ways - umbrella review Jan 2024
• Deaths due to falls doubled in just a decade (age-adjusted, perhaps decreased vitamin D) – June 2019
• Preventing Falls in Older Adults – Vitamin D combination is the best - JAMA Meta-analysis Nov 2017
• Falls cut in half by 100,000 IU vitamin D monthly - RCT 2016
• Falls reduced by a third if achieved 40 ng level vitamin D– RCT Sept 2018
  • Note: It took 6 months to get to that level. Most trials last only 3 months
• Vitamin D prevents falls – majority of meta-analyses conclude – meta-meta analysis Feb 2015
• Falls reduced by Vitamin D: 13 percent reduction if more than 700 IU – review of 38 trials – Aug 2022

Left hand column section as of Nov 2024

Fracture

• Hip fractures are predicted by 10 factors – low Vitamin D is the biggest – Aug 2023
• Vitamin D and fractures – 24 meta-analyses and counting – Dec 2014
• Low trauma bone fractures in seniors – considering Vitamin D loading dose for all, without testing – Nov 2019
• Vitamin K (any amount and any kind) reduced bone fractures by 24 percent – meta-analysis – May 2019
• 77+ Hip fracture items in VitaminDWiki title   Click here for details examples:
  • Risk of Hip fracture cut in half if Vitamin D was prescribed - Aug 2023
  • Call to action: Vitamin D to prevent of treat hip fracture (50,000 weekly for 8 weeks, then bi-weekly) – Holick July 2020