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Vitamin D not help fractures and falls if not vitamin D deficient – meta-analysis Oct 2018

Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis

Lancet DOI: 10.1016/S2213-8587(18)30265-1
Mark J Bolland, PhD; Andrew Grey, MD; Alison Avenell, MD

  1. Only 6% of the trials were done in populations with vitamin D deficiency ( < 10 ng), who would stand to benefit most from supplementation.
  2. Only 40% of the people who were supplemented achieved > 30 ng of vitamin D
    • Typically need > 40 ng and other nutrients (e.g. Vitamin K), exercise to help
  3. Suspect that many of the trials did not wait for 4+ months for vitamin D level to plateau before counting falls and fractures
  4. Interestingly, Dr. Bolland published another study in BMC (Oct 2018) pointing out that many Vitamin D trials are worthless because they were performed on populations which had enough vitamin D doi: 10.1186/s12874-018-0555-1
  5. Ignored the additional items proven to needed for strong (not just more dense) bones
  6. They did not look at bone strength, but only bone density, a poor proxy
  7. They did not look at the items proven to improve fragility and decrease falls
  8. They considered high-dose to be > 800 IU, 50,000 IU is high dose, not 800 IU
  9. They are totally unaware that the Vitamin D receptor can limit the vitamin D getting to tissues such as bone and muscle
  10. One researcher noticed the long dosing intervals in several of the studies (interval was not mentioned in meta-analysis)
  • Sanders 2010 used 12 month dosing - which has been known for a long time to not be useful
  • Smith 2007 used 12 month dosing of Vitamin D2
  • Law 2006 used 3 month dosing of Vitamin D2
  • Khaw 2017 used 1 month dosing
  • Trivedi 2003 used 4 month dosing
    • Note: A decrease in response to Vitamin D doses starts at about 1/2 month

Strong bones need more than just vitamin D

Falls and Fractures category contains the following summary

Study ignored Sarcopenia

muscle loss, fraility, falling,... which is helped by Vitamin D etc.

Many experts said why the study should be ignored

PDF is available free at Sci-Hub  10.1016/S2213-8587(18)30265-1

The effects of vitamin D on fractures, falls, and bone mineral density are uncertain, particularly for high vitamin D doses. We aimed to determine the effect of vitamin D supplementation on fractures, falls, and bone density.

In this systematic review, random-effects meta-analysis, and trial sequential analysis, we used findings from literature searches in previously published meta-analyses. We updated these findings by searching PubMed, Embase, and Cochrane Central on Sept 14, 2017, and Feb 26, 2018, using the search term “vitamin D” and additional keywords, without any language restrictions. We assessed randomised controlled trials of adults (>18 years) that compared vitamin D with untreated controls, placebo, or lower-dose vitamin D supplements. Trials with multiple interventions (eg, co-administered calcium and vitamin D) were eligible if the study groups differed only by use of vitamin D. We excluded trials of hydroxylated vitamin D analogues. Eligible studies included outcome data for total or hip fractures, falls, or bone mineral density measured at the lumbar spine, total hip, femoral neck, total body, or forearm. We extracted data about participant characteristics, study design, interventions, outcomes, funding sources, and conflicts of interest. The co-primary endpoints were participants with at least one fracture, at least one hip fracture, or at least one fall; we compared data for fractures and falls using relative risks with an intention-to-treat analysis using all available data. The secondary endpoints were the percentage change in bone mineral density from baseline at lumbar spine, total hip, femoral neck, total body, and forearm.

We identified 81 randomised controlled trials (n=53 537 participants) that reported fracture (n=42), falls (n=37), or bone mineral density (n=41). In pooled analyses, vitamin D had no effect on total fracture (36 trials; n=44 790, relative risk 1·00, 95% CI 0·93–1·07), hip fracture (20 trials; n=36 655, 1·11, 0·97–1·26), or falls (37 trials; n=34 144, 0·97, 0·93–1·02). Results were similar in randomised controlled trials of high-dose versus low-dose vitamin D and in subgroup analyses of randomised controlled trials using doses greater than 800 IU per day. In pooled analyses, there were no clinically relevant between-group differences in bone mineral density at any site (range −0·16% to 0·76% over 1–5 years). For total fracture and falls, the effect estimate lay within the futility boundary for relative risks of 15%, 10%, 7·5%, and 5% (total fracture only), suggesting that vitamin D supplementation does not reduce fractures or falls by these amounts. For hip fracture, at a 15% relative risk, the effect estimate lay between the futility boundary and the inferior boundary, meaning there is reliable evidence that vitamin D supplementation does not reduce hip fractures by this amount, but uncertainty remains as to whether it might increase hip fractures. The effect estimate lay within the futility boundary at thresholds of 0·5% for total hip, forearm, and total body bone mineral density, and 1·0% for lumbar spine and femoral neck, providing reliable evidence that vitamin D does not alter these outcomes by these amounts.

Our findings suggest that vitamin D supplementation does not prevent fractures or falls, or have clinically meaningful effects on bone mineral density. There were no differences between the effects of higher and lower doses of vitamin D. There is little justification to use vitamin D supplements to maintain or improve musculoskeletal health. This conclusion should be reflected in clinical guidelines.

Funding: Health Research Council of New Zealand.

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