Vitamin D Does Not Reduce Fractures in seniors (VITAL 2,000 IU D, no Calcium) - Dec 2022

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Supplemental Vitamin D Does Not Reduce the Risk of Fracture in Older Adults

Am Fam Physician. 2022;106(6):718

Clinical Question
Does supplemental vitamin D reduce the risk of fracture in older adults?

Bottom Line
Vitamin D level is a very good marker of ill health but not a very good treatment target. A large study showed that supplemental vitamin D does not reduce the risk of fracture, even in people with low baseline vitamin D levels or a previous fracture. (Level of Evidence = 1b)

Synopsis
The study randomized 25,871 patients, including men 50 years and older and women 55 years and older, in a two-by-two factorial design to receive 2,000 IU of vitamin D or placebo per day, and 1,000 mg of omega-3 fatty acid or placebo per day. Patients were not selected based on their fracture risk or vitamin D levels; participants with a history of cancer, cardiovascular disease, or hypercalcemia were excluded. The primary goal of the VITAL trial was to evaluate the effect of these supplements on cancer and cardiovascular outcomes. Fractures were assessed based on patient self-reported data in an annual survey and confirmed by medical record review. The mean age of participants was 57 years, 51% were women, and 20% were Black. Approximately 25% of patients had a baseline vitamin D level less than 24 ng per mL (59.90 nmol per L), and 1.5% had levels less than 12 ng per mL (29.95 nmol per L). In each group, 42% were taking supplemental vitamin D, and those patients agreed to limit the amount they were taking to no more than 800 mg per day during the study. There was a total of 1,991 fractures in 1,551 patients, with no difference in total, nonvertebral, or osteoporotic fractures (i.e., hip, wrist, humerus, and spine). The authors did a series of prespecified subgroup analyses and found no benefit in patients in the placebo group who were not taking supplemental vitamin D or calcium or in patients with a previous fragility fracture. The mean 25-hydroxyvitamin D level was 30.7 ng per mL (76.63 nmol per L) at baseline, and there was no difference in fracture rates in different quartiles of vitamin D levels, including in patients with vitamin D levels less than 24 ng per mL (hazard ratio = 1.04; 95% CI, 0.80 to 1.36) and less than 12 ng per mL (hazard ratio = 1.03; 95% CI, 0.36 to 2.95). There were no differences among groups regarding renal stones, episodes of hypercalcemia, or other adverse events.

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The Vital Trial did not focus on falling nor bones, so did not include Calcium, etc,

Fractures are a result of BOTH Falling AND Poor bone strength

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8+ VitaminDWiki pages concern the VITAL trial

This list is automatically updated

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VitaminDwiki - Falls and Fractures category"

• 258 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

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