Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults – A Systematic Review and Meta-analysis
JAMA. 2017;318(24):2466-2482. doi:10.1001/jama.2017.19344
Jia-Guo Zhao, MD1; Xian-Tie Zeng, MD1; Jia Wang, MD1; et al Lin Liu, MD2
- This is perhaps the 25th meta-analysis of VItamin D and bone fractures.
There is no consensus across the many fracture meta-analyses
- Most ignore the size of the vitamin D dose
There is a lot of success in trials which use > 1,000 IU of vitamin D - None of the successful trials which give vitamin D to everyone are reported in meta-analyses (They virtually require a placebo)
- None of the successful trials which use other/more than Vitamin D and Calcium are ever reported in a meta-analysis, such as Magnesium, exercise, and sunshine
- Vitamin D and fractures – 24 meta-analyses and counting – Dec 2014
The meta-analysis on this page is perhaps #25 - Yet again, 800 IU of vitamin D was found to be barely enough to help bones – Lancet Oct 2013
- Vitamin D, K2, Magnesium, etc increase bone density when taking together– Jan 2012
- Is it ethical to NOT give vitamin D in osteoporosis trials– NEJM Sept 2010
That ethical conclusion was made 7 years before this JAMA meta-analysis - Vitamin D may prevent falls and fractures without Calcium – an overview of 9 meta-analysis – Oct 2012
- Overview Fractures and vitamin D
- 20X increase in vitamin D sold and 36 percent decrease in osteoporosis business in Australia – Nov 2013 People are not waiting for official agreement, they are taking more Vit D and going to doctors less
Meta-analysis of Vitamin D category listing has 665 items
- It includes the many reasons that meta-analyses are not appropriate for Vitamin D
- It lists meta-analyses for Fractures/Falling, trauma/surgery, Seniors, etc
Intervention - Vitamin D category listing has 822 items
- Hip fractures reduced 2X to 6X with just 10 minutes of sunlight daily – RCT 2003-2010
- Less bone loss if take 100,000 IU vitamin D monthly – RCT Nov 2017
Download the PDF from Sci-Hub via VitaminDWiki
All of the studies in this meta-analysis should be ignored - Grassroots Health - Jan 2018
Vitamin D and Calcium is Not Necessary for Older Adults – Is this True? Jan 2018
Carole Baggerly at Grassroots Health considered each trial and discarded those which had
- Too infrequent dosing (such as 1 /year)
- Too small of dose sizes (< 1,000 IU)
- Trials which were too short (< 12 months)
Which left only one trial 4,000 IU of Vitamin D daily is safe, but takes a year to plateau (Best-D) – RCT Dec 2016
However the study was not large enough to have a statistically significant fracture result
Note how long it took for vitamin D levels in blood to rise
Problems with Zhao study - Osteoporosis International June 2018
Issues of trial selection and subgroup considerations in the recent meta-analysis of Zhao and colleagues on fracture reduction by calcium and vitamin D supplementation in community-dwelling older adults
H.A. Bischoff-Ferrari B. Dawson-Hughes W.C. Willett, https://doi.org/10.1007/s00198-018-4587-5
- "We discuss four concerns regarding this meta-analysis, including the target population, the selection of trials with regard to blinding and duration of follow-up, and the lack of adjustment for adherence to the interventions and subgroup analysis by bolus versus daily dosing for vitamin D."
Key Points
- Question Is supplementation with calcium, vitamin D, or combined calcium and vitamin D associated with a lower fracture incidence in community-dwelling older adults?
- Findings In this meta-analysis of 33 randomized clinical trials that included 51 145 participants, the use of supplements that included calcium, vitamin D, or both was not associated with a significant difference in the risk of hip fractures compared with placebo or no treatment (risk ratio, 1.53, 1.21, and 1.09, respectively).
- Meaning These findings do not support the routine use of these supplements in community-dwelling older adults.
Importance The increased social and economic burdens for osteoporosis-related fractures worldwide make the prevention of such injuries a major public health goal. Previous studies have reached mixed conclusions regarding the association between calcium, vitamin D, or combined calcium and vitamin D supplements and fracture incidence in older adults.
Objective To investigate whether calcium, vitamin D, or combined calcium and vitamin D supplements are associated with a lower fracture incidence in community-dwelling older adults.
Data Sources The PubMed, Cochrane library, and EMBASE databases were systematically searched from the inception dates to December 24, 2016, using the keywords calcium, vitamin D, and fracture to identify systematic reviews or meta-analyses. The primary randomized clinical trials included in systematic reviews or meta-analyses were identified, and an additional search for recently published randomized trials was performed from July 16, 2012, to July 16, 2017.
Study Selection Randomized clinical trials comparing calcium, vitamin D, or combined calcium and vitamin D supplements with a placebo or no treatment for fracture incidence in community-dwelling adults older than 50 years.
Data Extraction and Synthesis Two independent reviewers performed the data extraction and assessed study quality. A meta-analysis was performed to calculate risk ratios (RRs), absolute risk differences (ARDs), and 95% CIs using random-effects models.
Main Outcomes and Measures Hip fracture was defined as the primary outcome. Secondary outcomes were nonvertebral fracture, vertebral fracture, and total fracture.
Results A total of 33 randomized trials involving 51 145 participants fulfilled the inclusion criteria. There was no significant association of calcium or vitamin D with risk of hip fracture compared with placebo or no treatment (calcium: RR, 1.53 [95% CI, 0.97 to 2.42]; ARD, 0.01 [95% CI, 0.00 to 0.01]; vitamin D: RR, 1.21 [95% CI, 0.99 to 1.47]; ARD, 0.00 [95% CI, −0.00 to 0.01]. There was no significant association of combined calcium and vitamin D with hip fracture compared with placebo or no treatment (RR, 1.09 [95% CI, 0.85 to 1.39]; ARD, 0.00 [95% CI, −0.00 to 0.00]). No significant associations were found between calcium, vitamin D, or combined calcium and vitamin D supplements and the incidence of nonvertebral, vertebral, or total fractures. Subgroup analyses showed that these results were generally consistent regardless of the calcium or vitamin D dose, sex, fracture history, dietary calcium intake, and baseline serum 25-hydroxyvitamin D concentration.
Conclusions and Relevance In this meta-analysis of randomized clinical trials, the use of supplements that included calcium, vitamin D, or both compared with placebo or no treatment was not associated with a lower risk of fractures among community-dwelling older adults. These findings do not support the routine use of these supplements in community-dwelling older people.
9479 visitors, last modified 12 Jun, 2018,
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Follow this page for updates
- It includes the many reasons that meta-analyses are not appropriate for Vitamin D
- It lists meta-analyses for Fractures/Falling, trauma/surgery, Seniors, etc
Intervention - Vitamin D category listing has 822 items
- Hip fractures reduced 2X to 6X with just 10 minutes of sunlight daily – RCT 2003-2010
- Less bone loss if take 100,000 IU vitamin D monthly – RCT Nov 2017
Download the PDF from Sci-Hub via VitaminDWiki
All of the studies in this meta-analysis should be ignored - Grassroots Health - Jan 2018
Vitamin D and Calcium is Not Necessary for Older Adults – Is this True? Jan 2018
Carole Baggerly at Grassroots Health considered each trial and discarded those which had
- Too infrequent dosing (such as 1 /year)
- Too small of dose sizes (< 1,000 IU)
- Trials which were too short (< 12 months)
Which left only one trial 4,000 IU of Vitamin D daily is safe, but takes a year to plateau (Best-D) – RCT Dec 2016
However the study was not large enough to have a statistically significant fracture result
Note how long it took for vitamin D levels in blood to rise
Problems with Zhao study - Osteoporosis International June 2018
Issues of trial selection and subgroup considerations in the recent meta-analysis of Zhao and colleagues on fracture reduction by calcium and vitamin D supplementation in community-dwelling older adults
H.A. Bischoff-Ferrari B. Dawson-Hughes W.C. Willett, https://doi.org/10.1007/s00198-018-4587-5
- "We discuss four concerns regarding this meta-analysis, including the target population, the selection of trials with regard to blinding and duration of follow-up, and the lack of adjustment for adherence to the interventions and subgroup analysis by bolus versus daily dosing for vitamin D."
Key Points
- Question Is supplementation with calcium, vitamin D, or combined calcium and vitamin D associated with a lower fracture incidence in community-dwelling older adults?
- Findings In this meta-analysis of 33 randomized clinical trials that included 51 145 participants, the use of supplements that included calcium, vitamin D, or both was not associated with a significant difference in the risk of hip fractures compared with placebo or no treatment (risk ratio, 1.53, 1.21, and 1.09, respectively).
- Meaning These findings do not support the routine use of these supplements in community-dwelling older adults.
Importance The increased social and economic burdens for osteoporosis-related fractures worldwide make the prevention of such injuries a major public health goal. Previous studies have reached mixed conclusions regarding the association between calcium, vitamin D, or combined calcium and vitamin D supplements and fracture incidence in older adults.
Objective To investigate whether calcium, vitamin D, or combined calcium and vitamin D supplements are associated with a lower fracture incidence in community-dwelling older adults.
Data Sources The PubMed, Cochrane library, and EMBASE databases were systematically searched from the inception dates to December 24, 2016, using the keywords calcium, vitamin D, and fracture to identify systematic reviews or meta-analyses. The primary randomized clinical trials included in systematic reviews or meta-analyses were identified, and an additional search for recently published randomized trials was performed from July 16, 2012, to July 16, 2017.
Study Selection Randomized clinical trials comparing calcium, vitamin D, or combined calcium and vitamin D supplements with a placebo or no treatment for fracture incidence in community-dwelling adults older than 50 years.
Data Extraction and Synthesis Two independent reviewers performed the data extraction and assessed study quality. A meta-analysis was performed to calculate risk ratios (RRs), absolute risk differences (ARDs), and 95% CIs using random-effects models.
Main Outcomes and Measures Hip fracture was defined as the primary outcome. Secondary outcomes were nonvertebral fracture, vertebral fracture, and total fracture.
Results A total of 33 randomized trials involving 51 145 participants fulfilled the inclusion criteria. There was no significant association of calcium or vitamin D with risk of hip fracture compared with placebo or no treatment (calcium: RR, 1.53 [95% CI, 0.97 to 2.42]; ARD, 0.01 [95% CI, 0.00 to 0.01]; vitamin D: RR, 1.21 [95% CI, 0.99 to 1.47]; ARD, 0.00 [95% CI, −0.00 to 0.01]. There was no significant association of combined calcium and vitamin D with hip fracture compared with placebo or no treatment (RR, 1.09 [95% CI, 0.85 to 1.39]; ARD, 0.00 [95% CI, −0.00 to 0.00]). No significant associations were found between calcium, vitamin D, or combined calcium and vitamin D supplements and the incidence of nonvertebral, vertebral, or total fractures. Subgroup analyses showed that these results were generally consistent regardless of the calcium or vitamin D dose, sex, fracture history, dietary calcium intake, and baseline serum 25-hydroxyvitamin D concentration.
Conclusions and Relevance In this meta-analysis of randomized clinical trials, the use of supplements that included calcium, vitamin D, or both compared with placebo or no treatment was not associated with a lower risk of fractures among community-dwelling older adults. These findings do not support the routine use of these supplements in community-dwelling older people.
9479 visitors, last modified 12 Jun, 2018,
Printer Friendly
Follow this page for updates
- Hip fractures reduced 2X to 6X with just 10 minutes of sunlight daily – RCT 2003-2010
- Less bone loss if take 100,000 IU vitamin D monthly – RCT Nov 2017
Download the PDF from Sci-Hub via VitaminDWiki
All of the studies in this meta-analysis should be ignored - Grassroots Health - Jan 2018
Vitamin D and Calcium is Not Necessary for Older Adults – Is this True? Jan 2018
Carole Baggerly at Grassroots Health considered each trial and discarded those which had
- Too infrequent dosing (such as 1 /year)
- Too small of dose sizes (< 1,000 IU)
- Trials which were too short (< 12 months)
Which left only one trial 4,000 IU of Vitamin D daily is safe, but takes a year to plateau (Best-D) – RCT Dec 2016
However the study was not large enough to have a statistically significant fracture result
Note how long it took for vitamin D levels in blood to rise
Problems with Zhao study - Osteoporosis International June 2018
Issues of trial selection and subgroup considerations in the recent meta-analysis of Zhao and colleagues on fracture reduction by calcium and vitamin D supplementation in community-dwelling older adults
H.A. Bischoff-Ferrari B. Dawson-Hughes W.C. Willett, https://doi.org/10.1007/s00198-018-4587-5
- "We discuss four concerns regarding this meta-analysis, including the target population, the selection of trials with regard to blinding and duration of follow-up, and the lack of adjustment for adherence to the interventions and subgroup analysis by bolus versus daily dosing for vitamin D."
Key Points
- Question Is supplementation with calcium, vitamin D, or combined calcium and vitamin D associated with a lower fracture incidence in community-dwelling older adults?
- Findings In this meta-analysis of 33 randomized clinical trials that included 51 145 participants, the use of supplements that included calcium, vitamin D, or both was not associated with a significant difference in the risk of hip fractures compared with placebo or no treatment (risk ratio, 1.53, 1.21, and 1.09, respectively).
- Meaning These findings do not support the routine use of these supplements in community-dwelling older adults.
Importance The increased social and economic burdens for osteoporosis-related fractures worldwide make the prevention of such injuries a major public health goal. Previous studies have reached mixed conclusions regarding the association between calcium, vitamin D, or combined calcium and vitamin D supplements and fracture incidence in older adults.
Objective To investigate whether calcium, vitamin D, or combined calcium and vitamin D supplements are associated with a lower fracture incidence in community-dwelling older adults.
Data Sources The PubMed, Cochrane library, and EMBASE databases were systematically searched from the inception dates to December 24, 2016, using the keywords calcium, vitamin D, and fracture to identify systematic reviews or meta-analyses. The primary randomized clinical trials included in systematic reviews or meta-analyses were identified, and an additional search for recently published randomized trials was performed from July 16, 2012, to July 16, 2017.
Study Selection Randomized clinical trials comparing calcium, vitamin D, or combined calcium and vitamin D supplements with a placebo or no treatment for fracture incidence in community-dwelling adults older than 50 years.
Data Extraction and Synthesis Two independent reviewers performed the data extraction and assessed study quality. A meta-analysis was performed to calculate risk ratios (RRs), absolute risk differences (ARDs), and 95% CIs using random-effects models.
Main Outcomes and Measures Hip fracture was defined as the primary outcome. Secondary outcomes were nonvertebral fracture, vertebral fracture, and total fracture.
Results A total of 33 randomized trials involving 51 145 participants fulfilled the inclusion criteria. There was no significant association of calcium or vitamin D with risk of hip fracture compared with placebo or no treatment (calcium: RR, 1.53 [95% CI, 0.97 to 2.42]; ARD, 0.01 [95% CI, 0.00 to 0.01]; vitamin D: RR, 1.21 [95% CI, 0.99 to 1.47]; ARD, 0.00 [95% CI, −0.00 to 0.01]. There was no significant association of combined calcium and vitamin D with hip fracture compared with placebo or no treatment (RR, 1.09 [95% CI, 0.85 to 1.39]; ARD, 0.00 [95% CI, −0.00 to 0.00]). No significant associations were found between calcium, vitamin D, or combined calcium and vitamin D supplements and the incidence of nonvertebral, vertebral, or total fractures. Subgroup analyses showed that these results were generally consistent regardless of the calcium or vitamin D dose, sex, fracture history, dietary calcium intake, and baseline serum 25-hydroxyvitamin D concentration.
Conclusions and Relevance In this meta-analysis of randomized clinical trials, the use of supplements that included calcium, vitamin D, or both compared with placebo or no treatment was not associated with a lower risk of fractures among community-dwelling older adults. These findings do not support the routine use of these supplements in community-dwelling older people.
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