Need for Additional Calcium to Reduce the Risk of Hip Fracture With Vitamin D Supplementation: Evidence From a Comparative Meta-analysis of Randomized Controlled Trials
Abstract
A previous meta-analysis found that a daily dose of 700–800 IU of vitamin D reduces hip fractures by one-fourth in elderly individuals. Because combined deficiencies of vitamin D and calcium may lead to decreased bone strength and bone loss through negative calcium balance and its sequel, secondary hyperparathyroidism, it is important to know whether additional calcium will prevent hip fractures. Included in the analysis were randomized controlled trials (RCTs) comparing oral vitamin D, with or without calcium supplementation, to a placebo/no treatment condition in postmenopausal women and/or men aged 50 and older who were at risk of hip fracture. Based on 4 RCTs totaling 9083 patients, the pooled relative risk (RR) of hip fracture for vitamin D alone was 1.10 (95% confidence interval [CI], 0.89–1.36). The pooled RR for 2 RCTs administering 400 IU daily of vitamin D was 1.14 (95% CI, 0.87–1.49), and for 2 using 700–800 IU, it was 1.04 (95% CI, 0.75–1.46). For 6 RCTs evaluating calcium supplementation in addition to vitamin D in 45,509 individuals, the pooled RR for hip fracture was 0.82 (95% CI, 0.71–0.94). An adjusted indirect comparison of summary RR values from the 2 meta-analyses showed that the RR of hip fracture for vitamin D with supplemental calcium compared to vitamin D alone was 0.75 (95% CI, 0.58–0.96), suggesting that the vitamin D/calcium combination reduced the risk of hip fracture by 25% compared to vitamin D alone. One-way sensitivity analysis gave no…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 45,509 participants or records.
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