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Calcium, vitamin D supplementation fail to reduce fracture risk
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Supplementation with calcium, vitamin D or a combination of the two was not associated with a lower incidence of hip, nonvertebral, vertebral or total fractures, regardless of sex, fracture history or dietary calcium intake, according to findings published in JAMA.
Jia-Guo Zhao, MD, of the department of orthopedic surgery at Tianjin Hospital in China, and colleagues conducted a meta-analysis of 33 randomized trials involving 51,145 adults aged at least 50 years to assess whether calcium, vitamin D or combined calcium and vitamin D supplements were associated with a lower risk for incident fracture.
Calcium supplementation and placebo or no treatment were compared in 14 trials. Calcium supplementation was not significantly associated with hip fractures (RR = 1.53; 95% CI, 0.97-2.42), nonvertebral fractures (RR = 0.95; 95% CI, 0.82-1.11), vertebral fractures (RR = 0.83; 95% CI, 0.66-1.05) or total fractures (RR = 0.88; 95% CI, 0.75-1.03) compared with placebo or no treatment. Fracture risk was not associated with calcium in subgroups for hip, nonvertebral, vertebral or total fractures based on calcium dose, sex, fracture history, dietary calcium intake or baseline 25-hydroxyvitamin D concentration.
Vitamin D supplementation and placebo or no treatment were compared in 17 trials. Vitamin D supplementation was not significantly associated with hip fractures (RR = 1.21; 95% CI, 0.99-1.47), nonvertebral fractures (RR = 1.1; 95% CI, 1-1.21), vertebral fractures (RR = 0.97; 95% CI, 0.54-1.77) or total fractures (RR = 1.01; 95% CI, 0.87-1.17) compared with placebo or no treatment. The incidence of hip fracture was significantly higher with vitamin D supplementation in participants with baseline 25-(OH)D concentrations 20 ng/mL or higher compared with lower levels (RR = 1.49; 95% CI, 1.03-2.17).
Combination calcium and vitamin D supplementation and placebo or no treatment were compared in 13 trials. Combination supplementation was not significantly associated with hip fractures (RR = 1.09; 95% CI, 0.85-1.39), nonvertebral fractures (RR = 0.88; 95% CI, 0.75-1.03), vertebral fracture (RR = 0.63; 95% CI, 0.29-1.4) or total fractures (RR = 0.9; 95% CI, 0.78-1.04). Fracture risk was not associated with the combination supplementation in subgroups based on dose of calcium or vitamin D, sex, fracture history, dietary calcium intake or baseline 25-(OH)D concentration.
“This study found that the use of supplements that included calcium, vitamin D, or both calcium and vitamin D was not associated with a lower risk of fractures among community-dwelling older adults,” Zhao told Endocrine Today. “Hence, we do not support the routine use of these supplements in community-dwelling older people. It is time to stop taking calcium and vitamin D supplements for community-dwelling older adults.” – by Amber Cox
For more information:
Jia-Guo Zhao, MD, can be reached at orthopaedic@163.com.
Disclosures: The authors report no relevant financial disclosures.
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