Cocoa extract, multivitamin supplements do not lower fracture risk for older adults
Key takeaways:
- Older adults receiving a cocoa extract supplement had similar risk for incident fractures as those receiving placebo.
- A multivitamin and multimineral supplement was tied to a higher fracture risk than placebo.
Multivitamin and cocoa extract supplements do not protect against clinical fractures for older adults, according to data published in the Journal of Bone and Mineral Research.
As Healio previously reported, the Cocoa Supplement and Multivitamin Outcomes Study (COSMOS) randomly assigned 21,442 adults aged 60 years and older participating in the Women’s Health Initiative extension study or recruited from Brigham and Women’s Hospital to a daily cocoa extract with 500 mg flavanols and 80 mg epicatechin (Mars Edge), a daily multivitamin and multimineral supplement (Centrum Silver, Haleon), both supplements or placebo. In the primary analysis, researchers found that the cocoa extract supplement reduced the risk for cardiovascular death by 27% compared with placebo, and the multivitamin and multimineral supplement lowered lung cancer risk by 38% vs. placebo.
In a new analysis, researchers examined the effect of supplementation on self-reported incident fracture risk during a median follow-up of 3.6 years.
“No previous trials have tested the effects of cocoa extra supplementation on fractures in humans,” Carolyn J. Crandall, MD, MS, MACP, professor of medicine at the David Geffen School of Medicine at UCLA, told Healio. “Cocoa is a rich source of catechins, and animal studies show the potential benefits of catechins on markers of osteoporosis. Similarly, randomized clinical trials regarding the effects of multivitamin and multimineral supplements on fractures are lacking. Because 40% of older adults take multivitamin and multimineral supplements, even a small effect of these supplements on fracture risk could have important public health implications.”
There were 2,083 clinical fractures that occurred during follow-up. The risk for any incident clinical fractures was similar for adults receiving cocoa extract supplementation compared with placebo (HR = 1.03; 95% CI, 0.95-1.12; P = .49). There were no significant associations when individual types of fractures were assessed.
The risk for any incident fracture was higher among the multivitamin and multimineral supplement group vs. adults receiving placebo (HR = 1.09; 95% CI, 1-1.19). Adults receiving a multivitamin and multimineral supplement also had a higher risk for nonvertebral fractures than those not receiving that supplement (HR = 1.1; 95% CI, 1-1.2). No other significant associations were observed.
The effects of both supplements did not vary among prespecified subgroups, including sex, age, race and ethnicity, BMI, baseline chocolate intake, diabetes history, osteoporosis medication use at baseline and history of fragility fracture.
Crandall said older adults should not expect the supplements assessed in the trial to prevent fractures, though she noted findings could differ with other supplements.
“It is possible that different doses and preparation of cocoa extract and multivitamin and multimineral supplements taken over longer durations of time, or if initiated at younger ages, may have beneficial effects in fracture risk in older adults,” Crandall said.
For more information:
Carolyn J. Crandall, MD, MS, MACP, can be reached at ccrandall@mednet.ucla.edu.
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