Vitamin D and Calcium supplements do not reduce fracture risk in elderly, finds meta analysis

In the past, inconsistent findings in regard to the association between different concentrations of vitamin D, calcium or their combination and the risk of fracture have been reported in older people. According to an estimate, about 10.3% of older adults in the community have osteoporosis, and 43.9% have low bone mass thereby questioning the benefit of supplemental vitamin D, calcium, or their combination.

Dr Hu ZC at Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China and colleagues conducted a systematic review and network meta-analysis to compare the fracture risk using different concentrations of vitamin D, calcium or their combination. The network meta-analysis failed to find benefit for hip, vertebral, or total fractures from supplemental vitamin D, calcium, or their combination in community-dwelling older adults (aged ≥50 years). The findings of the study have been published in The BMJ Open.

The researchers conducted a Network meta-analysis of 25 placebo-controlled randomized controlled trials (RCTs; n=43,606). Randomised controlled trials in PubMed, Cochrane Library and Embase databases were systematically searched from the inception dates to 31 December 2017. The total fracture was defined as the primary outcome. Secondary outcomes were hip fracture and vertebral fracture. Due to the consistency of the original studies, a consistency model was adopted.The randomised controlled trials involved 43 510 participants who fulfilled the inclusion criteria.

The researchers studied

• 8 groups vs placebo or no treatment:
  
  
  
  • High calcium (≥800 mg/day).
  
  
  • Low calcium (<800 mg/day).
  
  
  • High vitamin D (≥800 IU/day).
  
  
  • Low vitamin D (<800 IU/day).
  
  
  • High calcium plus high vitamin D.
  
  
  • High calcium plus low vitamin D.
  
  
  • Low calcium plus high vitamin D.
  
  
  • Low calcium plus low vitamin D.
  
  
  
  

The researchers found no evidence that the risk of total fracture was reduced using different concentrations of vitamin D, calcium or their combination compared with placebo or no treatment. No significant associations were found between calcium, vitamin D, or combined calcium and vitamin D supplements and the incidence of hip or vertebral fractures.The Limitations of the study were that osteoporosis status of the people involved in the study was unknown and no data on frail elderly was available.

The researchers concluded that the use of supplements that included calcium, vitamin D or both was not found to be better than placebo or no treatment in terms of risk of fractures among community-dwelling older adults. It means the routine use of these supplements in community-dwelling older people should be treated more carefully.

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DOI: 10.1136/bmjopen-2018-024595