A pooled analysis of vitamin D dose requirements for fracture prevention.

By H.A. Bischoff-Ferrari, W. Willett, E. Orav, P. Lips, P. Meunier, Ronan A. Lyons, L. Flicker, J. Wark, R. Jackson, J. Cauley and 6 more. New England Journal of Medicine, 2012

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BACKGROUND The results of meta-analyses examining the relationship between vitamin D supplementation and fracture reduction have been inconsistent. METHODS We pooled participant-level data from 11 double-blind, randomized, controlled trials of oral vitamin D supplementation (daily, weekly, or every 4 months), with or without calcium, as compared with placebo or calcium alone in persons 65 years of age or older. Primary end points were the incidence of hip and any nonvertebral fractures according to Cox regression analyses, with adjustment for age group, sex, type of dwelling, and study. Our primary aim was to compare data from quartiles of actual intake of vitamin D (including each individual participant's adherence to the treatment and supplement use outside the study protocol) in the treatment groups of all trials with data from the control groups. RESULTS We included 31,022 persons (mean age, 76 years; 91% women) with 1111 incident hip fractures and 3770 nonvertebral fractures. Participants who were randomly assigned to receive vitamin D, as compared with those assigned to control groups, had a nonsignificant 10% reduction in the risk of hip fracture (hazard ratio, 0.90; 95% confidence interval [CI], 0.80 to 1.01) and a 7% reduction in the risk of nonvertebral fracture (hazard ratio, 0.93; 95% CI, 0.87 to 0.99). By quartiles of actual intake, reduction in the risk of fracture was shown only at the highest intake level (median, 800 IU daily; range, 792 to 2000), with a 30% reduction in the risk of hip fracture (hazard ratio, 0.70; 95% CI, 0.58 to 0.86) and a 14% reduction in the risk of any nonvertebral fracture (hazard ratio, 0.86; 95% CI, 0.76 to 0.96). Benefits at the highest level of vitamin D intake were fairly consistent across subgroups defined by age group, type of dwelling, baseline 25-hydroxyvitamin D level, and additional calcium intake. CONCLUSIONS High-dose vitamin D supplementation (≥800 IU daily) was somewhat favorable in the prevention of hip fracture and any nonvertebral fracture in persons 65 years of age or older. (Funded by the Swiss National Foundations and others.).

Subfields: Nutrition and Dietetics, Orthopedics and Sports Medicine, Pathology and Forensic Medicine

View Paper: https://www.semanticscholar.org/paper/138a6beeef1784902c8dbcc6c62ff9b84e8cfc10

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Citations in the corpus

Vitamin D—Effects on Skeletal and Extraskeletal Health and the Need for Supplementation (2013, background): “Several studies have been conducted to evaluate the effect of vitamin D supplementation on the fracture risk, with some studies showing a significant reduction of the risk of fractures while others didn’t [98].”
Vitamin D for Health: A Global Perspective (2013, neutral): “These findings support that a 25(OH)D level of more than 24 ng/mL may be most beneficial for reducing the risk of fractures.(78) With a similar tone and theme, a report from theUSPreventive Services Task Force concluded that current evidence is insufficient to assess the balance of benefits and harm”
Vitamin D: Metabolism, Molecular Mechanism of Action, and Pleiotropic Effects. (2016, background): “The dose of vitamin D has to be adequate ( 400 IU) to reduce fracture risk, and dosage has been different between several clinical trials (46).”
European guidance for the diagnosis and management of osteoporosis in postmenopausal women (2018, background): “ture and falls provided the daily dose of vitamin D is greater than 700 IU [165, 166].”
Frailty Consensus: A Call to Action (2013, positive): “67 In older persons who are 25(OH) vitamin D de ﬁ cient, there is evidence that vitamin D supplementation will reduce falls, 68 hip fractures, 69 and mortality.”