Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation

C M Weaver; D D Alexander; C J Boushey; B Dawson-Hughes; J M Lappe; M S LeBoff; S Liu; A C Looker; T C Wallace; D D Wang

doi:10.1007/s00198-015-3386-5

Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation

Osteoporos Int. 2016 Jan;27(1):367-76. doi: 10.1007/s00198-015-3386-5. Epub 2015 Oct 28.

Authors

C M Weaver¹, D D Alexander², C J Boushey³, B Dawson-Hughes⁴, J M Lappe^{5

6}, M S LeBoff⁷, S Liu⁸, A C Looker⁹, T C Wallace^{10

11}, D D Wang¹²

Affiliations

¹ Department of Nutrition Science, Women's Global Health Institute, Purdue University, West Lafayette, IN, USA.
² EpidStat Institute, Evergreen, CO, USA.
³ Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA.
⁴ Jean Mayer USDA Human Nutrition Research Center on Aging, Bone Metabolism Laboratory, Tufts University, Boston, MA, USA.
⁵ School of Nursing, Creighton University, Omaha, NE, USA.
⁶ School of Medicine, Creighton University, Omaha, NE, USA.
⁷ Skeletal Health and Osteoporosis Center and Bone Density Unit, Calcium and Bone Section, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
⁹ Division of Health and Nutrition Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA.
¹⁰ National Osteoporosis Foundation, 1150 17th Street NW, Suite 850, Washington, DC, 20036, USA. taylor.wallace@nof.org.
¹¹ Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA. taylor.wallace@nof.org.
¹² Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA.

Abstract

The aim was to meta-analyze randomized controlled trials of calcium plus vitamin D supplementation and fracture prevention. Meta-analysis showed a significant 15 % reduced risk of total fractures (summary relative risk estimate [SRRE], 0.85; 95 % confidence interval [CI], 0.73-0.98) and a 30 % reduced risk of hip fractures (SRRE, 0.70; 95 % CI, 0.56-0.87).

Introduction: Calcium plus vitamin D supplementation has been widely recommended to prevent osteoporosis and subsequent fractures; however, considerable controversy exists regarding the association of such supplementation and fracture risk. The aim was to conduct a meta-analysis of randomized controlled trials [RCTs] of calcium plus vitamin D supplementation and fracture prevention in adults.

Methods: A PubMed literature search was conducted for the period from July 1, 2011 through July 31, 2015. RCTs reporting the effect of calcium plus vitamin D supplementation on fracture incidence were selected from English-language studies. Qualitative and quantitative information was extracted; random-effects meta-analyses were conducted to generate summary relative risk estimates (SRREs) for total and hip fractures. Statistical heterogeneity was assessed using Cochran's Q test and the I (2) statistic, and potential for publication bias was assessed.

Results: Of the citations retrieved, eight studies including 30,970 participants met criteria for inclusion in the primary analysis, reporting 195 hip fractures and 2231 total fractures. Meta-analysis of all studies showed that calcium plus vitamin D supplementation produced a statistically significant 15 % reduced risk of total fractures (SRRE, 0.85; 95 % confidence interval [CI], 0.73-0.98) and a 30 % reduced risk of hip fractures (SRRE, 0.70; 95 % CI, 0.56-0.87). Numerous sensitivity and subgroup analyses produced similar summary associations. A limitation is that this study utilized data from subgroup analysis of the Women's Health Initiative.

Conclusions: This meta-analysis of RCTs supports the use of calcium plus vitamin D supplements as an intervention for fracture risk reduction in both community-dwelling and institutionalized middle-aged to older adults.

Keywords: Calcium; Fracture; Supplement; Vitamin D.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Bone Density Conservation Agents / therapeutic use*
Calcium / therapeutic use*
Dietary Supplements*
Drug Therapy, Combination
Humans
Osteoporosis, Postmenopausal / complications
Osteoporosis, Postmenopausal / drug therapy
Osteoporotic Fractures / etiology
Osteoporotic Fractures / prevention & control*
Randomized Controlled Trials as Topic
Risk Assessment / methods
Vitamin D / therapeutic use*

Substances

Bone Density Conservation Agents
Vitamin D
Calcium

Grants and funding

R01 AR059775/AR/NIAMS NIH HHS/United States