Clinical Edge

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Calcium & Vitamin D for Lower Fracture Incidence

JAMA; 2017 Dec 26; Zhao, Zeng, et al

The use of supplements that included calcium, vitamin D, or both compared with placebo or no treatment was not associated with a lower risk of fractures among community-dwelling older adults, a recent study found. The systematic review and meta-analysis in community-dwelling older adults included 33 randomized trials and 51,145 participants. Researchers found:

  • There was no significant association of calcium or vitamin D with risk of hip fracture compared with placebo or no treatment (calcium: RR, 1.53; vitamin D: RR, 1.21).
  • There was no significant association of combined calcium and vitamin D with hip fracture compared with placebo or no treatment (RR, 1.09).
  • No significant associations were found between calcium, vitamin D, or combined calcium and vitamin D supplements and the incidence of nonvertebral, vertebral, or total fractures.

Citation:

Zhao JG, Zeng XT, Wang J, Liu L. Association between calcium or vitamin D supplementation and fracture incidence in community-dwelling older adults. A systematic review and meta-analysis. JAMA. 2017;318(24):2466–2482. doi:10.1001/jama.2017.19344.

Commentary:

The decision to add vitamin D and calcium supplementation for older adults has generally been an easy one with potential benefit and little harm. That said, it is also a confusing area, since some studies have shown a decrease in falls with vitamin D supplementation, some show a decrease in fractures with vitamin D and calcium, while others like the one reviewed above do not show a benefit.1,2 A previous meta-analysis showed that oral vitamin D supplementation between 700 to 800 IU/d appears to reduce the risk of hip and any nonvertebral fractures in ambulatory or institutionalized elderly persons, but that a dose of 400 IU/d is not sufficient for fracture prevention.3 The study reviewed above, including all relevant studies to data, convincingly shows that using vitamin D and calcium does not decrease the likelihood of osteoporotic fractures among community dwelling older adults. Note that the population studied here is not a nursing home population, who tend to be frailer and who have a higher prevalence of severe osteoporosis than community living adults. While falls can cause osteoporotic fractures, the effect of vitamin D in decreasing falls may be due to improvement in muscle strength in vitamin D deficient individuals. So what should we do with this information? It does not appear that routine recommendations to take vitamin D and calcium provide much benefit. Perhaps, in high risk groups, checking vitamin D levels and providing vitamin D to those individuals whose levels are low makes sense. — Neil Skolnik, MD

  1. Larsen, ER, Mosekilde, L, Foldspang, A. Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: A pragmatic population-based 3-year intervention study. J Bone Miner Res. 2004;19:370–378. doi:10.1359/JBMR.0301240.
  2. Broe, KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DP. (2007). A higher dose of vitamin D reduces the risk of falls in nursing home residents: A randomized, multiple-dose study. J Am Geriatr Soc. 2007;55:234–239. doi:10.1111/j.1532-5415.2007.01048.x.
  3. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation. A meta-analysis of randomized controlled trials. JAMA.2005;293(18):2257–2264. doi:10.1001/jama.293.18.2257.

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