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Evidence Summary

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In people over 50 who live in the community, vitamin D or calcium supplements, alone or combined, do not prevent fractures

Zhao JG, Zeng XT, Wang J, et al. Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis. JAMA. 2017;318:2466-82.

Review question

What are the effects of vitamin D or calcium supplements, alone or combined, on fractures in people over 50 years of age living in the community?

Background

People don’t always get enough vitamin D and calcium in the food they eat. Vitamin D increases the uptake of calcium, which is the building block of bones, and it improves muscle function. Since both are important for bone health, people often take supplements with the goal of preventing broken bones (fractures).

How the review was done

The researchers did a systematic review, including studies up to July 2017. They found 33 randomized controlled trials that included 51, 154 healthy people over the age of 50 who were living in the community.

Vitamin D was studied in 17 trials, calcium in 14 trials, and vitamin D plus calcium in 13 trials.

The main results were number of hip fractures.

Vitamin D, with or without calcium, was compared with no treatment or placebo.

6 trials were high quality, 1 was low quality, and the rest were moderate quality.

What the researchers found

The findings are summarized in the Table below.

Conclusion

In people over 50 years of age who live in the community, vitamin D or calcium supplements, alone or combined, do not prevent fractures compared with placebo or no treatment.

Effect of vitamin D or calcium supplements, alone or combined, on hip fractures in community-dwelling people over 50 years of age

Supplements

Number of trials (number of people)

Rate of hip fractures with supplement

Rate of hip fractures without supplement

Effect of supplement at 3 months to 7 years

Vitamin D

9 trials (20,672 people)

2.1%

1.7%

No difference in hip fractures*

Calcium

6 trials (6703 people)

2.5%

1.6%

No difference in hip fractures*

Vitamin D plus calcium

7 trials (17,927 people)

1.5%

1.3%

No difference in hip fractures*

*Although the rates for the 2 groups look different, the differences were not statistically significant. This means that the difference could simply be due to chance rather than due to different treatments.




Glossary

Placebo
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Web Resources

  • Preventing Blood Clots After Hip or Knee Replacement Surgery or Surgery for a Broken Hip: A Review of the Research for Adults

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    This patient decision aid helps adults considering or planning to have a total hip or knee replacement surgery or surgery for a broken hip decide on the best method for preventing blood clots after surgery. It facilitates the process by outlining and comparing the benefits, risks and side effects of each treatment option.
  • Healthy Bones: A Decision Aid for Women After Menopause

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    This patient decision aid helps women who have gone through menopause and may have osteoporosis decide on methods to keep your bones healthy. It facilitates the process by outlining and comparing the choices such as medicine, menopausal hormone therapy (MHT), and exercise.
  • Osteoporosis screening: topic overview

    Health Link B.C.
    Osteoporosis Canada recommends everyone over age 65 have routine bone density tests. Start routine testing earlier if you are at increased risk for broken bones. Use the FRAX tool to predict your risk of having a fracture related to osteoporosis (link in this resource).
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