Vitamin D and Health

Table 22: Meta-analyses of trials on effect of vitamin D supplementation (+/- calcium) on fracture risk in adults ≥ 50y
Study Methods Results Author’s conclusions
Avenell et al (2014)
Selection criteria:
Inclusion: randomised or quasi-randomised
trials that compared vitamin D related
compounds, alone or with calcium, against
placebo, no intervention or calcium alone and
that reported fracture outcomes in older
people.
Exclusion: interventions that included
treatments other than vitamin D or calcium.
Studies in which participants were on
corticosteroid therapy.
Outcome measure
Primary outcome: hip fracture.
Secondary outcomes: any non-vertebral
fracture, vertebral fracture, any new fracture,
adverse effects.
53 trials (n=91,791): 31 trials on vitamin D (+/- calcium) in prevention of fractures in the
community, nursing home or hospital inpatients; 22 trials examined calcitriol or
alfacalcidol, mostly with participants who had osteoporosis.
Vitamin D alone vs placebo or no treatment
Hip fracture (11 trials, n=27,693): RR=1.12 (95% CI, 0.98-1.29)
Non-vertebral fractures (12 trials, n=22,930): RR=1.05 (95% CI 0.96-1.14)
Vertebral fractures (6 trials, n=11,396): RR=1.03 (95% CI, 0.76-1.39)
Any new fracture (15 trials, n=28,271): RR=1.03 (95% CI, 0.96-1.11)
Vitamin D plus calcium vs calcium alone
Hip fracture (7 trials, n=7411): RR=0.84 (95% CI, 0.63-1.13)
Non-vertebral fractures (6 trials, n=3336): RR=0.96 (95% CI, 0.76-1.16)
Vertebral fracture (2 trials, n=2681): RR=0.14 (95% CI, 0.01-2.77)
Vitamin D plus calcium vs placebo or no treatment
Hip fracture (9 trials, n= 49,853): RR=0.84 (95% CI, 0.74-0.96)
Non-vertebral fractures (8 trials, n=10,380): RR=0.86 (95% CI, 0.78-0.96)
Vertebral fractures (4 trials, n=42,185): RR=0.89 (95% CI, 0.74-1.09)
Any fracture (10 trials, n=49,976); RR=0.95 (95% CI, 0.9-0.99)
Vitamin D alone had no effect on
preventing hip fracture, nonvertebral
fracture, vertebral
fractures or any new fractures.
Vitamin D with calcium
supplements may prevent hip or
any type of fracture.
Bolland et al (2014)
Selection criteria:
Inclusion: RCTs included in meta-analyses
studying vitamin D with the outcome fracture.
Exclusion: cluster randomised trials, trials of
hydroxylated vitamin D or vitamin D
analogues, trials that included other
interventions only in the vitamin D group, trials
of fortified dairy products, and trials in
populations with chronic comorbidity other
than osteoporosis or frailty
Outcome measure
Fractures
22 RCTs (n=76,431)
Total fracture
Vitamin D only (15 RCTs): RR=0.97 (95% CI, 0.88-1.08)
Vitamin D and calcium (10 RCTs): RR=0.92 (95% CI, 0.85-0.99)
Vitamin D with and without calcium: RR=0.95 (95% CI, 0.88-1.02) p=0.13
Hip fracture
Vitamin D only: RR=1.11 (95% CI, 0.97-1.27)
Vitamin D and calcium: RR=0.84 (95% CI, 0.74-0.96)
Vitamin D with and without calcium: RR=0.97 (95% CI. 0.86-1.08) p=0.55
Vitamin D with or without Ca had
no effect on total fracture.
Vitamin D had no effect on hip
fracture but vitamin D + Ca
reduced hip fractures.
Trial sequential meta-analysis
found that vitamin D
supplementation (± Ca) does not
reduce skeletal outcomes in
community dwelling individuals by
more than 15%.
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