Vitamin D and Health

Study Methods Results Author’s conclusions
Bischoff-Ferrari et
al (2009)
Selection criteria
Inclusion: Oral vitamin D supplementation (D2
or D3); minimum follow-up 1y; > 1 fracture;
mean age ≥ 65 y; double-blinded; adherence
reported; explanation of how fractures
ascertained.
Exclusion: Uncontrolled trials; observational
studies, animal studies; studies with patients
following organ transplantation or stroke,
receiving steroid therapy or with Parkinson’s
disease or unstable health states.
Outcome measure
Nonvertebral or hip fracture.
12 double-blind RCTs (n=42,279) comparing oral vitamin D (± Ca) with calcium or placebo.
Nonvertebral fractures (12 RCTs): RR = 0.86 (0.77-0.96)
Evidence of heterogeneity (Q test: p=0.04); resolved after stratifying trials by received dose
For 3 trials ≤ 10 µg, RR = 1.02 (0.92-1.15) (Q test, p=0.64)
For 9 trials ≥ 10 µg, RR = 0.80 (0.72-0.89) (Q test, p=0.31)
Hip fractures (8 RCTs): RR = 0.91 (0.78-1.05)
Evidence of heterogeneity (Q test, p=0.08); resolved after stratifying trials by received dose
For 3 trials ≤ 10 µg, RR = 1.09 (0.90-1.32) (Q test, p=0.81)
For 5 trials ≥ 10 µg, RR = 0.82 (0.69-0.97) (Q test, p=0.18)
Non-vertebral fracture prevention
with vitamin D is dose dependent.
A higher received dose of
supplemental vitamin D (12-19 µg
daily) should reduce nonvertebral
fractures by at least 20% and hip
fractures by at least 18%.
Table 23: RCTs on vitamin D supplementation and increased fracture risk in adults ≥ 50y
Study/country Population Intervention & duration Baseline 25(OH)D
concentration (nmol/L)
12 m post intervention 25(OH)D
concentration (nmol/L)
Results
Comments
Sanders et al
(2010)
Victoria,
Australia
Women considered
to be at high risk of
fracture (n=2256)
Age: 70+ y.
1. 12,500 µg D3 given as
single annual dose orally.
2. Placebo
Duration: 3-5 years
(n=131)
Median (IQR): 49 (40-63)
≥ 74
1. 9.5%
2. 5.3%
51-74
1. 44.5%
2. 33.32%
26-50
1. 41.9%
2. 57.9%
≤ 25
1. 4%
2. 3.5%
Vitamin D vs placebo group:
Incident rate ratio:
1.26 (95% CI, 1.00-1.59)
(p=0.047)
Significant increase in
fracture with high dose of
vitamin D3.
201