Picking a Bone With Calcium and Vitamin D Supplementation

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Key points
• For older adults who do not live in nursing homes, supplementation with vitamin D, calcium, or both did not lower the risk of fractures when compared with placebo.

• Routine supplementation with vitamin D and/or calcium is not warranted in older community-dwelling individuals.

Background
Nearly half of women over 50 will suffer from osteoporotic fractures, resulting in high rates of morbidity. Zhao and colleagues¹ point out that hip fractures in particular have high mortality, and older people in nursing homes are at higher risk than those who live in the community.

Established practice guidelines recommend vitamin D and calcium supplementation in older adults; however, there is a lack of good evidence that supplementation prevents osteoporotic fractures in this population. The researchers sought to determine whether older community-dwelling adults benefit from these supplements, and they recently presented their findings in JAMA.

The study
Zhao and colleagues conducted a systematic review and meta-analysis that looked at randomized clinical trials of calcium and or vitamin D supplementation for fracture prevention. Ultimately, 33 trials were included, representing 51,145 subjects.

The results
• There was no significant association between calcium or vitamin D and hip fracture risk when compared with placebo or no treatment (calcium relative risk [RR], 1.53; 95% confidence interval [CI], 0.97-2.42; vitamin D RR, 1.21; 95% CI, 0.99-1.47).

• There was no significant association between combined calcium and vitamin D supplementation and hip fracture risk when compared with placebo or no treatment (RR, 1.09; 95% CI, 0.85-1.39).

• There was no association between calcium, vitamin D, or both with non-vertebral, vertebral, or total fractures.

• Results were consistent regardless of dose, gender, fracture history, diet, or baseline vitamin D concentration.

Implications for clinicians
• For adults over 50 who live in the community, it is not helpful to recommend vitamin D and or calcium supplementation for the prevention of osteoporotic fractures.

• Clinicians may counsel older patients that differences may exist between those living in nursing homes versus those living in the community and may recommend vitamin D and/or calcium supplementation if they deem it appropriate for institutionalized patients.

References:

1. 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;318:2466-2482. Doi:10.1001/jama.2017.19344