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Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis.

Abstract The increased social and economic burdens for osteoporosis-related fractures worldwide make the prevention of such injuries a major public health goal. Previous studies have reached mixed conclusions regarding the association between calcium, vitamin D, or combined calcium and vitamin D supplements and fracture incidence in older adults.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title jama
Publication Year Start




PMID- 29279934
OWN - NLM
STAT- In-Process
LR  - 20171228
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Linking)
VI  - 318
IP  - 24
DP  - 2017 Dec 26
TI  - Association Between Calcium or Vitamin D Supplementation and Fracture Incidence
      in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis.
PG  - 2466-2482
LID - 10.1001/jama.2017.19344 [doi]
AB  - Importance: The increased social and economic burdens for osteoporosis-related
      fractures worldwide make the prevention of such injuries a major public health
      goal. Previous studies have reached mixed conclusions regarding the association
      between calcium, vitamin D, or combined calcium and vitamin D supplements and
      fracture incidence in older adults. Objective: To investigate whether calcium,
      vitamin D, or combined calcium and vitamin D supplements are associated with a
      lower fracture incidence in community-dwelling older adults. Data Sources: The
      PubMed, Cochrane library, and EMBASE databases were systematically searched from 
      the inception dates to December 24, 2016, using the keywords calcium, vitamin D, 
      and fracture to identify systematic reviews or meta-analyses. The primary
      randomized clinical trials included in systematic reviews or meta-analyses were
      identified, and an additional search for recently published randomized trials was
      performed from July 16, 2012, to July 16, 2017. Study Selection: Randomized
      clinical trials comparing calcium, vitamin D, or combined calcium and vitamin D
      supplements with a placebo or no treatment for fracture incidence in
      community-dwelling adults older than 50 years. Data Extraction and Synthesis: Two
      independent reviewers performed the data extraction and assessed study quality. A
      meta-analysis was performed to calculate risk ratios (RRs), absolute risk
      differences (ARDs), and 95% CIs using random-effects models. Main Outcomes and
      Measures: Hip fracture was defined as the primary outcome. Secondary outcomes
      were nonvertebral fracture, vertebral fracture, and total fracture. Results: A
      total of 33 randomized trials involving 51145 participants fulfilled the
      inclusion criteria. 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 [95% CI, 0.97 to 2.42]; ARD, 0.01 [95% CI, 0.00 to 0.01]; vitamin D: RR,
      1.21 [95% CI, 0.99 to 1.47]; ARD, 0.00 [95% CI, -0.00 to 0.01]. There was no
      significant association of combined calcium and vitamin D with hip fracture
      compared with placebo or no treatment (RR, 1.09 [95% CI, 0.85 to 1.39]; ARD, 0.00
      [95% CI, -0.00 to 0.00]). 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. Subgroup analyses showed that these 
      results were generally consistent regardless of the calcium or vitamin D dose,
      sex, fracture history, dietary calcium intake, and baseline serum
      25-hydroxyvitamin D concentration. Conclusions and Relevance: In this
      meta-analysis of randomized clinical trials, 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. 
      These findings do not support the routine use of these supplements in
      community-dwelling older people.
FAU - Zhao, Jia-Guo
AU  - Zhao JG
AD  - Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China.
FAU - Zeng, Xian-Tie
AU  - Zeng XT
AD  - Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China.
FAU - Wang, Jia
AU  - Wang J
AD  - Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China.
FAU - Liu, Lin
AU  - Liu L
AD  - Department of Orthopaedic Surgery, Hebei Province Cangzhou Hospital of Integrated
      Traditional and Western Medicine, Cangzhou, China.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
EDAT- 2017/12/28 06:00
MHDA- 2017/12/28 06:00
CRDT- 2017/12/28 06:00
PHST- 2017/12/28 06:00 [entrez]
PHST- 2017/12/28 06:00 [pubmed]
PHST- 2017/12/28 06:00 [medline]
AID - 2667071 [pii]
AID - 10.1001/jama.2017.19344 [doi]
PST - ppublish
SO  - JAMA. 2017 Dec 26;318(24):2466-2482. doi: 10.1001/jama.2017.19344.