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Title: Calcium plus vitamin D supplementation and risk of fractures: an updated meta analysis from the National Osteoporosis Foundation

Author
item WEAVER, CONNIE - Purdue University
item ALEXANDER, DOMINIK - Epidstat Institute
item BOUSHEY, CAROL - University Of Hawaii
item DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item LAPPE, JOAN - Creighton University
item LEBOFF, MERYL - Brigham & Women'S Hospital
item LOOKER, ANNE - Centers For Disease Control And Prevention (CDC) - United States
item WALLACE, TAYLOR - National Osteoporosis Foundation
item LIU, SHANSHAN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item WANG, DEENA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Annals of Internal Medicine
Publication Type: Review Article
Publication Acceptance Date: 10/22/2015
Publication Date: 10/28/2015
Citation: Weaver, C.M., Alexander, D.D., Boushey, C.J., Dawson-Hughes, B., Lappe, J.M., Leboff, M.S., Looker, A.C., Wallace, T.C., Liu, S., Wang, D.D. 2015. Calcium plus vitamin D supplementation and risk of fractures: an updated meta analysis from the National Osteoporosis Foundation. Annals Of Internal Medicine. 27(1):367-376.

Interpretive Summary:

Technical Abstract: Introduction: Calcium plus vitamin D supplementation has been widely recommended to prevent osteoporosis and subsequent fractures; however, considerable controversy exists regarding the association of such supplementation and fracture risk. The aim was to conduct a meta-analysis of randomized controlled trials [RCTs] of calcium plus vitamin D supplementation and fracture prevention in adults. Methods: A PubMed literature search was conducted for the period from July 1, 2011 through July 31, 2015. RCTs reporting the effect of calcium plus vitamin D supplementation on fracture incidence were selected from English-language studies. Qualitative and Quantitative information was extracted; random-effects meta-analyses were conducted to generate summary relative risk estimates (SRREs) for total and hip fractures. Statistical heterogeneity was assessed using Cochran's Q test and the I2 statistic, and potential for publication bias was assessed. Results: Of the citations retrieved, eight studies including 30,970 participants met criteria for inclusion in the primary analysis, reporting 195 hip fractures and 2231 total fractures. Meta-analysis of all studies showed that calcium plus vitamin D supplementation produced a statistically significant 15% reduced risk of total fractures (SRRE, 0.85; 95% confidence interval [CI], 0.73-0.98)and a 30% reduced risk of hip fractures (SRRE, 0.70; 95% CI, 0.56-0.87). Numerous sensitivity and subgroup analyses produced similar summary associations. A limitation is that this study utilized data from subgroup analysis of the Women's Health Initiative. Conclusions: This meta-analysis of RCTs supports the use of calcium plus vitamin D supplements as an intervention for fracture risk reduction in both community-dwelling and institutionalized middle-aged to older adults.