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Title: Issues of trial selection and subgroup considerations in the recent meta-analysis of Zhao and colleagues on fracture reduction by calcium and vitamin D supplementation in community-dwelling older adults

Author
item BISCHOFF-FERRARI, HEIKE - University Hospital Zurich
item DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item WILLETT, WALTER - Harvard University

Submitted to: Osteoporosis International
Publication Type: Other
Publication Acceptance Date: 5/22/2018
Publication Date: 6/12/2018
Citation: Bischoff-Ferrari, H., Dawson-Hughes, B., Willett, W.C. 2018. Issues of trial selection and subgroup considerations in the recent meta-analysis of Zhao and colleagues on fracture reduction by calcium and vitamin D supplementation in community-dwelling older adults. Osteoporosis International. 29(9):2151-2152. https://doi.org/10.1007/s00198-018-4587-5.
DOI: https://doi.org/10.1007/s00198-018-4587-5

Interpretive Summary:

Technical Abstract: Title Response: Issues of trial selection and subgroup considerations by dosing regimens and application. Zhao and colleagues are addressing an important question about the efficacy of calcium and vitamin D as well as their combination among community-dwelling adults age 50+. However, we are concerned about four aspects of their approach, which may affect the validity of their conclusions and implications for public health. First, with the inclusion of trials among middle-aged adults age 50+ and exclusion of seniors living in institutions, the authors selected a target population less vulnerable to low calcium intake, vitamin D deficiency and fracture risk. While the authors were fairly clear that they are limiting their analysis to community-dwelling participants, they ignore that results were previously found to be similar in community-dwelling and institutionalized persons, and this led to exclusion of much relevant data on the overall efficacy of calcium and vitamin D. Second, the authors included many studies that had little chance to demonstrate a benefit of the interventions: In one third of the trials follow-up was too short to demonstrate a benefit on fracture risk by the interventions as skeletal benefits cannot be expected to occur immediately (11 of 33 with follow-up of