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A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention / Heike A Bischoff-Ferrari, Walter C Willett, Endel J Orav, Paul Lips, Pierre J Meunier, Ronan Lyons, Leon Flicker, John Wark, Rebecca D Jackson, Jane A Cauley, Haakon E Meyer, Michael Pfeifer, Kerrie M Sanders, Hannes B Stähelin, Robert Theiler, Bess Dawson-Hughes
New England Journal of Medicine, Volume: 367, Issue: 1, Pages: 40 - 49
Swansea University Author: Ronan Lyons
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BACKGROUNDThe results of meta-analyses examining the relationship between vitamin D supplementationand fracture reduction have been inconsistent.METHODSWe pooled participant-level data from 11 double-blind, randomized, controlled trialsof oral vitamin D supplementation (daily, weekly, or every 4 mon...
|Published in:||New England Journal of Medicine|
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BACKGROUNDThe results of meta-analyses examining the relationship between vitamin D supplementationand fracture reduction have been inconsistent.METHODSWe pooled participant-level data from 11 double-blind, randomized, controlled trialsof oral vitamin D supplementation (daily, weekly, or every 4 months), with or withoutcalcium, as compared with placebo or calcium alone in persons 65 years of age orolder. Primary end points were the incidence of hip and any nonvertebral fracturesaccording to Cox regression analyses, with adjustment for age group, sex, type ofdwelling, and study. Our primary aim was to compare data from quartiles of actualintake of vitamin D (including each individual participant’s adherence to thetreatment and supplement use outside the study protocol) in the treatment groupsof all trials with data from the control groups.RESULTSWe included 31,022 persons (mean age, 76 years; 91% women) with 1111 incident hipfractures and 3770 nonvertebral fractures. Participants who were randomly assignedto receive vitamin D, as compared with those assigned to control groups, had anonsignificant 10% reduction in the risk of hip fracture (hazard ratio, 0.90; 95%confidence interval [CI], 0.80 to 1.01) and a 7% reduction in the risk of nonvertebralfracture (hazard ratio, 0.93; 95% CI, 0.87 to 0.99). By quartiles of actual intake,reduction in the risk of fracture was shown only at the highest intake level (median,800 IU daily; range, 792 to 2000), with a 30% reduction in the risk of hip fracture(hazard ratio, 0.70; 95% CI, 0.58 to 0.86) and a 14% reduction in the risk of any nonvertebralfracture (hazard ratio, 0.86; 95% CI, 0.76 to 0.96). Benefits at the highestlevel of vitamin D intake were fairly consistent across subgroups defined by age group,type of dwelling, baseline 25-hydroxyvitamin D level, and additional calcium intake.CONCLUSIONSHigh-dose vitamin D supplementation (!800 IU daily) was somewhat favorable inthe prevention of hip fracture and any nonvertebral fracture in persons 65 years ofage or older.
Fracture; Vitamin D; Prevention; Older People
Swansea University Medical School