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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 Orcid Logo, 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 Orcid Logo

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DOI (Published version): 10.1056/NEJMoa1109617

Abstract

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...

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Published in: New England Journal of Medicine
ISSN: 0028-4793 1533-4406
Published: 2012
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URI: https://cronfa.swan.ac.uk/Record/cronfa13315
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2015-12-08T11:01:04.4460358</datestamp><bib-version>v2</bib-version><id>13315</id><entry>2012-11-20</entry><title>A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention</title><swanseaauthors><author><sid>83efcf2a9dfcf8b55586999d3d152ac6</sid><ORCID>0000-0001-5225-000X</ORCID><firstname>Ronan</firstname><surname>Lyons</surname><name>Ronan Lyons</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2012-11-20</date><deptcode>MEDS</deptcode><abstract>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&#x2019;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.</abstract><type>Journal Article</type><journal>New England Journal of Medicine</journal><volume>367</volume><journalNumber>1</journalNumber><paginationStart>40</paginationStart><paginationEnd>49</paginationEnd><publisher/><issnPrint>0028-4793</issnPrint><issnElectronic>1533-4406</issnElectronic><keywords>Fracture; Vitamin D; Prevention; Older People</keywords><publishedDay>31</publishedDay><publishedMonth>12</publishedMonth><publishedYear>2012</publishedYear><publishedDate>2012-12-31</publishedDate><doi>10.1056/NEJMoa1109617</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2015-12-08T11:01:04.4460358</lastEdited><Created>2012-11-20T08:47:30.3817630</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Heike A</firstname><surname>Bischoff-Ferrari</surname><order>1</order></author><author><firstname>Walter C</firstname><surname>Willett</surname><order>2</order></author><author><firstname>Endel J</firstname><surname>Orav</surname><order>3</order></author><author><firstname>Paul</firstname><surname>Lips</surname><order>4</order></author><author><firstname>Pierre J</firstname><surname>Meunier</surname><order>5</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><orcid>0000-0001-5225-000X</orcid><order>6</order></author><author><firstname>Leon</firstname><surname>Flicker</surname><order>7</order></author><author><firstname>John</firstname><surname>Wark</surname><order>8</order></author><author><firstname>Rebecca D</firstname><surname>Jackson</surname><order>9</order></author><author><firstname>Jane A</firstname><surname>Cauley</surname><order>10</order></author><author><firstname>Haakon E</firstname><surname>Meyer</surname><order>11</order></author><author><firstname>Michael</firstname><surname>Pfeifer</surname><order>12</order></author><author><firstname>Kerrie M</firstname><surname>Sanders</surname><order>13</order></author><author><firstname>Hannes B</firstname><surname>St&#xE4;helin</surname><order>14</order></author><author><firstname>Robert</firstname><surname>Theiler</surname><order>15</order></author><author><firstname>Bess</firstname><surname>Dawson-Hughes</surname><order>16</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2015-12-08T11:01:04.4460358 v2 13315 2012-11-20 A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false 2012-11-20 MEDS 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. Journal Article New England Journal of Medicine 367 1 40 49 0028-4793 1533-4406 Fracture; Vitamin D; Prevention; Older People 31 12 2012 2012-12-31 10.1056/NEJMoa1109617 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University 2015-12-08T11:01:04.4460358 2012-11-20T08:47:30.3817630 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Heike A Bischoff-Ferrari 1 Walter C Willett 2 Endel J Orav 3 Paul Lips 4 Pierre J Meunier 5 Ronan Lyons 0000-0001-5225-000X 6 Leon Flicker 7 John Wark 8 Rebecca D Jackson 9 Jane A Cauley 10 Haakon E Meyer 11 Michael Pfeifer 12 Kerrie M Sanders 13 Hannes B Stähelin 14 Robert Theiler 15 Bess Dawson-Hughes 16
title A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention
spellingShingle A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention
Ronan Lyons
title_short A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention
title_full A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention
title_fullStr A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention
title_full_unstemmed A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention
title_sort A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention
author_id_str_mv 83efcf2a9dfcf8b55586999d3d152ac6
author_id_fullname_str_mv 83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
author Ronan Lyons
author2 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
format Journal article
container_title New England Journal of Medicine
container_volume 367
container_issue 1
container_start_page 40
publishDate 2012
institution Swansea University
issn 0028-4793
1533-4406
doi_str_mv 10.1056/NEJMoa1109617
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 0
active_str 0
description 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.
published_date 2012-12-31T06:26:36Z
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