Vitamin D Supplementation and Fracture Incidence in Elderly Persons

Elderly men and women aged 70 years and older were recruited in Amsterdam and surrounding areas from general practitioners, apartment houses, and homes for the elderly. In the vitamin D group, the demographic extraction included 958 women and 333 men, with mean age 80.0 ± 5.9 years (range 70 to 97).

Vitamin D3 400 IU was given orally as one tablet daily for 3 to 3.5 years, with follow-up extending up to 4 years. Participants were also advised to consume at least three servings of dairy products per day to help maintain calcium intake of 800 to 1000 mg/day, and additional vitamin D supplements and multivitamins were discouraged.

Daily vitamin D3 did not reduce hip fractures or other peripheral fractures in this Dutch elderly population. In the intention-to-treat analysis, hip fractures occurred in 58 vitamin D participants versus 48 placebo participants (P = 0.39; HRR 1.18, 95% CI 0.81 to 1.71), and other peripheral fractures occurred in 77 versus 74 (P = 0.86; HRR 1.03, 95% CI 0.75 to 1.40). Mortality was also not significantly different, with 282 deaths in the vitamin D group versus 306 in placebo (P = 0.20). Subgroup analyses in apartment house or home residents and in adults aged 80 years or older were similarly null.

Follow-up was limited to a median of 3.5 years, with a maximum of 4 years, which may have constrained the ability to detect longer-term fracture effects. The trial was conducted in Dutch elderly adults from a single geographic setting, limiting generalizability, and ethnicity was not reported. No benefit emerged in subgroup analyses or in the active-treatment estimates, reducing confidence that a clinically meaningful effect was missed.