What is the impact of daily oral supplementation of vitamin D3 (cholecalciferol) plus calcium on the incidence of hip fracture in older people? A systematic review and meta‐analysis
What this study found
Daily oral vitamin D3 plus calcium reduced hip fracture incidence and non-vertebral fractures in older adults. Across the included trials, hip fractures and non-vertebral fractures were lower with supplementation, and the effect appeared stronger for 800 IU vitamin D3 plus 1200 mg calcium than for 800 IU plus 1000 mg calcium. Femoral neck bone mineral density did not increase significantly. The review reported no statistical heterogeneity across studies.
- Study & population
- Systematic review and meta-analysis of 7 studies including 12,620 older adults, with 6060 in intervention arms and 6560 in control arms.
- Intervention
- Daily oral vitamin D3 plus calcium was evaluated across 7 randomized trials, with most regimens using vitamin D3 800 IU plus calcium 1000 to 1200 mg taken orally for 18 to 62 months.
- Key limitation
- The independent effects of calcium and vitamin D could not be separated because the interventions were combination regimens.
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Open PDFOriginal abstract
Abstract Introduction Hip fractures have a huge impact in reducing the quality of life and increasing mortality. This review aims to assess the impact of daily oral supplementation of vitamin D3 plus calcium on the incidence of hip fracture in people over 65 years. Methods PRISMA guidelines were followed and RCTs that evaluated the effectiveness of daily oral supplementation of vitamin D3 plus calcium in preventing hip fracture in adults over 65 years were included in the study. The databases such as Cochrane Library, Embase, Medline, PubMed, CINAHL, Web of Science and Scopus were searched from October 2019‐ January 2020.The Cochrane risk of bias tool was used to check the quality of the included studies. A meta‐analysis with fixed effect model using Review Manager (Revman 5.3) was used to analyse the data. Results The meta‐analysis of seven RCTs on vitamin D3 plus calcium supplementation and hip fracture (n = 12,620) identified odds ratio (OR) of 0.75; 95% Confidence interval (CI): 0.64, 0.87; p = .0003. Daily oral supplementation of 800 IU of Vitamin D3 plus 1200 mg of calcium was found more effective (n = 5676 participants; OR = 0.69; 95% CI: 0.58, 0.82; p < .0001) than daily oral supplementation of 800 IU of Vitamin D3 plus 1000 mg of calcium (n = 6555,OR = 1.08; 95% CI: 0.74, 1.56; p = .70) in reducing hip fracture. A meta‐analysis of the seven RCTs to identify the incidence of non‐vertebral fracture gave the OR of 0.80; 95% CI: 0.72, 0.89; p < .0001. A meta‐analysis of three RCTs on femoral neck bone mineral density (BMD) (n = 483) gave a mean difference of 1.21; 95% CI: ‐0.79, 3.20; p = .24. Conclusion Daily oral supplementation 800 IU of vitamin D3 plus 1200 mg of calcium reduces hip fracture and non‐vertebral fracture in older people. Administering vitamin D3 and calcium supplements had no effect in increasing the femoral neck BMD. Implications for practice Even though it is evident from the review that optimal daily intake of vitamin D3 plus calcium supplementation help in the prevention of fracture, it is only one essential element in fracture prevention. Also, people who are on dietary supplements should be compliant with same for better result. Efforts to prevent bone loss and osteoporosis should begin from an early age. It includes maintaining a healthy lifestyle, optimal intake of calcium and vitamin D3, proper nutrition, adequate exposure to sunlight, exercise etc. Proper education on healthy lifestyle, avoiding risk factors like smoking, caffeine, alcohol and awareness of bone health should continue throughout life with emphasis during menopause when increased bone loss is expected.