Vitamin Supplements Do Not Lower Fracture Risk

A new study suggests that prescribing calcium, vitamin D, or both is not associated with a lower risk of fractures among community-dwelling older adults.

Researchers at Tianjin First Central Hospital (TJFCH; Tianjin, China) and Cangzhou Hospital of Integrated Traditional and Western Medicine (Cangzhou, China) conducted a meta-analysis of studies from the PubMed, Cochrane library, and EMBASE databases in order to investigate if calcium, vitamin D, or combined supplements are associated with a lower fracture incidence in community-dwelling adults older than 50 years of age. Hip fracture was defined as the primary outcome, with secondary outcomes including nonvertebral fracture, vertebral fracture, and total fracture.

The analysis of 33 randomized clinical trials involving 51,145 adults over 50 who lived in nursing homes and other residential care facilities revealed no significant association of calcium or vitamin D with risk of hip fracture, compared to placebo or no treatment. The incidence of nonvertebral, vertebral, or total fractures was not associated with supplementation. The results were constant, regardless of calcium or vitamin D dose, sex, fracture history, dietary calcium intake, and baseline serum 25-hydroxyvitamin D concentration. The study was published on December 26, 2017, in JAMA.

“The increased social and economic burdens for osteoporosis-related fractures worldwide make the prevention of such injuries a major public health goal,” concluded lead author Jia-Guo Zhao, MD, of TJFCH, and colleagues. “Previous studies have reached mixed conclusions regarding the association between calcium, vitamin D, or combined calcium and vitamin D supplements and fracture incidence in older adults. These findings do not support the routine use of these supplements in community-dwelling older people.”

Calcium supplements, commonly recommended to the elderly, and particularly to postmenopausal women in order to maintain bone health and prevent osteoporosis, have also been suggested as beneficial agents to improve serum cholesterol profile and to control hypertension. However, no strong epidemiological evidence suggests that calcium supplementation might provide cardiovascular benefits, and one 2010 study suggests that using calcium supplements without co-administered vitamin D is associated with an increased risk of myocardial infarct (MI) in men.

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