Information sourced from NEJM Journal Watch:
Supplemental Calcium or Vitamin D Doesn’t Lower Fracture Risk in Community-Dwelling Adults
Guidelines that recommend supplementation for older adults living in institutions should not be applied to adults living independently.
Several guidelines recommend calcium, vitamin D, or both types of supplementation to prevent fractures in older adults (focusing mostly on frail elders and those living in institutions; Osteoporos Int 2010; 21:1151). In this meta-analysis, researchers identified 33 randomized controlled trials that involved community-dwelling adults (age, ≥50; total patients, 51,145). The trials comprised 44 separate studies (14 of calcium supplementation alone, 17 of vitamin D supplementation alone, and 13 of combined supplementation). Studies that involved patients with corticosteroid-induced osteoporosis, and those in which other drugs or dietary interventions were combined with vitamin D or calcium supplementation were excluded.
The pooled analyses for all three study clusters showed no benefit for any supplementation intervention in reducing relative risk for hip fracture (the primary outcome). Secondary outcomes (vertebral, nonvertebral, and total fractures) also were not affected by any of the interventions. The overall results applied to subgroups with 25-hydroxyvitamin D levels lower than 20 ng/mL or daily dietary calcium intake lower than 900 mg, to women, and to people with previous fractures.
A colleague of mine recently saw a healthy 56-year-old woman who was persistent in her desire for a vitamin D test. When the result came back at 13 ng/mL, she asked about supplementation. Her educational sophistication was such that she was given this meta-analysis and was told that no evidence supported supplementation but that the decision was hers. What she decided is not yet known.
These results clearly show that recommendations for calcium, vitamin D, or combined supplementation in frail older adults or those living in institutions should not be applied to community-living adults. The difference in outcomes with supplementation between these groups might be explained by higher fracture risk in frail or institutionalized elders.
Thomas L. Schwenk, MD reviewing Zhao J-G et al. JAMA 2017 Dec 26.
Zhao J-G et al. Association between calcium or vitamin D supplementation and fracture incidence in community-dwelling older adults: A systematic review and meta-analysis. JAMA 2017 Dec 26; 318:2466.
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