Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials
Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B
JAMA · 896 citas
Etiquetas de revisión
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Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 2005-05-10 · JAMA · vol. 293 · número 18 · pág. 2257
- Editorial
- American Medical Association
- Citado
- 1,530 citas · más que el 100% de estudios similares · 80.5× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 47 trabajos
- Acceso
- De pago
- Áreas de investigación
- Vitamin D Research Studies · Bone health and osteoporosis research · Vitamin K Research Studies
- Palabras clave
- vitamin D supplementation, fracture prevention, hip fracture, non-vertebral fractures, older adults, vitamin D3, vitamin D2, calcium supplementation, vitamin D dose, falls, bone mineral density, osteoporosis, fracture risk reduction, vitamin D deficiency, falls in older adults
- MeSH
- humans, cholecalciferol, ergocalciferols, vitamin d, dietary supplements, aged, fractures, bone, randomized controlled trials as topic
6 autores
- Heike Annette Bischoff-Ferrari🇺🇸Harvard University
- Walter Churchill Willett
- John B. Wong
- Edward L. Giovannucci
- Thomas Dietrich
- Bess Dawson‐Hughes
Resumen
El texto original del estudio, en el idioma en que se publicó.
Context
The role and dose of oral vitamin D supplementation in nonvertebral fracture prevention have not been well established.
Objective
To estimate the effectiveness of vitamin D supplementation in preventing hip and nonvertebral fractures in older persons.
Data sources
A systematic review of English and non-English articles using MEDLINE and the Cochrane Controlled Trials Register (1960-2005), and EMBASE (1991-2005). Additional studies were identified by contacting clinical experts and searching bibliographies and abstracts presented at the American Society for Bone and Mineral Research (1995-2004). Search terms included randomized controlled trial (RCT), controlled clinical trial, random allocation, double-blind method, cholecalciferol, ergocalciferol, 25-hydroxyvitamin D, fractures, humans, elderly, falls, and bone density.
Study selection
Only double-blind RCTs of oral vitamin D supplementation (cholecalciferol, ergocalciferol) with or without calcium supplementation vs calcium supplementation or placebo in older persons (> or =60 years) that examined hip or nonvertebral fractures were included.
Data extraction
Independent extraction of articles by 2 authors using predefined data fields, including study quality indicators.
Data synthesis
All pooled analyses were based on random-effects models. Five RCTs for hip fracture (n = 9294) and 7 RCTs for nonvertebral fracture risk (n = 9820) met our inclusion criteria. All trials used cholecalciferol. Heterogeneity among studies for both hip and nonvertebral fracture prevention was observed, which disappeared after pooling RCTs with low-dose (400 IU/d) and higher-dose vitamin D (700-800 IU/d), separately. A vitamin D dose of 700 to 800 IU/d reduced the relative risk (RR) of hip fracture by 26% (3 RCTs with 5572 persons; pooled RR, 0.74; 95% confidence interval [CI], 0.61-0.88) and any nonvertebral fracture by 23% (5 RCTs with 6098 persons; pooled RR, 0.77; 95% CI, 0.68-0.87) vs calcium or placebo. No significant benefit was observed for RCTs with 400 IU/d vitamin D (2 RCTs with 3722 persons; pooled RR for hip fracture, 1.15; 95% CI, 0.88-1.50; and pooled RR for any nonvertebral fracture, 1.03; 95% CI, 0.86-1.24).
Conclusions
Oral vitamin D supplementation between 700 to 800 IU/d appears to reduce the risk of hip and any nonvertebral fractures in ambulatory or institutionalized elderly persons. An oral vitamin D dose of 400 IU/d is not sufficient for fracture prevention.
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