Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials
Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB, Orav EJ, Thoma A, Kiel DP, Henschkowski J
Archives of internal medicine · 477 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
- 2009-03-23 · Arch Intern Med · vol. 169 · número 6 · pág. 551
- Editorial
- American Medical Association
- Citado
- 776 citas · más que el 100% de estudios similares · 70.9× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 42 trabajos
- Acceso
- Acceso abierto (copia en repositorio) · OTHER-OA
- Áreas de investigación
- Vitamin D Research Studies · Bone health and osteoporosis research · Vitamin K Research Studies
- Palabras clave
- vitamin D supplementation, non-vertebral fractures, hip fracture, fracture prevention, dose-response relationship, older adults, calcium supplementation, 25-hydroxyvitamin D, medication adherence, community-dwelling older adults, institutionalized elderly
- MeSH
- humans, hip fractures, vitamin d, administration, oral, double-blind method, dose-response relationship, drug, dietary supplements, aged, randomized controlled trials as topic
9 autores
- Heike Annette Bischoff-Ferrari🇨🇭University of Zurich; University Hospital Zurich
- Walter Churchill Willett
- John B. Wong
- Andreas Ernst Stuck
- Hannes B. Staehelin
- Endel John Orav
- Anna Thoma
- Douglas P. Kiel
- Jana Henschkowski
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
Antifracture efficacy with supplemental vitamin D has been questioned by recent trials.
Methods
We performed a meta-analysis on the efficacy of oral supplemental vitamin D in preventing nonvertebral and hip fractures among older individuals (> or =65 years). We included 12 double-blind randomized controlled trials (RCTs) for nonvertebral fractures (n = 42 279) and 8 RCTs for hip fractures (n = 40 886) comparing oral vitamin D, with or without calcium, with calcium or placebo. To incorporate adherence to treatment, we multiplied the dose by the percentage of adherence to estimate the mean received dose (dose x adherence) for each trial.
Results
The pooled relative risk (RR) was 0.86 (95% confidence interval [CI], 0.77-0.96) for prevention of nonvertebral fractures and 0.91 (95% CI, 0.78-1.05) for the prevention of hip fractures, but with significant heterogeneity for both end points. Including all trials, antifracture efficacy increased significantly with a higher dose and higher achieved blood 25-hydroxyvitamin D levels for both end points. Consistently, pooling trials with a higher received dose of more than 400 IU/d resolved heterogeneity. For the higher dose, the pooled RR was 0.80 (95% CI, 0.72-0.89; n = 33 265 subjects from 9 trials) for nonvertebral fractures and 0.82 (95% CI, 0.69-0.97; n = 31 872 subjects from 5 trials) for hip fractures. The higher dose reduced nonvertebral fractures in community-dwelling individuals (-29%) and institutionalized older individuals (-15%), and its effect was independent of additional calcium supplementation.
Conclusion
Nonvertebral fracture prevention with vitamin D is dose dependent, and a higher dose should reduce fractures by at least 20% for individuals aged 65 years or older.
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