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Meta-Analysis
. 2016 Jan;27(1):367-76.
doi: 10.1007/s00198-015-3386-5. Epub 2015 Oct 28.

Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation

C M Weaver  1 , D D Alexander  2 , C J Boushey  3 , B Dawson-Hughes  4 , J M Lappe  5   6 , M S LeBoff  7 , S Liu  8 , A C Looker  9 , T C Wallace  10   11 , D D Wang  12
Affiliations
Meta-Analysis

Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation

C M Weaver et al. Osteoporos Int. 2016 Jan.

Erratum in

Abstract

The aim was to meta-analyze randomized controlled trials of calcium plus vitamin D supplementation and fracture prevention. Meta-analysis showed a significant 15 % reduced risk of total fractures (summary relative risk estimate [SRRE], 0.85; 95 % confidence interval [CI], 0.73-0.98) and a 30 % reduced risk of hip fractures (SRRE, 0.70; 95 % CI, 0.56-0.87).

Introduction: Calcium plus vitamin D supplementation has been widely recommended to prevent osteoporosis and subsequent fractures; however, considerable controversy exists regarding the association of such supplementation and fracture risk. The aim was to conduct a meta-analysis of randomized controlled trials [RCTs] of calcium plus vitamin D supplementation and fracture prevention in adults.

Methods: A PubMed literature search was conducted for the period from July 1, 2011 through July 31, 2015. RCTs reporting the effect of calcium plus vitamin D supplementation on fracture incidence were selected from English-language studies. Qualitative and quantitative information was extracted; random-effects meta-analyses were conducted to generate summary relative risk estimates (SRREs) for total and hip fractures. Statistical heterogeneity was assessed using Cochran's Q test and the I (2) statistic, and potential for publication bias was assessed.

Results: Of the citations retrieved, eight studies including 30,970 participants met criteria for inclusion in the primary analysis, reporting 195 hip fractures and 2231 total fractures. Meta-analysis of all studies showed that calcium plus vitamin D supplementation produced a statistically significant 15 % reduced risk of total fractures (SRRE, 0.85; 95 % confidence interval [CI], 0.73-0.98) and a 30 % reduced risk of hip fractures (SRRE, 0.70; 95 % CI, 0.56-0.87). Numerous sensitivity and subgroup analyses produced similar summary associations. A limitation is that this study utilized data from subgroup analysis of the Women's Health Initiative.

Conclusions: This meta-analysis of RCTs supports the use of calcium plus vitamin D supplements as an intervention for fracture risk reduction in both community-dwelling and institutionalized middle-aged to older adults.

Keywords: Calcium; Fracture; Supplement; Vitamin D.

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Figures

Fig. 1
Fig. 1
Flowchart for the selection of eligible studies
Fig. 2
Fig. 2
Calcium plus vitamin D supplementation versus placebo and total fracture. a Meta-analysis of eight RCTs. b Funnel plot of standard error by log rate ratio for calcium plus vitamin D supplementation and risk of total fracture. aBased on data from Table 6 in Prentice et al. [10] regarding adherence to study pills and no personal supplements. CI confidence interval, SSRE summary relative risk estimate
Fig. 3
Fig. 3
Calcium plus vitamin D supplementation versus placebo and hip fracture. a Meta-analysis of six RCTs. b Funnel plot of standard error by log rate ratio for calcium plus vitamin D supplementation and risk of hip fracture. aBased on data from Table 6 in Prentice et al. [10] regarding adherence to study pills and no personal supplements. CI confidence interval, SSRE summary relative risk estimate
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