What is the impact of daily oral supplementation of vitamin D3 (cholecalciferol) plus calcium on the incidence of hip fracture in older people? A systematic review and meta-analysis.
Preethy Manoj, Rosemarie Derwin, Sherly George
PMID 35842938WHAT IT FOUND
Daily oral vitamin D3 plus calcium reduced hip fractures by about 25% in older adults.
The benefit was seen in trials using 800 IU vitamin D3 plus 1200 mg calcium, not in trials using 800 IU vitamin D3 plus 1000 mg calcium.
Key findings
01Meta-analysis of seven RCTs found daily oral vitamin D3 plus calcium lowered hip fracture odds (OR 0.75; 95% CI 0.64 to 0.87; p = .0003), about a 25% reduction.
02In subgroup analyses, trials using 800 IU vitamin D3 plus 1200 mg calcium showed a hip fracture reduction (OR 0.69; 95% CI 0.58 to 0.82; p < .0001), while trials using 800 IU vitamin D3 plus 1000 mg calcium did not (OR 1.08; 95% CI 0.74 to 1.56; p = .70).
03Vitamin D3 plus calcium did not significantly increase femoral neck bone mineral density (mean difference 1.21; 95% CI -0.79 to 3.20; p = .24).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review only included English-language studies conducted in developed countries, so the findings may not apply to other populations. Risk of bias was not uniformly low: allocation concealment was unclear in most studies, and some studies had selection or attrition bias concerns. The included trials used vitamin D3 plus calcium together, so the independent effect of either component cannot be identified. Baseline vitamin D levels were not reported, so response may vary by initial vitamin D status. The femoral neck bone mineral density analysis included only 483 participants from three studies.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not read the 25% hip fracture reduction as proof that vitamin D alone prevents fractures, or that supplementation improves femoral neck bone density. The trials tested vitamin D3 plus calcium together, and the femoral neck bone mineral density result was not statistically significant.