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Submitted on July 3, 2006
Accepted on January 23, 2007
Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium (S.B., D.V.), and Division of Geriatric Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium (S.B.), Department of Endocrinology, VU University Medical Center, Amsterdam, The Netherlands (P.L.), Division of Endocrinology, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium (R.B., D.V.), Division of Aging and Division of Rheumatology, Immunology and Allergy, The Robert B. Brigham Arthritis and Musculoskeletal Diseases Clinical Research Center, Brigham and Women's Hospital, Boston, Massachusetts 02115 (H.A.B.-F.) and Department of Orthopaedics and Traumatology, AZ-VUB, Vrije University Brussels, B-1050 Brussels, Belgium (P.H.)
* To whom correspondence should be addressed. E-mail: steven.boonen{at}uz.kuleuven.ac.be.
Purpose: To extend the meta-analysis of Bischoff-Ferrari et al. (JAMA 2005;293:2257-2264), which found that vitamin D 700-800 IU/d reduced hip-fracture risk in elderly individuals by 25%, by defining the need for additional calcium supplementation in individuals receiving vitamin D for the prevention of hip fractures.
Data sources: MEDLINE® and EMBASE.com (search terms: "vitamin D" AND "hip fracture"), bibliographies of articles retrieved, and the authors' reference files.
Study selection: Randomized controlled trials (RCTs) of oral vitamin D with or without calcium supplementation vs. placebo/no treatment in postmenopausal women and/or older men (
50 yr) specifically reporting a risk of hip fracture.
Data extraction: Independent extraction by two authors using predefined criteria, including study quality indicators.
Data synthesis: All pooled analyses are based on random-effects models. Based on four RCTs (9083 patients), the pooled relative risk (RR) of hip fracture for vitamin D alone was 1.10 (95% confidence intervals [CI] 0.89, 1.36). No between-trial heterogeneity was observed. For the six RCTs (45,509 patients) of vitamin D with calcium supplementation, the pooled RR for hip fracture was 0.82 (95% CI 0.71, 0.94). There was no heterogeneity between trials. In an adjusted indirect comparison of the summary RRs from the two meta-analyses, the RR for hip fracture for vitamin D with calcium vs. vitamin D alone was 0.75 (95% CI 0.58, 0.96).
Conclusions: Our analyses, designed to extend the findings of Bischoff-Ferrari et al., suggest that oral vitamin D appears to reduce the risk of hip fractures only when calcium supplementation is added.
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