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The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis.

The lancet. Diabetes & endocrinology
April 1, 2014
Mark J Bolland et al. (4 authors)
Journal ArticleMeta-AnalysisResearch Support, Non-U.S. Gov'tReviewHuman Study
Study Details

Study Goal

The researchers aimed to determine whether vitamin D supplementation, with or without calcium, reduces skeletal or non-skeletal outcomes such as fractures, cardiovascular events, cancer, and mortality.

Results Summary

The study found that vitamin D supplementation, with or without calcium, did not significantly reduce the risk of myocardial infarction, stroke, cancer, or total fracture by 15% or more. Calcium co-administered with vitamin D reduced hip fracture risk in institutionalized individuals but not in community-dwelling individuals.

Population

Unselected community-dwelling individuals and institutionalized individuals.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (9)
InterventionDirectionEndpointPopulationDosageImpactClaim #
vitamin D supplementation with or without calcium
no change
myocardial infarction or ischaemic heart disease
patients
by 15% or more
does not alter the relative risk
#1
vitamin D supplementation with or without calcium
no change
stroke or cerebrovascular disease
patients
by 15% or more
does not alter the relative risk
#2
vitamin D supplementation with or without calcium
no change
cancer
patients
by 15% or more
does not alter the relative risk
#3
vitamin D supplementation with or without calcium
no change
total fracture
patients
by 15% or more
does not alter the relative risk
#4
vitamin D supplementation alone
no change
hip fracture
patients
by 15% or more
did not reduce
#5
Vitamin D co-administered with calcium
decrease
hip fracture
institutionalised individuals
-
reduced
#6
Vitamin D co-administered with calcium
no change
hip fracture
community-dwelling individuals
by 15% or more
did not alter the relative risk
#7
vitamin D with or without calcium
decrease
death
-
-
reduces the risk
#8
vitamin D supplementation with or without calcium
no change
skeletal or non-skeletal outcomes
unselected community-dwelling individuals
by more than 15%
does not reduce
#9
Abstract

BACKGROUND: Vitamin D insufficiency is associated with many disorders, leading to calls for widespread supplementation. Some investigators suggest that more clinical trials to test the effect of vitamin D on disorders are needed. METHODS: We did a trial sequential meta-analysis of existing randomised controlled trials of vitamin D supplements, with or without calcium, to investigate the possible effect of future trials on current knowledge. We estimated the effects of vitamin D supplementation on myocardial infarction or ischaemic heart disease, stroke or cerebrovascular disease, cancer, total fracture, hip fracture, and mortality in trial sequential analyses using a risk reduction threshold of 5% for mortality and 15% for other endpoints. FINDINGS: The effect estimate for vitamin D supplementation with or without calcium for myocardial infarction or ischaemic heart disease (nine trials, 48 647 patients), stroke or cerebrovascular disease (eight trials 46 431 patients), cancer (seven trials, 48 167 patients), and total fracture (22 trials, 76 497 patients) lay within the futility boundary, indicating that vitamin D supplementation does not alter the relative risk of any of these endpoints by 15% or more. Vitamin D supplementation alone did not reduce hip fracture by 15% or more (12 trials, 27 834 patients). Vitamin D co-administered with calcium reduced hip fracture in institutionalised individuals (two trials, 3853 patients) but did not alter the relative risk of hip fracture by 15% or more in community-dwelling individuals (seven trials, 46 237 patients). There is uncertainty as to whether vitamin D with or without calcium reduces the risk of death (38 trials, 81 173). INTERPRETATION: Our findings suggest that vitamin D supplementation with or without calcium does not reduce skeletal or non-skeletal outcomes in unselected community-dwelling individuals by more than 15%. Future trials with similar designs are unlikely to alter these conclusions. FUNDING: Health Research Council of New Zealand.

Medical Subject Headings (MeSH)
AdultAgedAged, 80 and overBone DiseasesCalcium, DietaryDietary SupplementsEndpoint DeterminationFemaleHumansMaleMiddle AgedNeoplasmsRandomized Controlled Trials as TopicVascular DiseasesVitamin DVitamins
Study Links
Quality Scores
SafetyNot Assessed
Efficacy30/10
Quality85/10
Citation Metrics
Total Citations305
Citations/Year27.7
Relative Citation Ratio12.20
NIH Percentile98.5%
Research Impact Scores
APT Score0.95
Weight Score2.04
Normalized Score0.49
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