Impact of vitamin D supplementation on falls and fractures-A critical appraisal of the quality of the evidence and an overview of the available guidelines.
Study Goal
The researchers aimed to systematically assess the quality of evidence evaluating the effect of vitamin D and calcium supplementation (CaD) on falls and fractures.
Results Summary
CaD may reduce the risk of falls inconsistently but shows a protective effect in reducing hip fractures by 16-33% and any fracture by 5-19%, particularly in institutionalized individuals. The evidence is limited by methodological variability and heterogeneity.
Population
Institutionalized individuals and community-dwelling adults.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
Vitamin D and calcium supplementation (CaD) | decrease | falls | institutionalized individuals and/or those from the community | - | may reduce the risk | #1 |
Vitamin D and calcium supplementation (CaD) | decrease | hip fracture | community-dwelling and institutionalized individuals | 16-33% | reducing the risk | #2 |
Vitamin D and calcium supplementation (CaD) | decrease | any fracture | community-dwelling and institutionalized individuals | 5-19% | reducing the risk | #3 |
Vitamin D and calcium supplementation (CaD) | decrease | fracture (hip and any fracture) | institutionalized and community individuals | - | reduces the risk | #4 |
INTRODUCTION: The beneficial effect of vitamin D supplementation on musculo-skeletal outcomes have been recently questioned and recommendations regarding supplementation vary widely. The aim of this paper is to systematically assess the quality of the evidence evaluating the effect of vitamin D supplementation on falls and fractures. METHODS: We conducted a systematic search in Medline, PubMed, and Embase and selected systematic reviews (SRs) / meta-analyses (MAs) of randomized controlled trials (RCTs) on vitamin D supplementation and falls or fracture, published between 2012 - 2018. We identified 5 MAs of RCTs on falls, 4 on fractures and 4 on both outcomes. We applied the critical appraisal tool "A MeaSurement Tool to Assess systematic Reviews 2" - AMSTAR 2 - to assess the quality of the identified MAs. RESULTS: Vitamin D and calcium supplementation (CaD), compared to calcium only or placebo, may reduce the risk of falls, in institutionalized individuals and/or those from the community, but the data is inconsistent. The largest and most consistent evidence for a protective effect of CaD, compared to placebo or control, is in reducing the risk of hip fracture, by 16-33%, and any fracture, by 5-19%. This effect was demonstrated when combining trials in community-dwelling and institutionalized individuals, potentially driven by data from institutionalized individuals as shown in 3 SRs/MAs. Major limitations to the quality of the evidence include variability in the methodology of MAs, but more importantly, differences between trials in terms of subjects' characteristics, vitamin D regimens, outcome definition and ascertainment, risk of bias, trial duration and/or low power. The quality of the included MAs was moderate to critically low. CONCLUSIONS: While the effect on falls is inconsistent, CaD reduces the risk of fracture (hip and any fracture), as shown in meta-analyses pooling data of studies combining institutionalized and community individuals. The evidence is however limited by major shortcomings and heterogeneity.