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High-dose vitamin D prevents fractures in some older people

Clinical question
Does vitamin D supplementation decrease falls or hip fractures in elderly patients?

Bottom line
This analysis showed that high doses of vitamin D -- 700 IU to 800 IU per day -- with calcium supplementation are needed to produce a benefit on important fractures in elderly people living in an institution. The effect was not seen in older people living in the community. (LOE = 1a)

Reference
Cranney A, Horsley T, O'Donnell S, et al. Effectiveness and Safety of Vitamin D in Relation to Bone Health. Evidence Report/Technology Assessment No. 158 (Prepared by the University of Ottawa Evidence-based Practice Center (UO-EPC) under Contract No. 290-02-0021. AHRQ Publication No. 07-E013. Rockville, MD: Agency for Healthcare Research and Quality. August 2007.
Link to free full-text AHRQ evidence report online

Study design: Meta-analysis (randomized controlled trials)

Setting: Various (meta-analysis)

Synopsis
Several meta-analyses have come to different conclusions regarding the effectiveness of vitamin D and calcium supplementation on important fractures in older people. This evidence report was compiled by the University of Ottawa Evidence-based Practice Center. To conduct their review they searched 6 databases, including the Cochrane Center Register of Controlled Trials, with 2 reviewers independently screening the literature and 2 researchers independently abstracting the data. The researchers graded the evidence but did not limit their analysis to high-quality studies. Vitamin D3 in doses of 400 IU to 800 IU per day without calcium supplementation did not reduce the risk of fractures. Higher doses -- 700 IU to 800 IU per day -- combined with calcium supplementation reduced both nonvertebral fractures and hip fractures. However, the researchers found via subgroup analysis that the effect on hip fractures is limited to older people living in institutions and is not seen in community-dwelling elderly. Vitamin D supplementation also has a small and inconsistent effect on the prevention of falls, reducing the likelihood by approximately 20% (odds ratio = 0.79; 95% CI, 0.65 - 0.96). Another recent meta-analysis found a similar decrease (Tang BM, et al. Lancet 2007;370:657-66).

Copyright© 2008 John Wiley & Sons, Inc. www.essentialevidence.com