INTRODUCTION: Although a well-established component of bone metabolism, the efficacy and safety of vitamin D supplementation for the prevention of fractures in elderly healthy individuals is still unclear.
PURPOSE: To perform a meta-analysis comparing vitamin D supplementation with placebo and its contributions on fracture incidence.
METHODS: This meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO), under protocol CRD42023484979. We systematically searched PubMed, Embase, and Cochrane Central databases from inception to November 2023 for randomized controlled trials (RCTs) comparing vitamin D supplementation versus placebo in individuals with 60 years of age or more and without bone related medical conditions such as cancer and osteoporosis.
RESULTS: Seven RCTs with 71,899 patients were included, of whom 36,822 (51.2%) were women. There was no significant difference in total fracture incidence (RR 1.03; 95% CI 0.93-1.14; p = 0.56; I2 = 58%) between groups or subgroups. However, women had an increased risk for hip fractures (164 vs. 121 events; RR 1.34; 95% CI 1.06-1.70; p = 0.01; I2 = 0%). There was no significant difference in non-vertebral fractures, osteoporotic fractures development, or falls (RR 1.02; 95% CI 0.94-1.12; p = 0.6; I2 = 47%; RR 0.97; 95% CI 0.87-1.08; p = 0.63; I2 = 0%; RR 1.01; 95% CI 0.97-1.04; p = 0.66; I2 = 55%, respectively).
CONCLUSION: Vitamin D supplementation does not reduce the total fracture development rate in the elderly healthy population, and it may increase the incidence of hip fractures among elderly healthy women. This finding suggests refraining from prescribing high intermittent doses of vitamin D, without calcium, to individuals aged 60 or older with unknown vitamin D serum concentration or osteoporosis status and inadequate calcium intake.
| Discipline Area | Score |
|---|---|
| Geriatrics |  |
| Public Health | |
| Family Medicine (FM)/General Practice (GP) |  |
| General Internal Medicine-Primary Care(US) | |
I have several problems in judging the applicability of this analysis. No pre- or post-vitamin D levels are followed. Calcium supplementation in most of the included studies is not included, and the one study supplementing calcium is under the recommended levels for the average age group reported in this study.
I hope providers know this, but I suspect there are still many that are screening for Vit D and supplementing aggressively based on older cohort studies.
Vitamin D supplementation is not for all. This analysis underscores the lack of benefit and potential harm of blanket prescribing of Vit D supplements.
That Vit D supplementation can increase hip fracture risk in women is newsworthy, but this work raises more questions than it answers. High-dose Vit D supplements have been linked in RCTs to more falls, a potential pathway to more fractures. Is the hip fracture risk increased only with high-dose supplementation? Previous work has also suggested that Vit D benefits are limited to those who are Vit D deficient. Is the hip fracture risk only in those who are not Vit D deficient? Nevertheless, this finding is worth noting
Another article that reinforces that vitamin D supplementation is likely not effective for bone health.
The hypothesis testing in this study appears valid; that is, they made a comprehensive search for relevant studies and included appropriate studies in their meta-analysis. The results are not surprising since the lack of efficacy of Vit D supplementation in osteoporotic fractures in ambulatory women has been known for more than 20 years.
When in doubt, use caution. Do not go to any extremes until further information is available.
