Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men

Avenell, Alison; Mak, Jenson; O’Connell, Dianne

doi:10.1002/14651858.cd000227.pub4

Cited by 358 publications

(348 citation statements)

References 238 publications

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“…The authors concluded there is high-quality evidence that vitamin D alone is unlikely to be effective in preventing hip fractures or fracture of any type. However, none of the trials included tested vitamin D3 at doses greater than 800 IU/ day and the authors speculate that higher daily doses may be needed to raise serum 25-hydroxyvitamin D (25(OH)D) concentrations sufficiently [1].…”

Section: An Overview Of Evidencementioning

confidence: 99%

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Vitamin D, bones and muscle: myth versus reality

et al. 2017

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ObjectivesEvidence regarding the efficacy and dosing of vitamin D on fall and fracture prevention, with or without calcium, is characterised by uncertainty.MethodsA panel of experts was organised at the First Australasian Conference on Sarcopenia and Frailty in Melbourne, Australia, in November 2016 to provide an interpretation of the current evidence and to give their opinions regarding the supplementation of vitamin D in three hypothetical cases.Results and ConclusionThe authors conclude that (i) target serum 25(OH)D concentration should be 50 to 60 nmol/L year round, with a conservative upper limit <100 nmol/L; (ii) change in serum concentrations at any given dose is highly variable among individuals; (iii) dosing interval may need to be <2 months to have a continuous benefit; (iv) a loading dose can raise levels to target quickly, but there is no evidence yet that this has any positive effect on falls or fracture outcomes; and (v) a maintenance dose of 1000 IU/day, or given as an equivalent dose weekly or monthly, is sufficient for most individuals.

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Section: An Overview Of Evidencementioning

confidence: 99%

“…For vitamin D plus calcium, the Cochrane review concluded there is high-quality evidence that this combination reduces hip fractures by 16% as well as the risk of any type of fracture [1]. A recent systematic review indicated that increasing calcium intake has no effect on fracture risk [6].…”

Section: An Overview Of Evidencementioning

confidence: 99%

Vitamin D, bones and muscle: myth versus reality

et al. 2017

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“…25,27,28 When vitamin D was combined with calcium, the RR reductions were significant for total or nonvertebral fracture [25][26][27][28][29] and hip fractures, 25,28 with two results non-significant for hip fractures. 26,29 Two of the systematic reviews 26,29 found that higher doses of vitamin D (>400 IU or a median dose of 800 IU) resulted in better and statistically significant RR reductions for nonvertebral and hip fractures.…”

Section: Systematic Reviews/meta-analysesmentioning

confidence: 99%

Vitamin D: A Narrative Review Examining the Evidence for Ten Beliefs

Allan

Cranston²,

Lindblad

et al. 2016

J GEN INTERN MED

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Over the past decade, a large body of observational evidence has suggested an association between lower vitamin D status (25-hydroxyvitamin D) and multiple acute and chronic disorders, including cancer, multiple sclerosis, depression and respiratory tract infections. This evidence has fostered the hypothesis that increasing vitamin D intake may treat and prevent such disorders. Our objective was to perform a critical analysis of the highestlevel evidence for ten common beliefs regarding vitamin D for the prevention of falls, fractures and respiratory tract infections, the reduction of cancer incidence/mortality and overall mortality, and the prevention or treatment of depression/mental well-being, rheumatoid arthritis and multiple sclerosis, as well as maximum dosing and regular testing. We searched the Cochrane Database of Systematic Reviews and PubMed (up to August 2014) for randomized controlled trials and systematic reviews/ meta-analyses based on those studies. All searches were performed, all evidence reviewed and each section written by at least two authors. The evidence shows that vitamin D supplementation provides some benefit in fracture prevention (likely ∼10-15 % relative reduction), particularly at a dose ≥800 IU and with calcium; a likely benefit in the rate of falls, though it is less clear whether the number of fallers changes; and a possible small (∼5 %) relative reduction in mortality. Evidence does not support the use of vitamin D supplementation for the prevention of cancer, respiratory infections or rheumatoid arthritis. Similarly, evidence does not support vitamin D supplementation for the treatment of multiple sclerosis and rheumatoid arthritis or for improving depression/mental well-being. Regular testing of 25-hydroxyvitamin D is generally not required, and mega-doses (≥300,000 IU) appear to increase harms. Much of the evidence is at high risk of bias, with multiple flaws, including analyses of secondary endpoints, small and underpowered studies, inconsistent results and numerous other issues. Therefore, enthusiasm for a vitamin D panacea should be tempered.

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“…Preventative measures such as exercise, education and vitamin D supplements have been shown to have a non- or inconclusive effect in the residential care facility population (Avenell, Mak, & O’Connell, 2014; Bunn et al, 2014; Cameron et al, 2012). Although a review of complex multifactorial intervention programs has shown a reduction of recurrent fallers (Vlaeyen et al, 2015), there are considerable barriers for implementation outside the highly controlled circumstances of a study (Vlaeyen et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

There is more to life than risk avoidance – elderly people’s experiences of falls, fall-injuries and compliant flooring

Gustavsson

Jernbro

Nilson

2018

International Journal of Qualitative Studies on Health and Well

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Purpose: Falls are the most common cause of injury in all ages and are especially difficult to prevent among residential care residents. Compliant flooring that absorbs energy generated within the fall, has been proposed as a measure to prevent fall-injury, however little is known regarding the implementation aspects in clinical settings. The aim of this study is to explore the experiences of falls, the risk of fall-injury, prevention in general and specifically compliant flooring as an injury preventative measure amongst frail elderly people living in a residential care facility with compliant flooring. Through this, generate a theory that further explains the underlying barriers of active prevention amongst elderly people. Method: We used the grounded theory method and conducted semi-structured in-depth interviews with eight elderly people in residential care (data collected between February and December 2017). Results: The identified categories were Falling as a part of life, Fearing the consequences and A wish to prevent falls and injuries. Through the results it was clear that There is more to life than risk avoidance, permeated the interviews, therefore forming the grounded theory. The interviewees viewed falls as something common and normal, and were uninterested in focusing on the risk of falls. Although they wanted to prevent falls, it was often difficult to integrate preventative measures into their everyday life. They embraced the idea of an injury-reducing compliant flooring, however their main interests lay elsewhere, preferring to focus on social interaction and issues concerning daily activities. Conclusions: The theory generated in this paper proposes explanations on the obstacles of implementing fall prevention measures in an elderly frail population. The findings give insights as to why interest and compliance for active fall prevention measures are low. We conclude that complaint flooring, from the perspective of the residents, can work well in residential care.

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Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men

Abstract: Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men.

Cited by 358 publications

References 238 publications

Vitamin D, bones and muscle: myth versus reality

Vitamin D, bones and muscle: myth versus reality

Vitamin D: A Narrative Review Examining the Evidence for Ten Beliefs

There is more to life than risk avoidance – elderly people’s experiences of falls, fall-injuries and compliant flooring

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