Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults

Kahwati, Leila C.; Weber, Rachel Palmieri; Pan, Huiling; Gourlay, Margaret L.; LeBlanc, Erin S.; Coker‐Schwimmer, Manny; Viswanathan, Meera

doi:10.1001/jama.2017.21640

Cited by 177 publications

(159 citation statements)

References 38 publications

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“…This large study dominated the Cochrane meta‐analyses. In a more recent meta‐analyses by Kahwati and colleagues no increased incidence of stones was found. However, the recent evidence report compiled for the US Preventive Services Task Force (USPSTF) (which included the WHI and two studies by Lappe and colleagues) also found an increased risk for kidney stones in combined supplementation.…”

Section: Discussionmentioning

confidence: 88%

“…The increased risk occurs at lower concentrations of 25(OH)D in black Americans than in white Americans . Finally, a recent systematic analysis carried out for the US Public Health Task Force resulted in a recommendation against using vitamin D supplements for prevention of falls and fractures in community dwelling adults who do not have osteoporosis or vitamin D deficiency . This recommendation in part emanated from omitting studies that included subjects with vitamin D deficiency from consideration.…”

Section: Discussionmentioning

confidence: 99%

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Vitamin D Supplementation in Elderly Black Women Does Not Prevent Bone Loss: A Randomized Controlled Trial

Aloia

Fazzari

Islam

et al. 2018

Journal of Bone and Mineral Research

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Black Americans have lower levels of serum 25(OH)D but superior bone health compared to white Americans. There is controversy over whether they should be screened for vitamin D deficiency and have higher vitamin D requirements than recommended by the Institute of Medicine (IOM). The purpose of this trial was to determine whether Vitamin D supplementation in elderly black women prevents bone loss. A total of 260 healthy black American women, 60 years of age and older were recruited to take part in a two-arm, double-dummy 3-year randomized controlled trial (RCT) of vitamin D versus placebo. The study was conducted in an ambulatory clinical research center. Vitamin D dose was adjusted to maintain serum 25(OH)D above 75 nmol/L. Bone mineral density (BMD) and serum were measured for parathyroid hormone (PTH), C-terminal crosslink telopeptide (CTX), and bone-specific alkaline phosphatase (BSAP) every 6 months. Baseline serum 25(OH)D was 54.8 ± 16.8 nmol/L. There was no group × time interaction effect for any BMD measurement. For all BMD measurements, except for total body and spine, there was a statistically significant negative effect of time (p < 0.001). An equivalency analysis showed that the treatment group was equivalent to the control group. Serum PTH and BSAP declined, with a greater decline of PTH in the treatment group. The rate of bone loss with serum 25(OH)D above 75 nmol/L is comparable to the rate of loss with serum 25(OH)D at the Recommended Dietary Allowance (RDA) of 50 nmol/L. Black Americans should have the same exposure to vitamin D as white Americans. © 2018 American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Vitamin D Supplementation in Elderly Black Women Does Not Prevent Bone Loss: A Randomized Controlled Trial

Aloia

Fazzari

Islam

et al. 2018

Journal of Bone and Mineral Research

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“…12,13 The USPSTF analysed 11 randomized clinical trials (N = 51 419) in adults 50 years and older conducted over 2 to 7 years. 12,13 The USPSTF found adequate evidence that daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium has no benefit for the primary prevention of fractures in community-dwelling, post-menopausal women. 12,13 In…”

Section: Discussionmentioning

confidence: 99%

Circulating serum vitamin D levels and total body bone mineral density: A Mendelian randomization study

Sun

Zhao

Hou

et al. 2019

J Cellular Molecular Medi

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Until recently, randomized controlled trials have not demonstrated convincing evidence that vitamin D, or vitamin D in combination with calcium supplementation could improve bone mineral density (BMD), osteoporosis and fracture. It remains unclear whether vitamin D levels are causally associated with total body BMD. Here, we performed a Mendelian randomization study to investigate the association of vitamin D levels with total body BMD using a large‐scale vitamin D genome‐wide association study (GWAS) dataset (including 79 366 individuals) and a large‐scale total body BMD GWAS dataset (including 66,628 individuals). We selected three Mendelian randomization methods including inverse‐variance weighted meta‐analysis (IVW), weighted median regression and MR‐Egger regression. All these three methods did not show statistically significant association of genetically increased vitamin D levels with total body BMD. Importantly, our findings are consistent with recent randomized clinical trials and Mendelian randomization study. In summary, we provide genetic evidence that increased vitamin D levels could not improve BMD in the general population. Hence, vitamin D supplementation alone may not be associated with reduced fracture incidence among community‐dwelling adults without known vitamin D deficiency, osteoporosis, or prior fracture.

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“…Over the past two decades, laboratory and epidemiological studies have also suggested that low vitamin D status may be associated with a variety of health risks, including respiratory illnesses (infections and asthma), adverse pregnancy outcomes, and chronic diseases of adulthood, such as osteoporosis and cardiovascular disease . To date, clinical trials have contributed a limited amount of empirical evidence to support the beneficial effects of vitamin D, primarily on the risk of respiratory infections and some adverse pregnancy outcomes; however, there is limited evidence thus far from randomized clinical trials to support effects on health outcomes other than bone health …”

Section: Vitamin D Physiologymentioning

confidence: 99%

Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low‐ and middle‐income countries

Roth

Abrams

Aloia

et al. 2018

Annals of the New York Academy of Sciences

415

340

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Vitamin D is an essential nutrient for bone health and may influence the risks of respiratory illness, adverse pregnancy outcomes, and chronic diseases of adulthood. Because many countries have a relatively low supply of foods rich in vitamin D and inadequate exposure to natural ultraviolet B (UVB) radiation from sunlight, an important proportion of the global population is at risk of vitamin D deficiency. There is general agreement that the minimum serum/plasma 25-hydroxyvitamin D concentration (25(OH)D) that protects against vitamin D deficiency-related bone disease is approximately 30 nmol/L; therefore, this threshold is suitable to define vitamin D deficiency in population surveys. However, efforts to assess the vitamin D status of populations in low- and middle-income countries have been hampered by limited availability of population-representative 25(OH)D data, particularly among population subgroups most vulnerable to the skeletal and potential extraskeletal consequences of low vitamin D status, namely exclusively breastfed infants, children, adolescents, pregnant and lactating women, and the elderly. In the absence of 25(OH)D data, identification of communities that would benefit from public health interventions to improve vitamin D status may require proxy indicators of the population risk of vitamin D deficiency, such as the prevalence of rickets or metrics of usual UVB exposure. If a high prevalence of vitamin D deficiency is identified (>20% prevalence of 25(OH)D < 30 nmol/L) or the risk for vitamin D deficiency is determined to be high based on proxy indicators (e.g., prevalence of rickets >1%), food fortification and/or targeted vitamin D supplementation policies can be implemented to reduce the burden of vitamin D deficiency-related conditions in vulnerable populations.

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Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults

Abstract: Vitamin D supplementation alone or with calcium was not associated with reduced fracture incidence among community-dwelling adults without known vitamin D deficiency, osteoporosis, or prior fracture. Vitamin D with calcium was associated with an increase in the incidence of kidney stones.

Cited by 177 publications

References 38 publications

Vitamin D Supplementation in Elderly Black Women Does Not Prevent Bone Loss: A Randomized Controlled Trial

Vitamin D Supplementation in Elderly Black Women Does Not Prevent Bone Loss: A Randomized Controlled Trial

Circulating serum vitamin D levels and total body bone mineral density: A Mendelian randomization study

Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low‐ and middle‐income countries

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