Does Calcium and Vitamin D supplementation alone reduce the risk of fractures in at-risk patient?

Bottom Line:

The calcium and Vitamin D supplementation alone does not cause significant reduction in risk of fractures in at risk women. There is no data available for male population.

Review

Dawson [1] and group studied the calcium (about 500 mg) and Vitamin D (700 IU) supplementation in elderly men and women in ambulatory setting for a three year period. A clinically relevant reduction in nonvertebral fracture rates was noted in the in elderly white women not currently taking estrogen replacement. The similar can not be concluded for the elderly men. The meta-analysis by Biscoff [2] found heterogeneity among the clinical trials on this topic. When they separated the studies by different doses of Vitamin D, it was noted that Vitamin D doses of 700 IU to 800 IU per day resulted in a significant decrease in hip fractures. How ever, two large studies [3, 4] in patients at high risk or with a previous osteoporotic fracture for whom these doses did not decrease the rate of fracture. The latest results from the Women’s Health Initiative (WHI) published in NJEM [5] where the postmenopausal women who were given calcium (1000mg) and Vitamin D (400 IU) and followed for 7 year, revealed that among healthy postmenopausal women, calcium with vitamin D supplementation resulted in a small but significant improvement in hip bone density but there was no significant reduction in hip factures. One may think that if these women were given higher doses of Vitamin D may have given different results. But the Cochrane review [8] indicated that Vitamin D alone showed no statistically significant effect on hip fracture.

References

1. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997;337:670-6
2. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation. A meta-analysis of randomized controlled trials. JAMA 2005; 293:2257-64
3. Porthouse J, Cockayne S, King C, et at. Randomized Controlled trial of Calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. BMJ 2005;330: 1003-06
4. Grant AM, Avenell A, Campbell MK, et al, for the RECORD Trial Group. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomized Evaluation Of Calcium OR vitamin D, RECORD): a randomised placebo-controlled trial. Lancet 2005; 365:1621-28.
5. Jackson RD, et al. Calcium plus Vitamin D Supplementation and the Risk of Fractures. New England Journal of Medicine 354(7): 6690683 Feb 16, 2006.
6. Francis, Roger M. Calcium, vitamin D and involutional osteoporosis. Current Opinion in Clinical Nutritional and Metabolic Care, 2006, 9:13-17.
7. Feaskanich D, Willet WC, Coldotz GA. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. The Am J of Clin Nutri Vol 77, No. 2, 504-511, Feb 2003.
8. Avenell A, Gillespie WJ, Gillespie LD, O’Connell DL. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis (Cochrane Review). In: The Cochrane Library, Issue 1, 2006. Chichester, UK: John Wiley and Sons, Ltd.