Vitamin D and calcium supplementation for reducing hip fractures in the elderly.
Osteoporosis is a serious worldwide health problem affecting almost all elderly people, which increases the risk for fractures. Osteoporotic fractures can affect any bone with hip fracture being the most serious. Vitamin D and calcium are known to have beneficial effects on bone and are often prescribed for bone health. This review critically analysed studies that evaluated whether Calcium and Vitamin D supplementation reduces the incidence of hip fractures in older adults when compared to a placebo or no intervention. PICO question: In elderly persons does calcium and vitamin D supplementation reduce the incidence of hip fractures compared with placebo or no intervention? Since studies of high quality were found, only meta-analysis and SR of RCT's and single RCT's were included. Included studies required to have a population aged 50 or over, comparing vitamin D and calcium supplementation against placebo or no intervention, and reporting hip fracture outcome separately. In single RCT's, one hip fracture must have occurred and each group must have at least 100 participants. The appropriate CASP tools were used to assess the quality of the studies. Vitamin D and calcium supplementation reduced hip fractures incidence in elderly (Avenell et al., 2009; Boonen et al., 2007; Chapuy et al., 1992). However, secondary analysis showed statistically significant reduction in hip fracture incidence only in institutionalised elderly and not living in community. Institutionalised elderly were more deficient of vitamin D at baseline when compared to community studies. An intake of 800-1,000IU vitamin D3 and 1..8 grams calcium daily might reduce hip fracture incidence in elderly people. Dairy products are the best source of these minerals. A good strategy would be considering subsidising dairy products for this age group and local manufacturers for increasing the amount of these minerals in their products. Health promotion and educating elderly and their carers about the importance of vitamin D and calcium intake might also be beneficial. Further research studies include considering a cost-benefit analysis of providing vitamin D and calcium supplements to those at more risk for fractures. This may be necessary in order to evaluate the effectiveness of calcium and vitamin D supplementation in reducing hip fractures in monetary terms. Additionally, more dose finding studies and studies addressing the male gender needs to be done.
Vitamin D, Calcium, Hip fractures, Osteoporosis, Older people
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