Re: Calcium, Vitamin D and Hip Fracture

[Guest guest]

Hi folks:

Here is the abstract of a somewhat earlier paper by the same authors:

Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis.

Avenell A, Gillespie WJ, Gillespie LD, O'Connell DL.

Health Services Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, Scotland, UK, AB25 2ZD. a.avenell@...

BACKGROUND: Vitamin D and related compounds have been used to prevent fractures.

OBJECTIVES: To determine the effects of vitamin D or analogues, with or without calcium, in the prevention of fractures in older people.

SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group trials register, the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE, EMBASE, CINAHL, and reference lists of articles. Most recent search: March 2005.

SELECTION CRITERIA: Randomised or quasi-randomised trials comparing vitamin D or an analogue, alone or with calcium, against placebo, no intervention, or calcium, reporting fracture outcomes, in older people.

DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality, and extracted data. Data were pooled, where admissible, using the fixed-effect model, or random-effects model if the relative risks were heterogeneous.

MAIN RESULTS: Vitamin D alone showed no statistically significant effect on hip fracture (seven trials, 18,668 participants, RR 1.17, 95% CI 0.98 to 1.41), vertebral fracture (four trials, 5698 participants, RR (random effects) 1.13, 95% CI 0.50 to 2.55) or any new fracture (eight trials, 18,903 participants, RR 0.99, 95% CI 0.91 to 1.09).Vitamin D with calcium marginally reduced hip fractures (seven trials, 10,376 participants, RR 0.81, 95% CI 0.68 to 0.96), non-vertebral fractures (seven trials, 10,376 participants, RR 0.87, 95% CI 0.78 to 0.97), but there was no evidence of effect of vitamin D with calcium on vertebral fractures. The effect appeared to be restricted to those living in institutional care.Hypercalcaemia was more common when vitamin D or its analogues was given compared with placebo or calcium (14 trials, 8035 participants, RR 2.38, 95% CI 1.52 to 3.71). The risk was particularly high with calcitriol (three trials, 742 participants, RR 14.94, 95% CI 2.95 to 75.61). There was no evidence that vitamin D increased gastro-intestinal symptoms (seven trials, 10,188 participants, RR (random effects) 1.03, 95% CI 0.79 to 1.36) or renal disease (nine trials, 10,107 participants, RR 0.80, 95% CI 0.34 to 1.87).

AUTHORS' CONCLUSIONS: Frail older people confined to institutions may sustain fewer hip and other non-vertebral fractures if given vitamin D with calcium supplements. Effectiveness of vitamin D alone in fracture prevention is unclear. There is no evidence of advantage of analogues of vitamin D compared with vitamin D. Calcitriol may be associated with an increased incidence of adverse effects. Dose, frequency, and route of administration of vitamin D in older people require further investigation.

PMID: 16034849

Rodney.

>> Review: vitamin D plus calcium, but not vitamin D alone, prevents> osteoporotic fractures in older people> Avenell A, Gillespie WJ, Gillespie LD, et al.> > "Vitamin D and vitamin D analogues for preventing fractures associated> with involutional and post-menopausal osteoporosis."> > Cochrane Database Syst Rev 2005;(3):CD000227.> > Q In older people, does supplementation with vitamin D, with or without> calcium, reduce fractures?> > METHODS> Data sources 10 databases, lists of conference abstracts, bibliographies> of relevant studies, and contact with researchers in the field.> Study selection and assessment: randomised and quasirandomised> controlled trials (RCTs) that compared vitamin D or its analogue (with> or without calcium) with placebo, no intervention, or calcium alone in> postmenopausal women or men >65 years of age. Studies of patients on> corticosteroid therapy were excluded. 2 reviewers assessed study> quality.> Outcomes: new vertebral, hip, and other non-vertebral fractures and> adverse events.> MAIN RESULTS> 38 RCTs met the selection criteria. The quality of study methods ranged> from poor to satisfactory: 34% had concealment of allocation, and 54%> were blinded. Vitamin D alone did not prevent hip, vertebral, or any> fracture more than placebo or no treatment. Vitamin D plus calcium> prevented hip and non-vertebral fractures more than placebo or no> treatment, but not more than calcium alone. ................> Olof ell, MD, PhD> > Malmo University Hospital, Malmo, Sweden.> ======================================> The full text is free with registration.> PMID: 16034849> Rodney.>

[Guest guest]

It is disappointing to see studies that just focus on Vitamin D and

Calcium without controlling other variables. Bones consist of a

protein matrix, mostly collagen, which supports the calcium phosphate

crystals in the bone. Bones require calcium, phosphorus, magnesium,

fluoride, iron, zinc, copper, sodium, Vitamin D, Vitamin K, and

protein. The following paper has a good overview of all the

requirements for healthy bones:

Nutrition in Bone Health Revisited: A Story Beyond Calcium

http://www.jacn.org/cgi/content/full/19/6/715

" Overall, it appears that both low and high protein diets may be

detrimental to bone health. Low protein diets interfere with

intestinal Ca absorption and IGF-1 levels, and high protein diets

induce excess urine Ca loss. Diets containing moderate protein levels

(approximately 1.0†" 1.5 g/kg) are probably optimal for bone health. "

Notice that this is higher than the minimum of 0.8 g/kg which is the

RDA for protein. The suggested range corresponds to 70 to 100 grams

of protein per day for a 150 lb person.

Tony

http://www.scientificpsychic.com/health/vitamins.html

> >

> > Review: vitamin D plus calcium, but not vitamin D alone, prevents

> > osteoporotic fractures in older people

> > Avenell A, Gillespie WJ, Gillespie LD, et al.

> >

> > " Vitamin D and vitamin D analogues for preventing fractures associated

> > with involutional and post-menopausal osteoporosis. "

> >

> > Cochrane Database Syst Rev 2005;(3):CD000227.

> >

> > Q In older people, does supplementation with vitamin D, with or

> without

> > calcium, reduce fractures?

> >

> > METHODS

> > Data sources 10 databases, lists of conference abstracts,

> bibliographies

> > of relevant studies, and contact with researchers in the field.

> > Study selection and assessment: randomised and quasirandomised

> > controlled trials (RCTs) that compared vitamin D or its analogue (with

> > or without calcium) with placebo, no intervention, or calcium alone in

> > postmenopausal women or men >65 years of age. Studies of patients on

> > corticosteroid therapy were excluded. 2 reviewers assessed study

> > quality.

> > Outcomes: new vertebral, hip, and other non-vertebral fractures and

> > adverse events.

> > MAIN RESULTS

> > 38 RCTs met the selection criteria. The quality of study methods

> ranged

> > from poor to satisfactory: 34% had concealment of allocation, and 54%

> > were blinded. Vitamin D alone did not prevent hip, vertebral, or any

> > fracture more than placebo or no treatment. Vitamin D plus calcium

> > prevented hip and non-vertebral fractures more than placebo or no

> > treatment, but not more than calcium alone. ................

> > Olof ell, MD, PhD

> >

> > Malmo University Hospital, Malmo, Sweden.

> > ======================================

> > The full text is free with registration.

> > PMID: 16034849

> > Rodney.

> >

>