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J Clin Endocrinol Metab. 2007 Apr;92(4):1415-23. Epub 2007 Jan 30.

Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative metaanalysis of randomized controlled trials.

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  • 1Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Belgium, and Brigham and Women's Hospital, Boston, MA 02115, USA.



The purpose of this study was to extend the metaanalysis of Bischoff-Ferrari et al., which found that 700-800 IU/d vitamin D reduced hip fracture risk in elderly individuals by 25%, by defining the need for additional calcium supplementation in individuals receiving vitamin D for the prevention of hip fractures.


MEDLINE and (search terms: "vitamin D" and "hip fracture"), bibliographies of articles retrieved, and the authors' reference files were used as data sources.


Selected studies were randomized controlled trials (RCTs) of oral vitamin D with or without calcium supplementation vs. placebo/no treatment in postmenopausal women and/or older men (>or=50 yr) specifically reporting a risk of hip fracture.


Independent extraction was performed by two authors using predefined criteria, including study quality indicators.


All pooled analyses are based on random-effects models. Based on four RCTs (9083 patients), the pooled relative risk (RR) of hip fracture for vitamin D alone was 1.10 [95% confidence intervals (CI) 0.89, 1.36]. No between-trial heterogeneity was observed. For the six RCTs (45,509 patients) of vitamin D with calcium supplementation, the pooled RR for hip fracture was 0.82 (95% CI 0.71, 0.94). There was no heterogeneity between trials. In an adjusted indirect comparison of the summary RRs from the two metaanalyses, the RR for hip fracture for vitamin D with calcium vs. vitamin D alone was 0.75 (95% CI 0.58, 0.96).


Our analyses, designed to extend the findings of Bischoff-Ferrari et al., suggest that oral vitamin D appears to reduce the risk of hip fractures only when calcium supplementation is added.

[PubMed - indexed for MEDLINE]
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