Vitamin D Supplementation and Fractures in Adults: A Systematic Umbrella Review of Meta-Analyses of Controlled Trials

被引：54

作者：

Chakhtoura, Marlene ^{[1
]}

Bacha, Dania S. ^{[1
]}

Gharios, Charbel ^{[1
]}

Ajjour, Sara ^{[1
]}

Assaad, Mariam ^{[1
]}

Jabbour, Yara ^{[1
]}

Kahale, Francesca ^{[1
]}

Bassatne, Aya ^{[1
]}

Antoun, Stephanie ^{[1
]}

Akl, Elie A. ^{[2
,3
]}

Bouillon, Roger ^{[4
]}

Lips, Paul ^{[5
]}

Ebeling, Peter R. ^{[6
]}

Fuleihan, Ghada El-Hajj ^{[1
]}

机构：

[1] Amer Univ Beirut, Med Ctr, WHO Collaborating Ctr Metab Bone Disorders, Calcium Metab & Osteoporosis Program, POB 113,6044-C8, Beirut 11072020, Lebanon

[2] Amer Univ Beirut, Med Ctr, Dept Internal Med, Beirut 11072020, Lebanon

[3] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON L8S 4L8, Canada

[4] Katholieke Univ Leuven, Dept Chron Dis Metab & Ageing, B-3000 Leuven, Belgium

[5] Univ Amsterdam, VU Univ, Med Ctr, Dept Internal Med,Endocrine Sect, NL-1007 MB Amsterdam, Netherlands

[6] Monash Univ, Sch Clin Sci, Dept Med, Clayton, Vic 3168, Australia

来源：

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM | 2022年 / 107卷 / 03期

基金：

美国国家卫生研究院;

关键词：

vitamin D; fractures; adults; umbrella review; RANDOMIZED CONTROLLED-TRIAL; DWELLING OLDER-ADULTS; HIP FRACTURE; CALCIUM SUPPLEMENTATION; ELDERLY-WOMEN; SECONDARY HYPERPARATHYROIDISM; UPDATED METAANALYSIS; PLUS CALCIUM; D DEFICIENCY; BONE HEALTH;

D O I：

10.1210/clinem/dgab742

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Context The growing number of systematic reviews/meta-analyses (SR/MAs) on vitamin D (+/- calcium) for fracture prevention has led to contradictory guidelines. Objective This umbrella review aims to assess the quality and explore the reasons for the discrepancy of SR/MAs of trials on vitamin D supplementation for fracture risk reduction in adults. Methods We searched 4 databases (2010-2020), Epistemonikos, and references of included SRs/MAs, and we contacted experts in the field. We used A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) for quality assessment. We compared results and investigated reasons for discordance using matrices and subgroup analyses (PROSPERO registration: CRD42019129540). We included 13 SR/MAs on vitamin D and calcium (Ca/D) and 19 SR/MAs on vitamin D alone, compared to placebo/control. Results Only 2 from 10 SRs/MAs on Ca/D were of moderate quality. Ca/D reduced the risk of hip fractures in 8 of 12 SRs/MAs (relative risk [RR] 0.61-0.84), and any fractures in 7 of 11 SR/MAs (RR 0.74-0.95). No fracture risk reduction was noted in SRs/MAs exclusively evaluating community-dwelling individuals or in those on vitamin D alone compared to placebo/control. Discordance in results between SRs/MAs stems from inclusion of different trials, related to search periods and eligibility criteria, and varying methodology (using intention to treat, per-protocol, or complete case analysis from individual trials). Conclusion Ca/D reduces the risk of hip and any fractures, possibly driven by findings from institutionalized individuals. Individual participant data meta-analyses of patients on Ca/D with sufficient follow-up periods, and subgroup analyses, would unravel determinants for a beneficial response to supplementation.

引用

页码：882 / 898

页数：17

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