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A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention

Identifieur interne : 005F30 ( Main/Exploration ); précédent : 005F29; suivant : 005F31

A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention

Auteurs : Heike A. Bischoff-Ferrari [Suisse] ; Walter C. Willett [États-Unis] ; Endel J. Oray [États-Unis] ; Paul Lips [Pays-Bas] ; Pierrej. Meunier [France] ; Ronan A. Lyons [Royaume-Uni] ; Leon Flicker [Royaume-Uni] ; John Wark [Australie] ; Rebecca D. Jackson [États-Unis] ; Jane A. Cauley [États-Unis] ; Haakon E. Meyer [États-Unis] ; Michael Pfeifer [Allemagne] ; Kerrie M. Sanders [Australie] ; Hannes B. St Helin [Suisse] ; Robert Theiler [Suisse] ; Bess Dawson-Hughes [États-Unis]

Source :

RBID : Pascal:12-0280096

Descripteurs français

English descriptors

Abstract

BACKGROUND The results of meta-analyses examining the relationship between vitamin D supplementation and fracture reduction have been inconsistent. METHODS We pooled participant-level data from 11 double-blind, randomized, controlled trials of oral vitamin D supplementation (daily, weekly, or every 4 months), with or without calcium, as compared with placebo or calcium alone in persons 65 years of age or older. Primary end points were the incidence of hip and any nonvertebral fractures according to Cox regression analyses, with adjustment for age group, sex, type of dwelling, and study. Our primary aim was to compare data from quartiles of actual intake of vitamin D (including each individual participant's adherence to the treatment and supplement use outside the study protocol) in the treatment groups of all trials with data from the control groups. RESULTS We included 31,022 persons (mean age, 76 years; 91% women) with 1111 incident hip fractures and 3770 nonvertebral fractures. Participants who were randomly assigned to receive vitamin D, as compared with those assigned to control groups, had a nonsignificant 10% reduction in the risk of hip fracture (hazard ratio, 0.90; 95% confidence interval [CI], 0.80 to 1.01) and a 7% reduction in the risk of nonvertebral fracture (hazard ratio, 0.93; 95% CI, 0.87 to 0.99). By quartiles of actual intake, reduction in the risk of fracture was shown only at the highest intake level (median, 800 IU daily; range, 792 to 2000), with a 30% reduction in the risk of hip fracture (hazard ratio, 0.70; 95% CI, 0.58 to 0.86) and a 14% reduction in the risk of any non-vertebral fracture (hazard ratio, 0.86; 95% CI, 0.76 to 0.96). Benefits at the highest level of vitamin D intake were fairly consistent across subgroups defined by age group, type of dwelling, baseline 25-hydroxyvitamin D level, and additional calcium intake. CONCLUSIONS High-dose vitamin D supplementation (≥800 IU daily) was somewhat favorable in the prevention of hip fracture and any nonvertebral fracture in persons 65 years of age or older. (Funded by the Swiss National Foundations and others.).


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Le document en format XML

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<title xml:lang="en" level="a">A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention</title>
<author>
<name sortKey="Bischoff Ferrari, Heike A" sort="Bischoff Ferrari, Heike A" uniqKey="Bischoff Ferrari H" first="Heike A." last="Bischoff-Ferrari">Heike A. Bischoff-Ferrari</name>
<affiliation wicri:level="1">
<inist:fA14 i1="01">
<s1>Center on Aging and Mobility, University of Zurich and Waid City Hospital, Zurich, and the Department of Rheumatology, University Hospital Zurich</s1>
<s2>Zurich</s2>
<s3>CHE</s3>
<sZ>1 aut.</sZ>
</inist:fA14>
<country>Suisse</country>
<wicri:noRegion>Zurich</wicri:noRegion>
</affiliation>
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<name sortKey="Willett, Walter C" sort="Willett, Walter C" uniqKey="Willett W" first="Walter C." last="Willett">Walter C. Willett</name>
<affiliation wicri:level="3">
<inist:fA14 i1="04">
<s1>Departments of Nutrition, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University</s1>
<s2>Boston</s2>
<s3>USA</s3>
<sZ>2 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<placeName>
<settlement type="city">Boston</settlement>
<region type="state">Massachusetts</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Oray, Endel J" sort="Oray, Endel J" uniqKey="Oray E" first="Endel J." last="Oray">Endel J. Oray</name>
<affiliation wicri:level="3">
<inist:fA14 i1="05">
<s1>Biostatistics, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University</s1>
<s2>Boston</s2>
<s3>USA</s3>
<sZ>3 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<placeName>
<settlement type="city">Boston</settlement>
<region type="state">Massachusetts</region>
</placeName>
</affiliation>
</author>
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<name sortKey="Lips, Paul" sort="Lips, Paul" uniqKey="Lips P" first="Paul" last="Lips">Paul Lips</name>
<affiliation wicri:level="3">
<inist:fA14 i1="07">
<s1>Department of Internal Medicine and Endocrinology and the EMGO Institute for Health and Care Research, VU University Medical Center</s1>
<s2>Amsterdam</s2>
<s3>NLD</s3>
<sZ>4 aut.</sZ>
</inist:fA14>
<country>Pays-Bas</country>
<placeName>
<settlement type="city">Amsterdam</settlement>
<region nuts="2" type="province">Hollande-Septentrionale</region>
</placeName>
</affiliation>
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<name sortKey="Meunier, Pierrej" sort="Meunier, Pierrej" uniqKey="Meunier P" first="Pierrej." last="Meunier">Pierrej. Meunier</name>
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<inist:fA14 i1="08">
<s1>Claude Bernard University of Lyon</s1>
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</inist:fA14>
<country>France</country>
<placeName>
<region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
<settlement type="city">Lyon</settlement>
</placeName>
</affiliation>
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<name sortKey="Lyons, Ronan A" sort="Lyons, Ronan A" uniqKey="Lyons R" first="Ronan A." last="Lyons">Ronan A. Lyons</name>
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<s1>Department of Public Health, Swansea University</s1>
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<country>Royaume-Uni</country>
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</affiliation>
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<name sortKey="Flicker, Leon" sort="Flicker, Leon" uniqKey="Flicker L" first="Leon" last="Flicker">Leon Flicker</name>
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</inist:fA14>
<country>Royaume-Uni</country>
<wicri:noRegion>Crawley</wicri:noRegion>
</affiliation>
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<name sortKey="Wark, John" sort="Wark, John" uniqKey="Wark J" first="John" last="Wark">John Wark</name>
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<inist:fA14 i1="11">
<s1>Department of Medicine, Bone and Mineral Service, Royal Melbourne Hospital, Barwon Health University of Melbourne, Melbourne, VIC</s1>
<s3>AUS</s3>
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</inist:fA14>
<country>Australie</country>
<wicri:noRegion>Department of Medicine, Bone and Mineral Service, Royal Melbourne Hospital, Barwon Health University of Melbourne, Melbourne, VIC</wicri:noRegion>
<orgName type="university">Université de Melbourne</orgName>
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<settlement type="city">Melbourne</settlement>
<region type="état">Victoria (État)</region>
</placeName>
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<name sortKey="Jackson, Rebecca D" sort="Jackson, Rebecca D" uniqKey="Jackson R" first="Rebecca D." last="Jackson">Rebecca D. Jackson</name>
<affiliation wicri:level="1">
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<s1>Departments of Internal Medicine, Endocrinology, Diabetes, and Metabolism, Ohio State University</s1>
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<sZ>9 aut.</sZ>
</inist:fA14>
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<name sortKey="Cauley, Jane A" sort="Cauley, Jane A" uniqKey="Cauley J" first="Jane A." last="Cauley">Jane A. Cauley</name>
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<s1>Department of Epidemiology, University of Pittsburgh</s1>
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</inist:fA14>
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<settlement type="city">Pittsburgh</settlement>
<region type="state">Pennsylvanie</region>
<settlement type="city">Pittsburgh</settlement>
</placeName>
<orgName type="university">Université de Pittsburgh</orgName>
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<name sortKey="Meyer, Haakon E" sort="Meyer, Haakon E" uniqKey="Meyer H" first="Haakon E." last="Meyer">Haakon E. Meyer</name>
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<s1>University of Oslo and Norwegian Institute of Public Health</s1>
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<country>États-Unis</country>
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<settlement type="city">Oslo</settlement>
<region nuts="2">Østlandet</region>
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<name sortKey="Pfeifer, Michael" sort="Pfeifer, Michael" uniqKey="Pfeifer M" first="Michael" last="Pfeifer">Michael Pfeifer</name>
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<s1>Institute of Clinical Osteology and German Osteology Foundation, Bad Pyrmont</s1>
<s3>DEU</s3>
<sZ>12 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<wicri:noRegion>Bad Pyrmont</wicri:noRegion>
<wicri:noRegion>Institute of Clinical Osteology and German Osteology Foundation, Bad Pyrmont</wicri:noRegion>
</affiliation>
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<name sortKey="Sanders, Kerrie M" sort="Sanders, Kerrie M" uniqKey="Sanders K" first="Kerrie M." last="Sanders">Kerrie M. Sanders</name>
<affiliation wicri:level="4">
<inist:fA14 i1="12">
<s1>Department of Clinical and Biomedical Sciences, Barwon Health University of Melbourne, Melbourne, VIC</s1>
<s3>AUS</s3>
<sZ>13 aut.</sZ>
</inist:fA14>
<country>Australie</country>
<wicri:noRegion>Department of Clinical and Biomedical Sciences, Barwon Health University of Melbourne, Melbourne, VIC</wicri:noRegion>
<orgName type="university">Université de Melbourne</orgName>
<placeName>
<settlement type="city">Melbourne</settlement>
<region type="état">Victoria (État)</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="St Helin, Hannes B" sort="St Helin, Hannes B" uniqKey="St Helin H" first="Hannes B." last="St Helin">Hannes B. St Helin</name>
<affiliation wicri:level="1">
<inist:fA14 i1="03">
<s1>Department of Geriatrics, University Hospital Basel</s1>
<s2>Basel</s2>
<s3>CHE</s3>
<sZ>14 aut.</sZ>
</inist:fA14>
<country>Suisse</country>
<wicri:noRegion>Basel</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Theiler, Robert" sort="Theiler, Robert" uniqKey="Theiler R" first="Robert" last="Theiler">Robert Theiler</name>
<affiliation wicri:level="1">
<inist:fA14 i1="02">
<s1>Department of Rheumatology, City Hospital Triemli</s1>
<s2>Zurich</s2>
<s3>CHE</s3>
<sZ>15 aut.</sZ>
</inist:fA14>
<country>Suisse</country>
<wicri:noRegion>Zurich</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Dawson Hughes, Bess" sort="Dawson Hughes, Bess" uniqKey="Dawson Hughes B" first="Bess" last="Dawson-Hughes">Bess Dawson-Hughes</name>
<affiliation wicri:level="3">
<inist:fA14 i1="06">
<s1>Harvard School of Public Health, and the Bone Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University</s1>
<s2>Boston</s2>
<s3>USA</s3>
<sZ>16 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<placeName>
<settlement type="city">Boston</settlement>
<region type="state">Massachusetts</region>
</placeName>
</affiliation>
</author>
</analytic>
<series>
<title level="j" type="main">The New England journal of medicine</title>
<title level="j" type="abbreviated">N. Engl. j. med.</title>
<idno type="ISSN">0028-4793</idno>
<imprint>
<date when="2012">2012</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt>
<title level="j" type="main">The New England journal of medicine</title>
<title level="j" type="abbreviated">N. Engl. j. med.</title>
<idno type="ISSN">0028-4793</idno>
</seriesStmt>
</fileDesc>
<profileDesc>
<textClass>
<keywords scheme="KwdEn" xml:lang="en">
<term>Dose</term>
<term>Fracture</term>
<term>Medicine</term>
<term>Metaanalysis</term>
<term>Prevention</term>
<term>Requirement</term>
<term>Vitamin D</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr">
<term>Vitamine D</term>
<term>Métaanalyse</term>
<term>Dose</term>
<term>Fracture</term>
<term>Exigence</term>
<term>Prévention</term>
<term>Médecine</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr">
<term>Médecine</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">BACKGROUND The results of meta-analyses examining the relationship between vitamin D supplementation and fracture reduction have been inconsistent. METHODS We pooled participant-level data from 11 double-blind, randomized, controlled trials of oral vitamin D supplementation (daily, weekly, or every 4 months), with or without calcium, as compared with placebo or calcium alone in persons 65 years of age or older. Primary end points were the incidence of hip and any nonvertebral fractures according to Cox regression analyses, with adjustment for age group, sex, type of dwelling, and study. Our primary aim was to compare data from quartiles of actual intake of vitamin D (including each individual participant's adherence to the treatment and supplement use outside the study protocol) in the treatment groups of all trials with data from the control groups. RESULTS We included 31,022 persons (mean age, 76 years; 91% women) with 1111 incident hip fractures and 3770 nonvertebral fractures. Participants who were randomly assigned to receive vitamin D, as compared with those assigned to control groups, had a nonsignificant 10% reduction in the risk of hip fracture (hazard ratio, 0.90; 95% confidence interval [CI], 0.80 to 1.01) and a 7% reduction in the risk of nonvertebral fracture (hazard ratio, 0.93; 95% CI, 0.87 to 0.99). By quartiles of actual intake, reduction in the risk of fracture was shown only at the highest intake level (median, 800 IU daily; range, 792 to 2000), with a 30% reduction in the risk of hip fracture (hazard ratio, 0.70; 95% CI, 0.58 to 0.86) and a 14% reduction in the risk of any non-vertebral fracture (hazard ratio, 0.86; 95% CI, 0.76 to 0.96). Benefits at the highest level of vitamin D intake were fairly consistent across subgroups defined by age group, type of dwelling, baseline 25-hydroxyvitamin D level, and additional calcium intake. CONCLUSIONS High-dose vitamin D supplementation (≥800 IU daily) was somewhat favorable in the prevention of hip fracture and any nonvertebral fracture in persons 65 years of age or older. (Funded by the Swiss National Foundations and others.).</div>
</front>
</TEI>
<affiliations>
<list>
<country>
<li>Allemagne</li>
<li>Australie</li>
<li>France</li>
<li>Pays-Bas</li>
<li>Royaume-Uni</li>
<li>Suisse</li>
<li>États-Unis</li>
</country>
<region>
<li>Auvergne-Rhône-Alpes</li>
<li>Hollande-Septentrionale</li>
<li>Massachusetts</li>
<li>Pennsylvanie</li>
<li>Rhône-Alpes</li>
<li>Victoria (État)</li>
<li>Østlandet</li>
</region>
<settlement>
<li>Amsterdam</li>
<li>Boston</li>
<li>Lyon</li>
<li>Melbourne</li>
<li>Oslo</li>
<li>Pittsburgh</li>
</settlement>
<orgName>
<li>Université de Melbourne</li>
<li>Université de Pittsburgh</li>
</orgName>
</list>
<tree>
<country name="Suisse">
<noRegion>
<name sortKey="Bischoff Ferrari, Heike A" sort="Bischoff Ferrari, Heike A" uniqKey="Bischoff Ferrari H" first="Heike A." last="Bischoff-Ferrari">Heike A. Bischoff-Ferrari</name>
</noRegion>
<name sortKey="St Helin, Hannes B" sort="St Helin, Hannes B" uniqKey="St Helin H" first="Hannes B." last="St Helin">Hannes B. St Helin</name>
<name sortKey="Theiler, Robert" sort="Theiler, Robert" uniqKey="Theiler R" first="Robert" last="Theiler">Robert Theiler</name>
</country>
<country name="États-Unis">
<region name="Massachusetts">
<name sortKey="Willett, Walter C" sort="Willett, Walter C" uniqKey="Willett W" first="Walter C." last="Willett">Walter C. Willett</name>
</region>
<name sortKey="Cauley, Jane A" sort="Cauley, Jane A" uniqKey="Cauley J" first="Jane A." last="Cauley">Jane A. Cauley</name>
<name sortKey="Dawson Hughes, Bess" sort="Dawson Hughes, Bess" uniqKey="Dawson Hughes B" first="Bess" last="Dawson-Hughes">Bess Dawson-Hughes</name>
<name sortKey="Jackson, Rebecca D" sort="Jackson, Rebecca D" uniqKey="Jackson R" first="Rebecca D." last="Jackson">Rebecca D. Jackson</name>
<name sortKey="Meyer, Haakon E" sort="Meyer, Haakon E" uniqKey="Meyer H" first="Haakon E." last="Meyer">Haakon E. Meyer</name>
<name sortKey="Oray, Endel J" sort="Oray, Endel J" uniqKey="Oray E" first="Endel J." last="Oray">Endel J. Oray</name>
</country>
<country name="Pays-Bas">
<region name="Hollande-Septentrionale">
<name sortKey="Lips, Paul" sort="Lips, Paul" uniqKey="Lips P" first="Paul" last="Lips">Paul Lips</name>
</region>
</country>
<country name="France">
<region name="Auvergne-Rhône-Alpes">
<name sortKey="Meunier, Pierrej" sort="Meunier, Pierrej" uniqKey="Meunier P" first="Pierrej." last="Meunier">Pierrej. Meunier</name>
</region>
</country>
<country name="Royaume-Uni">
<noRegion>
<name sortKey="Lyons, Ronan A" sort="Lyons, Ronan A" uniqKey="Lyons R" first="Ronan A." last="Lyons">Ronan A. Lyons</name>
</noRegion>
<name sortKey="Flicker, Leon" sort="Flicker, Leon" uniqKey="Flicker L" first="Leon" last="Flicker">Leon Flicker</name>
</country>
<country name="Australie">
<region name="Victoria (État)">
<name sortKey="Wark, John" sort="Wark, John" uniqKey="Wark J" first="John" last="Wark">John Wark</name>
</region>
<name sortKey="Sanders, Kerrie M" sort="Sanders, Kerrie M" uniqKey="Sanders K" first="Kerrie M." last="Sanders">Kerrie M. Sanders</name>
</country>
<country name="Allemagne">
<noRegion>
<name sortKey="Pfeifer, Michael" sort="Pfeifer, Michael" uniqKey="Pfeifer M" first="Michael" last="Pfeifer">Michael Pfeifer</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>

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