Vitamin D and calcium supplementation for preventing osteoporotic fractures in older adults

Abstract

Overview of Topic: Osteoporosis is the most prevalent chronic bone disease, affecting both men and women especially individuals over the age of 50 worldwide. Despite its high prevalence, osteoporosis is often not diagnosed before the patient sustains an osteoporotic fracture. Due to an increase in the global ageing population, the incidence of fragility fractures is also increasing and thus, preventative measures are needed. Calcium and vitamin D are an integral part in bone architecture and homoeostasis, therefore supplementation of their combination may prove to be beneficial in reducing fragility fracture rates. The research question and PICO elements: Does vitamin D in combination with calcium supplementation prevent the risk of osteoporotic fractures in older adults? The population(P) was older adults 50 years and older. The intervention (I) was vitamin D combined with calcium supplementation in comparison (C) with no supplementation. The outcome (O) being evaluated was the prevention or reduction of osteoporotic fractures. Inclusion and exclusion criteria: Adults 50 years and older receiving treatment in any healthcare setting were included. Participants receiving additional supplementation other than vitamin D and calcium were excluded. The outcome: 6 eligible studies were identified which consist of 4 systematic reviews with meta-analysis and two meta-analyses addressing the research question. Methods of appraisal : The CASP and JBI tool were implemented according to the study design. The main results and conclusions from evidence: The key studies produced mixed results as 1 study showed that vitamin D and calcium were not statistically significant in reducing the risk of osteoporotic fractures and another study showed that calcium and vitamin D increased BMD which is an essential factor in improving bone health. Despite this, it was not established that there was direct correlation between BMD and re-fractures. The rest of the studies, although statistically significant, had several methodological limitations. Implications and recommendations: Further research is needed to ascertain the relationship between the intervention and outcome especially in the local setting, however in the meantime it is still recommended that these supplements are given.