The team found that vitamin D3 did not reduce the risk of fractures compared to placebo in healthy middle-aged and older adults who did not have vitamin D deficiency or low bone mass or osteoporosis.
“Overall, the results of this large clinical trial do not support the use of vitamin D supplements to reduce fractures in generally healthy US men and women,”concludes lead author Meryl LeBoff, chief of the calcium and bone unit in the Department of Endocrine Disorders at Brigham and Women’s Hospital.
“These results do not apply to adults with vitamin D deficiency or low bone mass or osteoporosis.
Most participants in the study were not deficient and may already have achieved the vitamin D levels needed for bone health.”
Vitamin D supplements are widely recommended for bone health in the general population, but data on whether they prevent fractures are conflicting.
To address this, the researchers conducted a complementary study to that VITamin D and OmegA-3 TriaL (VITAL), a clinical study of more than 25,000 adults, also led by Brigham.
study results
A total of 1,991 incident fractures in 1,551 participants were confirmed over a mean follow-up of 5.3 years.
Compared to placebo, supplemental vitamin D3 (2000 IU/day) did not reduce total, non-vertebral, or hip fractures.
The analyzes also showed that there was no effect of supplemental vitamin D3 on major osteoporotic fractures, wrist fractures, or pelvic fractures.
Effects were not altered by age, gender, race, body mass index, baseline vitamin D blood levels, and personal intake of supplemental calcium and/or vitamin D at baseline.
“Although VITAL was originally designed to study cardiovascular and cancer outcomes, this is a wonderful example of how it has shed light on health outcomes far beyond its original goals.” says JoAnn Manson, co-author and director of the Department of Preventive Medicine at Brigham.
Previous work
Results from randomized controlled trials examining the effects of supplemental vitamin D on fracture outcomes have been conflicting, with the trials finding evidence of benefit, no effect, or harm.
Differences to explain the different results in these studies include the use of bolus dosing, co-administration of vitamin D with calcium, and small sample sizes.
No large randomized controlled trials have tested the effects of daily vitamin D supplementation alone (without concomitant calcium) in preventing fractures in the US population.
Systematic reviews and meta-analyses of randomized controlled trials have raised questions about whether supplemental vitamin D has beneficial effects on preventing bone fractures.
The Institute of Medicine (IOM) identified an increased fracture risk with both low and high 25-hydroxyvitamin D levels and emphasized the need for further research from large randomized controlled trials.
discussion of the findings
In discussing the results, the team highlights suggestions that the effect of supplemental vitamin D3 may be limited to those with low 25-hydroxyvitamin D levels.
A higher prevalence of vitamin D deficiency has been reported in black adults, obese postmenopausal women, older men, and older individuals with hip fractures.
“Our results do not suggest differences in the effect of supplemental vitamin D3 on fracture outcomes by race or ethnic group, BMI, or age,”writes the team.
Although most participants in our cohort may have already achieved the 25-hydroxyvitamin D level required for bone health, VITAL was large enough to stratify participants by baseline 25-hydroxyvitamin D level.
The team found no significant differences in fracture rates between the experimental groups according to different 25-hydroxyvitamin D thresholds.
“Our ongoing studies are focused on whether free vitamin D levels or genetic variation in vitamin D absorption, metabolism, or receptor function provide information about individuals who might benefit from supplemental vitamin D for musculoskeletal health “,adds dr LeBoff added.
Source: New England Journal of Medicine
Published online: DOI10.1056/NEJMoa2202106
“Supplement vitamin D and incidents in fractures in midlife and older adults.”
Authors: Meryl LeBoff et al.
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