No benefit of vitamin D supplementation for musculoskeletal health
medwireNews: The use of vitamin D supplements for maintaining or improving musculoskeletal health is not warranted, suggest the findings of an updated systematic review and meta-analysis.
The study showed that vitamin D supplementation had no “clinically relevant effects on fractures, falls, and bone mineral density,” and the researchers say that their findings “should be reflected in clinical guidelines.”
However, they caution: “The clear exception to this is for the prevention or treatment of the rare conditions of rickets and osteomalacia, which can occur after a prolonged lack of exposure to sunshine that leads to [vitamin D] concentrations lower than 25 nmol/L.”
Mark Bolland (University of Auckland, New Zealand) and colleagues identified 81 randomized controlled trials, comprising 53,537 participants, of vitamin D supplements that included fracture (n=42), falls (n=37), or bone mineral density (n=41) as an outcome.
This is at least 30 more trials (20,131 more participants) than were included in the last major systematic reviews of vitamin D and musculoskeletal health, published between 2012 and 2017, the team notes.
In pooled analyses, the researchers found that vitamin D had no significant effect on total fracture (36 trials; n=44,790), hip fracture (20 trials; n=36,655), or falls (37 trials; n=34,144).
The findings did not differ between trials comparing vitamin D with controls and those comparing high versus low doses of vitamin D, and the effect did not differ according to baseline vitamin D concentration, achieved vitamin D concentration, or by study design.
Likewise, there were no “consistent clinically relevant effects on bone mineral density” at the lumbar spine, total hip, femoral neck, total body, or forearm between participants who received vitamin D versus placebo or high- versus low-dose vitamin, regardless of trial duration, say the study authors.
Trial sequential analyses, which are cumulative meta-analyses carried out to reduce the risk for false-positive and false-negative results arising from repeated statistical testing, confirmed that vitamin D supplementation does not reduce the relative risk for total fracture or falls, and does not increase bone mineral density at all sites, say the authors.
Writing in The Lancet Diabetes & Endocrinology, Bolland et al conclude: “We believe there is no justification for more trials of vitamin D supplements with musculoskeletal outcomes because there is no longer equipoise about the effects of vitamin D on these outcomes.”
In an accompanying comment, J Chris Gallagher, from Creighton University Medical Center in Omaha, Nebraska, USA, says: “Bolland and colleagues are leaders in the field of meta-analysis and they have taken great care to analyse the data in every way possible, following PRISMA guidelines.”
He adds: “The authors should be complimented on an important updated analysis on musculoskeletal health, but already I can hear the fervent supporters—what about the extra-skeletal benefits of vitamin D? Within 3 years, we might have that answer because there are approximately 100,000 participants currently enrolled in randomised, placebo-controlled trials of vitamin D supplementation.
“I look forward to those studies giving us the last word on vitamin D,” Gallagher concludes.
By Laura Cowen
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