Oral vitamin D3 decreases fracture risk in the elderly
The Journal of Family Practice. 2003 March;52(3):431-454
March 1, 2003|The Journal of Family Practice
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- BACKGROUND: Previous studies have shown that daily supplementation with vitamin D3 (800 IU) and calcium decreases the incidence of fractures; however, conflicting data exist as to whether vitamin D3 alone has the same effect. Observational studies suggest that vitamin D may increase the incidence of cancer and cardiovascular disease.
- POPULATION STUDIED: This British study invited 9582 doctors from the Clinical Trials Studies Unit in Oxford and 1538 patients from a general practice in Ipswich, Suffolk, aged 65 to 85 years, to participate.
- STUDY DESIGN AND VALIDITY: After age, sex, and patient/physician stratification, subjects were randomly assigned to receive identical-appearing pills of vitamin D3 (100,000 IU) or placebo, which were mailed to them every 4 months for 5 years. Patients mailed back a card to confirm compliance and to report health and falls.
- OUTCOMES MEASURED: The primary outcome was any fracture as assessed by self-report or death certificate. Secondary outcomes included self-reported health and falls, cardiovascular and cancer incidence and mortality, and all-cause mortality.
- RESULTS: Compliance was similar among the physician and patient groups and between the placebo and vitamin D groups; fracture rates were similar among the physician and patient groups. Average calcium intake was similar.
PRACTICE RECOMMENDATIONS
Vitamin D3 (or its physiologic equivalent, ergocalciferol), administered at a dose of 100,000 IU every 4 months for 5 years, is effective for primary prevention of fractures in the active elderly aged 65 to 85 years.
This treatment regimen has no effect on cardiovascular, cancer, or all-cause mortality. Despite a seemingly large dose averaging 800 IU per day, this regimen is a safe, cheap (<$2 per year), and effective therapy for primary prevention of fractures.
