Researchers in Aberdeen have found that fractures were not prevented in elderly people who routinely took calcium and vitamin D supplements.
The findings are reported today in The Lancet and follow a major 5½ year trial involving almost 5,300 people aged 70 and over who had suffered a fracture in the last 10 years. Participants were recruited through fracture clinics and in-patient wards at 21 hospitals across the UK.
Fractures resulting from osteoporosis are an important cause of ill-health with annual public sector costs estimated to run into hundreds of millions of pounds.
From the age of 50, one in three women and one in twelve men will have an osteoporotic fracture, such as those of the hip, wrist or spine. Those who have already suffered a fracture of this kind are at increased risk of suffering a further fracture.
Vitamin D and calcium, alone or in combination, are often recommended for prevention of osteoporotic fractures.
Up until now it has not been clear if supplements of calcium and/or vitamin D are effective in preventing a further fracture among those who have already had one. However, research led by the University of Aberdeen suggests this is not the case.
Professor Adrian Grant is Director of the University’s Health Services Research Unit (HSRU), which has a national remit to research the best ways to provide health care and to train those working in the health services in research methods.
Professor Grant, principal investigator in the trial, said: “Fracture prevention is now widely practised for those at risk from osteoporosis.
“However, our findings indicate that routine supplementation with calcium and vitamin D3, either alone or in combination, is not effective in the prevention of further fractures in older people who have previously suffered a fracture.”
The trial was funded by the Medical Research Council, with support from Shire Pharmaceuticals and European pharmaceutical company Nycomed.
It investigated the effect of calcium and/or vitamin D3 on the incidence of further fractures in men and women aged 70 and over with a previous low-trauma fracture.
The trial office at HSRU coordinated the recruitment of 5,292 participants who were randomised to take 1000mg calcium, 800 International Units (IU) vitamin D3, both, or a placebo. Most participants were able to walk out of doors unaccompanied and less than 1% came from nursing homes.
The trial mainly examined the prevention of low-trauma fractures, but other outcomes including health status, mortality, falls and adverse events were also sought. Participants were followed up for between 24 and 62 months. Six hundred and ninety-eight participants (13%) suffered a further low-trauma fracture, including 183 people with hip fractures.
Professor Grant added: “We found no statistically significant differences between those allocated calcium and those not; those allocated vitamin D and those not; and those allocated both calcium and vitamin D versus placebo. We also noted no significant differences for hip fractures, mortality, falls or quality of life.
“We were a little surprised by our findings because, based on evidence available, the most likely finding was that the combination of calcium and vitamin D would prevent fractures. However, we didn’t find this to be the case.
“Our results suggest that we should consider other strategies for secondary fracture prevention, including pharmacological intervention with drugs such as bisphosphonates that help maintain bone density and reduce fractures.”
· Oral Vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial appears in The Lancet