Fall prevention with supplemental and active forms of vitamin D
Fall prevention with supplemental and active forms of vitamin D
Bischof-Ferrari BMJ 2009;339:b3692
Cochrane Database Syst Rev 2010(1):CD005465
Cochrane review 2010
Cochrane Database Syst Rev 2010(1):CD005465
Cochrane review 2010
post-hoc subgroup < 50 nmol/l 25(OH)D :
• rate of falls l...
J Am Geriatr Soc 2010, 58(7):1299-1310
J Am Geriatr Soc 2010, 58(7):1299-1310
fall reduction was significant in several subgroups of individuals:
1.mean age youn...
Calcium en vitamine D in interventie trials
2005-2010: 7 Meta-analyses vitamine D en fractuurreductie
• Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietr...
Bischoff-Ferrari. JAMA 2005, 293(18):2257-2264.
Fracture prevention with vitamin D supplementation: a meta-analysis of
ran...
Bischoff-Ferrari. JAMA 2005, 293(18):2257-2264.
Fracture prevention with vitamin D supplementation: a meta-analysis of
ran...
Boonen S. J Clin Endocrinol Metab 2007, 92(4):1415-1423.
Need for additional calcium to reduce the risk of hip fracture wi...
Boonen S. J Clin Endocrinol Metab 2007, 92(4):1415-1423.
Need for additional calcium to reduce the risk of hip fracture wi...
Tang. Lancet 2007, 370(9588):657-666.
Use of calcium or calcium in combination with vitamin D supplementation to
prevent f...
Tang. Lancet 2007, 370(9588):657-666.
Use of calcium or calcium in combination with vitamin D supplementation to
prevent f...
Bischoff-Ferrari. Arch Intern Med 2009, 169(6):551-561
Prevention of nonvertebral fractures with oral vitamin D and dose d...
Bischoff-Ferrari. Arch Intern Med 2009, 169(6):551-561
Prevention of nonvertebral fractures with oral vitamin D and dose d...
Bischoff-Ferrari. Arch Intern Med 2009, 169(6):551-
Avenell - Cochrane Database Syst Rev 2009(2):CD000227
Vitamin D and vitamin D analogues for preventing fractures associate...
Avenell - Cochrane Database Syst Rev 2009(2):CD000227
Vitamin D and vitamin D analogues for preventing fractures associate...
DIPART group. BMJ 2010, 340:b5463
Patient level pooled analysis of 68 500 patients from seven major vitamin D
fracture tri...
DIPART group. BMJ 2010, 340:b5463
Patient level pooled analysis of 68 500 patients from seven major vitamin D
fracture tri...
Tang et al. Lancet 2007; 370: 657–66
Dietary intake – hip#
Bischoff , Am J Clin Nutr 2007;86:1780 –90
Intervention calcium vs placebo on NV# and hip#
Bischoff , Am J Clin Nutr 2007;86:1780 –90
Bolland et al. meta-analyse, BMJ 2010.39440.525752.BE
• 11 RCTs met bijna 12.000 deelnemers, leeftijd 72 jaar, 83% vrouw
•...
• 11 RCTs met bijna 12.000 deelnemers, leeftijd 72 jaar, 83% vrouw
• serum 25 OH-D 65 nmol/l
• calcium supplementen ≥ 500 ...
Annual high-dose (500.000 IU vs placebo) oral vitamin D
and falls and fractures in 2256 women >70 yrs
• Sanders K et al JA...
Calcium en vitamine D-suppletie: discussiepunten
- Vitamine D: dosering of spiegel
- Dagelijks of bolus
- Advies op basis ...
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Seminar 26-11-10 - Vitamine d

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  • 10-07-13
  • 10-07-13
  • Seminar 26-11-10 - Vitamine d

    1. 1. Fall prevention with supplemental and active forms of vitamin D
    2. 2. Fall prevention with supplemental and active forms of vitamin D Bischof-Ferrari BMJ 2009;339:b3692
    3. 3. Cochrane Database Syst Rev 2010(1):CD005465 Cochrane review 2010
    4. 4. Cochrane Database Syst Rev 2010(1):CD005465 Cochrane review 2010 post-hoc subgroup < 50 nmol/l 25(OH)D : • rate of falls levels (RR 0.57, 95% CI 0.37 to 0.89) in 260 participants, 2 trials
    5. 5. J Am Geriatr Soc 2010, 58(7):1299-1310
    6. 6. J Am Geriatr Soc 2010, 58(7):1299-1310 fall reduction was significant in several subgroups of individuals: 1.mean age younger than 80 2.additional calcium therapy 3.dose of 800 IU or greater 4.cholecalciferol therapy no evidence was found of a relation between higher doses of vitamin D or longer duration of vitamin D therapy and treatment effect
    7. 7. Calcium en vitamine D in interventie trials
    8. 8. 2005-2010: 7 Meta-analyses vitamine D en fractuurreductie • Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B: Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 2005, 293(18):2257-2264. • Boonen S, Lips P, Bouillon R, Bischoff-Ferrari HA, Vanderschueren D, Haentjens P: Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab 2007, 92(4):1415-1423. • Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A: Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta- analysis. Lancet 2007, 370(9588):657-666. • Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB, Orav EJ, Thoma A, Kiel DP, Henschkowski J: Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta- analysis of randomized controlled trials. Arch Intern Med 2009, 169(6):551-561. • Avenell A, Gillespie WJ, Gillespie LD, O'Connell D: Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev 2009(2):CD000227. • Bergman GJ, Fan T, McFetridge JT, Sen SS: Efficacy of vitamin D3 supplementation in preventing fractures in elderly women: a meta-analysis. Curr Med Res Opin 2010, 26(5):1193-1201. • Patient level pooled analysis of 68 500 patients from seven major vitamin D fracture trials in US and Europe. BMJ 2010, 340:b5463 van den Bergh, Curr osteoporos reviews, in press
    9. 9. Bischoff-Ferrari. JAMA 2005, 293(18):2257-2264. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. • 5 RCTs for hip fracture (n = 9294) • 7 RCTs for nonvertebral fracture risk (n = 9820) • vitamin D 700 to 800 IU/d reduced the relative risk of hip fracture by 26% (3 RCTs with 5572 persons; RR 95% CI 0.61-0.88) • any nonvertebral fracture by 23% (5 RCTs with 6098 persons; RR 95% CI, 0.68-0.87) versus calcium or placebo in individuals ≥60 years • No significant benefit was observed for RCTs with 400 IU/d vitamin D (2 RCTs with 3722 persons)
    10. 10. Bischoff-Ferrari. JAMA 2005, 293(18):2257-2264. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. • 5 RCTs for hip fracture (n = 9294) • 7 RCTs for nonvertebral fracture risk (n = 9820) • vitamin D 700 to 800 IU/d colecalciferol reduced the relative risk of hip fracture by 26% (3 RCTs with 5572 persons; RR 95% CI 0.61- 0.88) • any nonvertebral fracture by 23% (5 RCTs with 6098 persons; RR 95% CI, 0.68-0.87) versus calcium or placebo in individuals ≥60 years • No significant benefit was observed for RCTs with 400 IU/d vitamin D (2 RCTs with 3722 persons) • => 700-800 IU/d vitamin D3
    11. 11. Boonen S. J Clin Endocrinol Metab 2007, 92(4):1415-1423. Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative meta-analysis of randomized controlled trials. • designed to extend the findings of Bischoff-Ferrari et al. 2005 • A total of 53,260 patients from nine RCTs were included in this analysis and all RCTs used cholecalciferol with a dose of 700–800 IU/d in six trials and 400 IU/d in the other three trials. • Calcium (500–1200 mg/d) was given with vitamin D in six RCTs. • only vitamin D with additional calcium demonstrated a significant reduction of hip and nonvertebral fractures versus placebo or no treatment • It has to be noted that two trials with very low nutritional baseline calcium intake had an important impact on the results of this meta- analysis
    12. 12. Boonen S. J Clin Endocrinol Metab 2007, 92(4):1415-1423. Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative meta-analysis of randomized controlled trials. • designed to extend the findings of Bischoff-Ferrari et al. 2005 • A total of 53,260 patients from nine RCTs were included in this analysis and all RCTs used cholecalciferol with a dose of 700–800 IU/d in six trials and 400 IU/d in the other three trials. • Calcium (500–1200 mg/d) was given with vitamin D in six RCTs. • only vitamin D with additional calcium demonstrated a significant reduction of hip and nonvertebral fractures versus placebo or no treatment • It has to be noted that two trials with very low nutritional baseline calcium intake had an important impact on the results of this meta- analysis • => + calcium, low nutritional intake
    13. 13. Tang. Lancet 2007, 370(9588):657-666. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta- analysis. • 17 trials met 63.897 personen: (RR 0.88; CI 0.83-0.95, p=0.0004) • 1000 mg per dag calcium monotherapie in 6 van de 9 trials: RR 0.90 (CI 0.80-1.00) • 7 van de 8 trials met calcium in combinatie met vitamin D:RR 0.87 (0.77-0.97), waarin beide analyse niet significant van elkaar verschilden. • 25(OH)D3 <25 nmol/l: met calcium en vitamine D-suppletie een grotere risicoreductie dan met calcium monotherapie (RR 0.86 vs. 0.94; p=0.06) • Dit effect verdween bij een afkappunt voor serum 25(OH)D van 50 nmol/l • Het effect was groter bij mensen met een lage calciuminname via de voeding (<700 mg/dag) en bij calciumdoseringen van 1200 mg
    14. 14. Tang. Lancet 2007, 370(9588):657-666. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta- analysis. • 17 trials met 63.897 patienten individuen: (RR 0.88; CI 0.83-0.95, p=0.0004) • 1000 mg per dag calcium monotherapie in 6 van de 9 trials: RR 0.90 (CI 0.80-1.00) • 7 van de 8 trials met calcium in combinatie met vitamin D:RR 0.87 (0.77-0.97), waarin beide analyse niet significant van elkaar verschilden. • 25(OH)D3 <25 nmol/l: met calcium en vitamine D-suppletie een grotere risicoreductie dan met calcium monotherapie (RR 0.86 vs. 0.94; p=0.06) • Dit effect verdween bij een afkappunt voor serum 25(OH)D van 50 nmol/l • Het effect was groter bij mensen met een lage calciuminname via de voeding (<700 mg/dag) en bij calciumdoseringen van 1200 mg • => combinatie van calcium en vitamine D bij lage calciuminname en bij 25(OH)D<50 nmol/l)
    15. 15. Bischoff-Ferrari. Arch Intern Med 2009, 169(6):551-561 Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. • 12 RCTs for nonvertebral fractures (two with ergocalciferol, ten with cholecalciferol, n=42.279 > 65 yr) • 8 RCTs for hip fractures (n=40 886) • The anti fracture efficacy of vitamin D increased significantly with higher received dose or higher achieved 25-hydroxyvitamin D levels (> 75nmol/l) for any nonvertebral fractures and for hip fractures • No fracture reduction for a dose of 400 IU/d or less, 482 to 770 IU/d of supplemental vitamin D reduced nonvertebral fractures by 20% and hip fractures by 18%. • better fracture reduction with cholecalciferol compared with ergocalciferol, whereas additional calcium did not further improve antifracture efficacy
    16. 16. Bischoff-Ferrari. Arch Intern Med 2009, 169(6):551-561 Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. • 12 RCTs for nonvertebral fractures (two with ergocalciferol, ten with cholecalciferol, n=42.279 > 65 yr) • 8 RCTs for hip fractures (n=40 886) • The anti fracture efficacy of vitamin D increased significantly with higher received dose or higher achieved 25-hydroxyvitamin D levels (> 75nmol/l) for any nonvertebral fractures and for hip fractures • No fracture reduction for a dose of 400 IU/d or less, 482 to 770 IU/d of supplemental vitamin D reduced nonvertebral fractures by 20% and hip fractures by 18%. • better fracture reduction with cholecalciferol compared with ergocalciferol, whereas additional calcium did not further improve antifracture efficacy • => higher dose or higher 25(OH)D levels (> 75nmol/l)
    17. 17. Bischoff-Ferrari. Arch Intern Med 2009, 169(6):551-
    18. 18. Avenell - Cochrane Database Syst Rev 2009(2):CD000227 Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. • Vitamin D alone appeared unlikely to be effective in preventing: • hip fracture (9 trials, 24,749 participants, RR 1.15 (0.99 -1.33) • vertebral fracture (5 trials, 9138 participants, RR 0.90 (0.42-1.92) • any new fracture (10 trials, 25,016 participants, RR 1.01 (0.93-1.09) • Vitamin D with calcium reduced hip fractures (eight trials, 46,658 participants, RR 0.84, 95% CI 0.73 to 0.96)
    19. 19. Avenell - Cochrane Database Syst Rev 2009(2):CD000227 Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. • Vitamin D alone appeared unlikely to be effective in preventing: • hip fracture (9 trials, 24,749 participants, RR 1.15 (0.99 -1.33) • vertebral fracture (5 trials, 9138 participants, RR 0.90 (0.42-1.92) • any new fracture (10 trials, 25,016 participants, RR 1.01 (0.93-1.09) • Vitamin D with calcium reduced hip fractures (eight trials, 46,658 participants, RR 0.84, 95% CI 0.73 to 0.96) • => vitamin D + calcium
    20. 20. DIPART group. BMJ 2010, 340:b5463 Patient level pooled analysis of 68 500 patients from seven major vitamin D fracture trials in US and Europe. • 7 RCT of vitamin D with calcium or vitamin D alone • 68.517 participants, mean 69.9 years • vitamin D with calcium – overall RR 0.92, (0.86-0.99, p=0.025) • hip fracture – RR 0.84 (0.70-1.01, P=0.07) • vitamin D given alone in doses of 400-800 IU per day was not effective in preventing fractures
    21. 21. DIPART group. BMJ 2010, 340:b5463 Patient level pooled analysis of 68 500 patients from seven major vitamin D fracture trials in US and Europe. • 7 RCT of vitamin D with calcium or vitamin D alone • 68.517 participants, mean 69.9 years • vitamin D with calcium – overall RR 0.92, (0.86-0.99, p=0.025) • hip fracture – RR 0.84 (0.70-1.01, P=0.07) • vitamin D given alone in doses of 400-800 IU per day was not effective in preventing fractures • => vitamin D + calcium
    22. 22. Tang et al. Lancet 2007; 370: 657–66
    23. 23. Dietary intake – hip# Bischoff , Am J Clin Nutr 2007;86:1780 –90
    24. 24. Intervention calcium vs placebo on NV# and hip# Bischoff , Am J Clin Nutr 2007;86:1780 –90
    25. 25. Bolland et al. meta-analyse, BMJ 2010.39440.525752.BE • 11 RCTs met bijna 12.000 deelnemers, leeftijd 72 jaar, 83% vrouw • serum 25 OH-D 65 nmol/l • calcium supplementen ≥ 500 mg per dag vs placebo gedurende 4 jaar zonder vitamine D. • RR myocardinfarct: 1.27 (CI 1.01 tot 1.59, P=0.038) • Het risico op herseninfarct, mortaliteit en het samengestelde eindpunt van myocardinfarct, CVA en mortaliteit was niet significant verhoogd
    26. 26. • 11 RCTs met bijna 12.000 deelnemers, leeftijd 72 jaar, 83% vrouw • serum 25 OH-D 65 nmol/l • calcium supplementen ≥ 500 mg per dag vs placebo gedurende 4 jaar zonder vitamine D. • RR myocardinfarct: 1.27 (CI 1.01 tot 1.59, P=0.038) • Het risico op herseninfarct, mortaliteit en het samengestelde eindpunt van myocardinfarct, CVA en mortaliteit was niet significant verhoogd • Analyse van 5 van de 11 trials met daarin ruim 8.000 patiënten, met data op patiënt niveau: alleen een verhoogd risico gevonden bij dieetinname van 805 mg/dag; RR 1.85, (CI 1.28 - 2.67) • Calcium supplement ≥ 1000 mg per dag behoudens 108 patiënten uit 1 trial die 600 mg/dag gebruikten Bolland et al. meta-analyse, BMJ 2010.39440.525752.BE
    27. 27. Annual high-dose (500.000 IU vs placebo) oral vitamin D and falls and fractures in 2256 women >70 yrs • Sanders K et al JAMA 2010; 303: 1815-22
    28. 28. Calcium en vitamine D-suppletie: discussiepunten - Vitamine D: dosering of spiegel - Dagelijks of bolus - Advies op basis van fractuurreductie bij interventie vs placebo (en niet in combinatie met anti-osteoporose therapie) - Calcium: - corrigeer vitamine D - suppletie op basis van voedingsanamanese - 500 mg is veelal voldoende

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