Background
Methods
Search Strategy and Eligibility
Quality Assessment of included studies
Statistical analysis and presentation of results
Results
Randomised controlled trials
Study first author (country) year | Study population | Mean age (years) | Vitamin D | Control | Hip Fractures | RR/HR | ||||
---|---|---|---|---|---|---|---|---|---|---|
n | Eqv daily dose and type | Mode of admin | 25(OH)D Baseline nmol/L | n | 25(OH)D Baseline nmol/L | Number Vit D/ Control | ||||
Vitamin D vs. Placebo/No treatment trials
| ||||||||||
Lips [29] (Netherlands) 1996 | Community & limited care residents | 80 | 1291 | 400 IU | oral | 27 | 1287 | 26 | 58/48 | HR |
D3
| 1.18 (0.81-1.71) | |||||||||
Meyer [30] (Norway) 2002 | Nursing home residents | 84.7 | 569 | 400 IU | oral | 47 | 575 | 51 | 50/47 | HR |
D3
| 1.09 (0.73-1.63) | |||||||||
Trivedi [31] (UK) 2003 | Community Doctors' and GP registry | 74.8 | 1345 | 822 IU | oral | NA | 1341 | 53.4 | 21/24 | HR |
D3
| 0.85 (0.47-1.53) | |||||||||
Grant [21] (UK) 2005 | Community residents with previous fracture | 77 | 1343 | 800 IU | oral | 38.0 | 1332 | 38.0 | 47/41 | RR |
D3
| 1.14 (0.75-1.72) | |||||||||
Law [32] (UK) 2006 | Residential care and nursing home residents | 85 | 1762 | 1100 IU | oral | 59 | 1955 | NA | 24/20 | RR |
D2
| 1.36 (0.80-2.34) | |||||||||
Lyons [22] (UK) 2007 | Residential, nursing homes and sheltered housing residents | 84 | 1725 | 822 IU | oral | NA | 1715 | NA | 112/104 | RR |
D2
| 1.07 (0.83-1.39) | |||||||||
Smith [33] (UK) 2007 | Community residents | 79.1 | 4727 | 822 IU | Intra-musc. (IM) | 141.25 | 4713 | 141.25 | 66/44 | HR |
D2
| 1.49 (1.02-2.18) | |||||||||
Vitamin D and Calcium vs. Calcium trials
| ||||||||||
Grant [21] (UK) 2005 | Community residents with previous fracture | 77 | 1306 | 800 IU D3 + 1000 mg Calcium(daily) | oral | 38.0 | 1311 | 38.0 | 46/49 | RR |
0.94 (0.63-1.40) |
Case-control studies
Vitamin D status
Study first author (location) year | Cases | Controls | Participant details | |||
---|---|---|---|---|---|---|
n | Mean Age (SD) years 25(OH)D (SD) nmol/L PTH (SD) pmol/L | Time sera collected (25(OH)D assay method) | n | Mean Age (SD) years 25(OH)D (SD) nmol/L PTH (SD) pmol/L | ||
Population based controls
| ||||||
Lund [34] | 67 | NR | On admission | 41 | NR |
Cases: Consecutive patients |
(Denmark) 1975 | 65.0 (45.0) NR | (CPB) | 55.0 (32.5) NR |
Controls: Elderly participants without malabsorption, hepatic or renal disease | ||
Baker [35] | 98 | 80.2 (7.3) | - | 76 | 79.4 (7.2) |
Cases: Consecutive admissions of Caucasian females |
(UK) 1979 | 34.5 (24.5) NR | 55.8 (33.8) NR |
Controls: Home-based age and sex matched selected from electoral register | |||
Hoikka [36] | 55 | 76.0 | - | 22 | 71.0 |
Cases: Patients admitted from Sept 1978- July 1979 |
(Finland) 1982 | 26.6 (18.5) NR | (HPLC) | 56.4 (28.2) NR |
Controls: Healthy age, sex and season matched | ||
Morris [38] | 67 | 77.9 | - | 50 | 71.5 |
Cases: Female hip fracture patients operated on by author |
(Australia) 1984 | 39.2 (21.3) NR | (CPB) | 67.6 (30.4) NR |
Controls: Home-based, ambulant elderly females | ||
Lips [39] | 86 | 73.1 (11.5) | - | 74 | 75.6 (4.2) |
Cases: Hip fracture patients |
(Netherlands) 1987 | 20.4 (11.5) | (CPB after HPLC) | 32.9 (13.6) |
Controls: Healthy, independent volunteers living in apartment house for elderly | ||
0.11 (0.05)* | 0.12 (0.05)* | |||||
Lau [40] | 198 | NR | On day of admission | 368 | NR |
Cases: Consecutive patients |
(Hong Kong) 1989 | 45.5 (16.4) NR | (CPB) | 73.8 (21.0) NR |
Controls: Sheltered housing residents | ||
Pun [41] | 69 | 78.1 (10.2) | Within 12 h admission | 28 | 71.2 (6.4) |
Cases: Female hip fracture patients |
(Hong Kong) 1990 | 43.7 (22.4) NR | (CPB) | 54.6 (13.1) NR |
Controls: Healthy female participants over 60 y | ||
MacDonald [42] | 61 | 78.9 (10.7) | Within 24 h admission pre-surgery | 61 | 78.6 (6.0) |
Cases: Unselected Chinese female patients admitted to orthopaedic ward |
(Hong Kong) 1992 | 45.8 (22.0) | (CPB) | 72.5 (21.5) |
Controls: Hostel for elderly, no fracture history | ||
4.59 (2.27) | 4.04 (2.24) | |||||
Boonen [44] | 117 | 79.2 (8.9) | Within 18 h fracture pre-surgery | 117 | 77.7 (5.4) |
Cases: Consecutive female patients |
(Belgium) 1997 | 25.3 (22.0) | (CPB) | 53.8 (33.3) |
Controls: Female, age matched, from general practices | ||
5.14 (4.66) | 1.70 (1.14) | |||||
Community based controls
| ||||||
Von Knorring [37] | 58 | 77.0 (9.3) | Prior to surgery | 41 | 78.0 (8.4) |
Cases: Patients admitted during 2 month periods in summer, winter and early spring |
(Finland) 1982 | 32.4 (17.0) | (CPB) | 44.7 (22.5) |
Controls: Age and sex matched non-orthopaedic outpatients or minor surgery patients | ||
0.45 (0.24)* | 0.35 (0.24)* | |||||
Benhamou [43] | 57 | 83.9 (5.9) | Within 24 h admission | 68 | 82.5 (5.0) |
Cases: Consecutively admitted patients |
(France) 1995 | 30.9 (12.2) | (RIA) | 38.4 (14.7) |
Controls: Patients in geriatric or rheumatology unit with no bone disease or fracture history | ||
6.34 (4.65) | 4.74 (2.21) | |||||
Thiebaud [45] | 179 | 80.2 (9.6) | 5-18 post fracture | 180 | 79.9 (9.6) |
Cases: Consecutive admissions of original hip fracture caused by fall from standing height or less |
(France) 1997 | 23.5 (20.3) | (Radio-receptor) | 30.6 (25.4) |
Controls: Age and sex matched emergency patients with no fracture history | ||
3.32 (2.77) | 4.62 (3.38) | |||||
Di Monaco [46] | 444 | 79.7 (8.6) | During hosp mean 35 days post fracture | 444 | 75.5 (5.7) |
Cases: Caucasian patients sustaining original hip fracture |
(Italy) 2004 | 21.2 (19.5) | (immuno-enzymatic) | 24.4 (21.7) |
Controls: Home-based elderly over 65 y referred for first osteodensiometry, no fracture history | ||
6.02 (4.56) | 5.28 (2.32) | |||||
Nuti [47] | 74 | 77.4 (9.3) | Within 24 h fracture | 73 | 71.2 (6.1) |
Cases: Self-sufficient, community-living female patients with adequate sunlight admitted between May-Dec 1999 |
(Italy) 2004 | 83.5 (55.0) | (CPB) | 107.3 (60.0) |
Controls: Metabolic disease unit outpatients with osteoporosis, no evident osteoporotic fractures admitted between Jul-Nov 1999. Otherwise as per cases | ||
4.02 (1.79) | 3.86 (1.43) | |||||
Bakhtiyarova [48] | 63 | 68.8 (9.5) | Within 3 days admission | 97 | 70.2 (8.3) |
Cases: Low trauma fracture patients |
(Russia) 2006 | 22.4 (11.4) | (CPB) | 28.1 (10.1) |
Controls: Patients of ophthalmology unit with no fracture | ||
3.7 (3.3) | 4.9 (2.8) | |||||
Giusti [49] | 160 | 84.0 (6.3) | Within 24 h admission (RIA) | 160 | 82.0 (7.6) |
Cases: Sampled patients admitted to Orthogeriatric unit between Nov 2004-Mar 2005 |
(Italy) 2006 | 9.4 (11.6) | 9.2 (9.1) |
Controls: Age, sex and place matched Acute Care unit patients admitted for non-bone reasons | |||
8.95 (7.79) | 9.16 (8.00) | |||||
Sakuma [50] | 50 | 82.6 (8.7) | On admission | 53 | 77.2 (5.3) |
Cases: Sado Island residents admitted to hospital from Jan-Dec 2004 |
(Japan) 2006 | 44.5 (19.4) | (ELISA) | 64.5 (18.5) |
Controls: Orthopaedic patients with no fracture admitted between Jul-Dec 2004 | ||
4.75 (2.34) | 3.31 (1.93) |
Parathyroid hormone
Cohort studies
Study First author (country) year | n | Follow up time | Study population Mean age years | Hip Fractures | Findings |
---|---|---|---|---|---|
Study of Osteoporotic Fractures | 9704 | Up to 5.9 years | Postmenopausal women | 332 | < 47.5 nmol/L vs. ≥47.5 nmol/L 25(OH)D |
Cummings [51] (USA) 1998 | 73 years (using randomly selected cases and controls) | RR Hip fracture 1.2 (0.7, 1.9) | |||
WHI-OS | 39793 | Up to 9.3 years | Postmenopausal women | 400 | Each 25 nmol/L decrease in 25(OH)D R Hip fracture 1.33 (1.06, 1.68) |
Cauley [52] (USA) 2008 | (median 7.1 years) | 71 years | ≤47.5 nmol/L vs. ≥70.7 nmol/L OR Hip fracture 1.71 (1.05, 2.79) | ||
NHANES III | 1917 | Mean 6.7 y | ≥65 y Caucasian adults | 156 | ≥62.5 nmol/L vs. <62.5 nmol/L 25(OH)D |
Looker [53] (USA) 2008 | 73 years | RR Hip fracture 0.64 (0.46, 0.89) |