Skip to main content
Erschienen in: Osteoporosis International 6/2007

01.06.2007 | Original Article

Preventing fractures among older people living in institutional care: a pragmatic randomised double blind placebo controlled trial of vitamin D supplementation

verfasst von: R. A. Lyons, A. Johansen, S. Brophy, R. G. Newcombe, C. J. Phillips, B. Lervy, R. Evans, K. Wareham, M. D. Stone

Erschienen in: Osteoporosis International | Ausgabe 6/2007

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Osteoporotic fractures in older people are a major and increasing public health problem. We examined the effect of vitamin D supplementation on fracture rate in people living in sheltered accommodation.

Methods

In a pragmatic double blind randomised controlled trial of 3 years duration, we examined 3,440 people (2,624 women and 816 men) living in residential or care home. We used four-monthly oral supplementation using 100,000 IU vitamin D2 (ergocalciferol). As a main outcome measure, we used the incidence of first fracture using an intention to treat analysis. This was a multicentre study in 314 care homes or sheltered accommodation complexes in South Wales, UK.

Results

The vitamin D and placebo groups had similar baseline characteristics. In intention-to-treat analysis, 205 first fractures occurred in the intervention group during a total of 2,846 person years of follow-up (7 fractures per 100 people per year of follow-up), with 218 first fractures in the control group over 2,860 person years of follow-up. The hazard ratio of 0.95 (95% confidence interval 0.79–1.15) for intervention compared to control was not statistically significant.

Conclusion

Supplementation with four-monthly 100,000 IU of oral vitamin D2 is not sufficient to affect fracture incidence among older people living in institutional care.
Literatur
1.
Zurück zum Zitat Brennan nee Saunders J, Johansen A, Butler J, Stone M, Richmond P, Jones S et al (2003) Place of residence and risk of fracture in older people: a population-based study of over 65-year-olds in Cardiff. Osteoporos Int 14(6):515–519PubMedCrossRef Brennan nee Saunders J, Johansen A, Butler J, Stone M, Richmond P, Jones S et al (2003) Place of residence and risk of fracture in older people: a population-based study of over 65-year-olds in Cardiff. Osteoporos Int 14(6):515–519PubMedCrossRef
2.
Zurück zum Zitat Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S et al (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327(23):1637–1642PubMedCrossRef Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S et al (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327(23):1637–1642PubMedCrossRef
3.
Zurück zum Zitat Lips P, Graafmans WC, Ooms ME, Bezemer PD, Bouter LM (1996) Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo-controlled clinical trial. Ann Intern Med 124(4):400–406PubMed Lips P, Graafmans WC, Ooms ME, Bezemer PD, Bouter LM (1996) Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo-controlled clinical trial. Ann Intern Med 124(4):400–406PubMed
4.
Zurück zum Zitat Trivedi DP, Doll R, Khaw KT (2003) Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. Bmj 326(7387):469PubMedCrossRef Trivedi DP, Doll R, Khaw KT (2003) Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. Bmj 326(7387):469PubMedCrossRef
5.
Zurück zum Zitat Porthouse J, Cockayne S, King C, Saxon L, Steele E, Aspray T et al (2005) Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. Bmj 330(7498):1003PubMedCrossRef Porthouse J, Cockayne S, King C, Saxon L, Steele E, Aspray T et al (2005) Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. Bmj 330(7498):1003PubMedCrossRef
6.
Zurück zum Zitat Grant AM, Avenell A, Campbell MK, McDonald AM, MacLennan GS, McPherson GC et al (2005) 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. Lancet 365(9471):1621–1628PubMedCrossRef Grant AM, Avenell A, Campbell MK, McDonald AM, MacLennan GS, McPherson GC et al (2005) 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. Lancet 365(9471):1621–1628PubMedCrossRef
7.
Zurück zum Zitat Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B (2005) Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. Jama 293(18):2257–2264PubMedCrossRef Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B (2005) Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. Jama 293(18):2257–2264PubMedCrossRef
8.
Zurück zum Zitat Avenell A, Gillespie WJ, Gillespie LD, O’Connell DL (2005) Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev 3:CD000227PubMed Avenell A, Gillespie WJ, Gillespie LD, O’Connell DL (2005) Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev 3:CD000227PubMed
9.
Zurück zum Zitat Law M, Withers H, Morris J, Anderson F (2006) Vitamin D supplementation and the prevention of fractures and falls: results of a randomised trial in elderly people in residential accommodation. Age Ageing 35(5):482–486PubMedCrossRef Law M, Withers H, Morris J, Anderson F (2006) Vitamin D supplementation and the prevention of fractures and falls: results of a randomised trial in elderly people in residential accommodation. Age Ageing 35(5):482–486PubMedCrossRef
10.
Zurück zum Zitat Lyons RA, Jones S, Kemp A, Sibert J, Shepherd J, Richmond P et al (2002) Development and use of a population based injury surveillance system: the all Wales Injury Surveillance System (AWISS). Inj Prev 8(1):83–86PubMedCrossRef Lyons RA, Jones S, Kemp A, Sibert J, Shepherd J, Richmond P et al (2002) Development and use of a population based injury surveillance system: the all Wales Injury Surveillance System (AWISS). Inj Prev 8(1):83–86PubMedCrossRef
11.
Zurück zum Zitat Brophy S, John G, Evans E, Lyons RA (2005) Methodological issues in the identification of hip fractures using routine hospital data: a database study. Osteoporos Int Brophy S, John G, Evans E, Lyons RA (2005) Methodological issues in the identification of hip fractures using routine hospital data: a database study. Osteoporos Int
12.
Zurück zum Zitat Anderson F (2004) Effect of annual intramuscular vitamin D supplementation on fracture risk in 9,440 community living older people: the Wessex Fracture Prevention Trial. ASBMR abstract 1220 Anderson F (2004) Effect of annual intramuscular vitamin D supplementation on fracture risk in 9,440 community living older people: the Wessex Fracture Prevention Trial. ASBMR abstract 1220
13.
Zurück zum Zitat Heikinheimo RJ, Inkovaara JA, Harju EJ, Haavisto MV, Kaarela RH, Kataja JM et al (1992) Annual injection of vitamin D and fractures of aged bones. Calcif Tissue Int 51(2):105–110PubMedCrossRef Heikinheimo RJ, Inkovaara JA, Harju EJ, Haavisto MV, Kaarela RH, Kataja JM et al (1992) Annual injection of vitamin D and fractures of aged bones. Calcif Tissue Int 51(2):105–110PubMedCrossRef
14.
Zurück zum Zitat Flicker L, MacInnis RJ, Stein MS, Scherer SC, Mead KE, Nowson CA et al (2005) Should older people in residential care receive vitamin D to prevent falls? Results of a randomized trial. J Am Geriatr Soc 53(11):1881–1888PubMedCrossRef Flicker L, MacInnis RJ, Stein MS, Scherer SC, Mead KE, Nowson CA et al (2005) Should older people in residential care receive vitamin D to prevent falls? Results of a randomized trial. J Am Geriatr Soc 53(11):1881–1888PubMedCrossRef
15.
Zurück zum Zitat Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 337(10):670–676PubMedCrossRef Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 337(10):670–676PubMedCrossRef
16.
Zurück zum Zitat Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE et al (2006) Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 354(7):669–683PubMedCrossRef Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE et al (2006) Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 354(7):669–683PubMedCrossRef
17.
Zurück zum Zitat Boonen S (2006) Fracture risk reduction with vitamin D supplementation requires additional calcium: evidence from a comparative meta-analysis. Osteoporos Int 17(Supp 2):13 Boonen S (2006) Fracture risk reduction with vitamin D supplementation requires additional calcium: evidence from a comparative meta-analysis. Osteoporos Int 17(Supp 2):13
18.
Zurück zum Zitat Armas LA, Hollis BW, Heaney RP (2004) Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab 89(11):5387–5391PubMedCrossRef Armas LA, Hollis BW, Heaney RP (2004) Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab 89(11):5387–5391PubMedCrossRef
19.
Zurück zum Zitat Trang HM, Cole DE, Rubin LA, Pierratos A, Siu S, Vieth R (1998) Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr 68(4):854–858PubMed Trang HM, Cole DE, Rubin LA, Pierratos A, Siu S, Vieth R (1998) Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr 68(4):854–858PubMed
20.
Zurück zum Zitat Harris SS, Dawson-Hughes B, Perrone GA (1999) Plasma 25-hydroxyvitamin D responses of younger and older men to three weeks of supplementation with 1800 IU/day of vitamin D. J Am Coll Nutr 18(5):470–474PubMed Harris SS, Dawson-Hughes B, Perrone GA (1999) Plasma 25-hydroxyvitamin D responses of younger and older men to three weeks of supplementation with 1800 IU/day of vitamin D. J Am Coll Nutr 18(5):470–474PubMed
21.
Zurück zum Zitat Harris SS, Dawson-Hughes B (2002) Plasma vitamin D and 25OHD responses of young and old men to supplementation with vitamin D3. J Am Coll Nutr 21(4):357–362PubMed Harris SS, Dawson-Hughes B (2002) Plasma vitamin D and 25OHD responses of young and old men to supplementation with vitamin D3. J Am Coll Nutr 21(4):357–362PubMed
22.
Zurück zum Zitat Grey J et al (1998) Secondary prevention of hip fracture: developing a simple protocol for trauma wards. Age Aging 27(Supp 2):19–20 Grey J et al (1998) Secondary prevention of hip fracture: developing a simple protocol for trauma wards. Age Aging 27(Supp 2):19–20
23.
Zurück zum Zitat Davies M, Mawer EB, Hann JT, Stephens WP, Taylor JL (1985) Vitamin D prophylaxis in the elderly: a simple effective method suitable for large populations. Age Ageing 14(6):349–354PubMedCrossRef Davies M, Mawer EB, Hann JT, Stephens WP, Taylor JL (1985) Vitamin D prophylaxis in the elderly: a simple effective method suitable for large populations. Age Ageing 14(6):349–354PubMedCrossRef
24.
Zurück zum Zitat Stephens WP, Klimiuk PS, Berry JL, Mawer EB (1981) Annual high-dose vitamin D prophylaxis in Asian immigrants. Lancet 2(8257):1199–1202PubMedCrossRef Stephens WP, Klimiuk PS, Berry JL, Mawer EB (1981) Annual high-dose vitamin D prophylaxis in Asian immigrants. Lancet 2(8257):1199–1202PubMedCrossRef
Metadaten
Titel
Preventing fractures among older people living in institutional care: a pragmatic randomised double blind placebo controlled trial of vitamin D supplementation
verfasst von
R. A. Lyons
A. Johansen
S. Brophy
R. G. Newcombe
C. J. Phillips
B. Lervy
R. Evans
K. Wareham
M. D. Stone
Publikationsdatum
01.06.2007
Verlag
Springer-Verlag
Erschienen in
Osteoporosis International / Ausgabe 6/2007
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-006-0309-5

Weitere Artikel der Ausgabe 6/2007

Osteoporosis International 6/2007 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

Klinikreform soll zehntausende Menschenleben retten

15.05.2024 Klinik aktuell Nachrichten

Gesundheitsminister Lauterbach hat die vom Bundeskabinett beschlossene Klinikreform verteidigt. Kritik an den Plänen kommt vom Marburger Bund. Und in den Ländern wird über den Gang zum Vermittlungsausschuss spekuliert.

TEP mit Roboterhilfe führt nicht zu größerer Zufriedenheit

15.05.2024 Knie-TEP Nachrichten

Der Einsatz von Operationsrobotern für den Einbau von Totalendoprothesen des Kniegelenks hat die Präzision der Eingriffe erhöht. Für die postoperative Zufriedenheit der Patienten scheint das aber unerheblich zu sein, wie eine Studie zeigt.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.