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Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force.

Abstract

BACKGROUND

Studies suggest that vitamin D supplementation may reduce cancer and fracture risks.

PURPOSE

To examine the benefits and harms of vitamin D with or without calcium supplementation on clinical outcomes of cancer and fractures in adults.

DATA SOURCES

English-language studies identified from MEDLINE and the Cochrane Central Register of Controlled Trials through July 2011.

STUDY SELECTION

Randomized, controlled trials (RCTs), prospective cohort studies, and nested case-control studies reporting incidence of or death from cancer and fracture outcomes.

DATA EXTRACTION

Multiple reviewers extracted details about participant characteristics, including baseline vitamin D status and use of supplements; details of statistical analyses, including adjustments for confounding; and methodological quality. Differences were resolved by consensus.

DATA SYNTHESIS

19 RCTs (3 for cancer and 16 for fracture outcomes) and 28 observational studies (for cancer outcomes) were analyzed. Limited data from RCTs suggested that high-dose (1000 IU/d) vitamin D supplementation can reduce the risk for total cancer, and data from observational studies suggested that higher blood 25-hydroxyvitamin D (25-[OH]D) concentrations might be associated with increased risk for cancer. Mixed-effects dose-response meta-analyses showed that each 10-nmol/L increase in blood 25-(OH)D concentration was associated with a 6% (95% CI, 3% to 9%) reduced risk for colorectal cancer but no statistically significant dose-response relationships for prostate and breast cancer. Random-effects model meta-analysis showed that combined vitamin D and calcium supplementation reduced fracture risk (pooled relative risk, 0.88 [CI, 0.78 to 0.99]) in older adults, but the effects differed according to study setting: institution (relative risk, 0.71 [CI, 0.57 to 0.89]) versus community-dwelling (relative risk, 0.89 [CI, 0.76 to 1.04]). One RCT showed adverse outcomes associated with supplementation, including increased risk for renal and urinary tract stones.

LIMITATIONS

Most trial participants were older (aged≥65 years) postmenopausal women. Observational studies were heterogeneous and were limited by potential confounders.

CONCLUSION

Combined vitamin D and calcium supplementation can reduce fracture risk, but the effects may be smaller among community-dwelling older adults than among institutionalized elderly persons. Appropriate dose and dosing regimens, however, require further study. Evidence is not sufficiently robust to draw conclusions regarding the benefits or harms of vitamin D supplementation for the prevention of cancer.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Tufts Evidence-based Practice Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts 02111, USA. mchung1@tuftsmedicalcenter.org

    , , ,

    Source

    Annals of internal medicine 155:12 2011 Dec 20 pg 827-38

    MeSH

    25-Hydroxyvitamin D 2
    Advisory Committees
    Age Factors
    Calcium
    Dietary Supplements
    Fractures, Bone
    Humans
    Neoplasms
    Sex Factors
    United States
    Urinary Calculi
    Vitamin D

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, U.S. Gov't, P.H.S.
    Review

    Language

    eng

    PubMed ID

    22184690

    Citation

    Chung, Mei, et al. "Vitamin D With or Without Calcium Supplementation for Prevention of Cancer and Fractures: an Updated Meta-analysis for the U.S. Preventive Services Task Force." Annals of Internal Medicine, vol. 155, no. 12, 2011, pp. 827-38.
    Chung M, Lee J, Terasawa T, et al. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155(12):827-38.
    Chung, M., Lee, J., Terasawa, T., Lau, J., & Trikalinos, T. A. (2011). Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 155(12), pp. 827-38. doi:10.7326/0003-4819-155-12-201112200-00005.
    Chung M, et al. Vitamin D With or Without Calcium Supplementation for Prevention of Cancer and Fractures: an Updated Meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2011 Dec 20;155(12):827-38. PubMed PMID: 22184690.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. AU - Chung,Mei, AU - Lee,Jounghee, AU - Terasawa,Teruhiko, AU - Lau,Joseph, AU - Trikalinos,Thomas A, PY - 2011/12/21/entrez PY - 2011/12/21/pubmed PY - 2012/2/11/medline SP - 827 EP - 38 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 155 IS - 12 N2 - BACKGROUND: Studies suggest that vitamin D supplementation may reduce cancer and fracture risks. PURPOSE: To examine the benefits and harms of vitamin D with or without calcium supplementation on clinical outcomes of cancer and fractures in adults. DATA SOURCES: English-language studies identified from MEDLINE and the Cochrane Central Register of Controlled Trials through July 2011. STUDY SELECTION: Randomized, controlled trials (RCTs), prospective cohort studies, and nested case-control studies reporting incidence of or death from cancer and fracture outcomes. DATA EXTRACTION: Multiple reviewers extracted details about participant characteristics, including baseline vitamin D status and use of supplements; details of statistical analyses, including adjustments for confounding; and methodological quality. Differences were resolved by consensus. DATA SYNTHESIS: 19 RCTs (3 for cancer and 16 for fracture outcomes) and 28 observational studies (for cancer outcomes) were analyzed. Limited data from RCTs suggested that high-dose (1000 IU/d) vitamin D supplementation can reduce the risk for total cancer, and data from observational studies suggested that higher blood 25-hydroxyvitamin D (25-[OH]D) concentrations might be associated with increased risk for cancer. Mixed-effects dose-response meta-analyses showed that each 10-nmol/L increase in blood 25-(OH)D concentration was associated with a 6% (95% CI, 3% to 9%) reduced risk for colorectal cancer but no statistically significant dose-response relationships for prostate and breast cancer. Random-effects model meta-analysis showed that combined vitamin D and calcium supplementation reduced fracture risk (pooled relative risk, 0.88 [CI, 0.78 to 0.99]) in older adults, but the effects differed according to study setting: institution (relative risk, 0.71 [CI, 0.57 to 0.89]) versus community-dwelling (relative risk, 0.89 [CI, 0.76 to 1.04]). One RCT showed adverse outcomes associated with supplementation, including increased risk for renal and urinary tract stones. LIMITATIONS: Most trial participants were older (aged≥65 years) postmenopausal women. Observational studies were heterogeneous and were limited by potential confounders. CONCLUSION: Combined vitamin D and calcium supplementation can reduce fracture risk, but the effects may be smaller among community-dwelling older adults than among institutionalized elderly persons. Appropriate dose and dosing regimens, however, require further study. Evidence is not sufficiently robust to draw conclusions regarding the benefits or harms of vitamin D supplementation for the prevention of cancer. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/22184690/full_citation L2 - https://www.annals.org/article.aspx?doi=10.7326/0003-4819-155-12-201112200-00005 DB - PRIME DP - Unbound Medicine ER -