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Molly Crenshaw

Dr. P

NUTR 346

Calcium Paper Review

11 March 2018

In this study, a relationship between vitamin D and calcium supplementation was

observed in order to determine if more vitamin D and calcium prevented bone fractures in older

populations. Other studies had come to mixed conclusions as to whether or not supplementation

helped, leading to the conduction of this study. Many trials were studied to find that

supplementation was not all that beneficial.

The objective of this study was to investigate whether supplements of vitamin D,

calcium, and the two combined led to a decreased number of bone fractures or was associated

with a lower risk of fractures in community-dwelling adults. There are a lot of older adults

(especially women) over the age of 50 who suffer from hip fractures. One study showed that

“more than one-fifth of patients died within 1 year of hip fracture” (Liu). This is an alarming

number of women who suffer traumatically from hip fractures. This study was conducted to see

if hip fractures could be prevented. If said fractures could be prevented, death could possibly be

prevented as well. The reason as to why the investigation was geared toward community-

dwelling adults as opposed to institution-dwelling adults is because by government, institution

meals are regulated. The meals they serve have to contain a certain amount of vitamin D and

calcium in each meal. All meals given have a nutrient requirement. In a community, everyone is
responsible for the food they eat. They get to choose what they do or do not eat. The meals aren’t

regulated which can mean that adults are not choosing calcium or vitamin D-rich foods.

This investigation used many resources such as PubMed, Chochrane library, and

EMBASE databases to research more about calcium and vitamin D analyses. They used these

databases because they are highly respected. They searched with the “keywords calcium, vitamin

D, and fracture” (Liu) in order to find published reviews on the interactions of supplements and

their relationship with fracture incidences. Another factor in their research methods was that they

only sought out systematic reviews “published in the last 10 years from December 24, 2006, to

December 24, 2016” (Liu). The reason there is only a ten year range of where they obtained their

research is because nutrition is a fairly young research category. Science has changed drastically

in the past recent years and systematic reviews from longer than ten years may not be relevant to

the more recent research today. Along with research methods, there are three inclusion criteria

for this study. They include randomized clinical trials that compared calcium, vitamin D, or the

two supplements combined with a placebo group. The second inclusion criteria included adults

over 50 years living in a community. The last criteria were trials that provided fracture data. The

exclusion criteria contained randomized clinical trials with no placebo group, trials with

corticosteroid-induced osteoporosis, and when supplementation was combined with other

treatments. Other exclusion criteria included trials with other forms of vitamin D and trials of

patients who had their dietary intake of these nutrients evaluated.

The end point of the study was the number of hip fractures, which could be measured. It

showed that supplements did not really help in the prevention of fractures. There were 51,145

participants involved of which supplementation was not beneficial. The same was the case for

calcium supplementation as well as for vitamin D. The combination of vitamin D and calcium
also had no significant difference in the number of fractures. Because of these results, it is

suggested that calcium not be recommended in order to prevent fractures. The conclusion that

this study reached was that the evidence was not there that supplementation reduces the risk of

hip fractures.

Even though there was a lot of evidence supporting the lack of effectiveness of

supplementation, there are many weaknesses and limitations of this study. It only included

participants in a community. However, previous trials had found that supplementation lowered

the risk of fractures for people living in an institution. These patients are more likely to develop

osteoporosis because of less mobility and not being able to get as much exposure to sun. Another

limitation is that it is a correlational study and did not include a measure of the vitamin D

baseline, so there was no way of measuring if their vitamin D and calcium levels had improved.

Based on the evidence here, I would not recommend supplementation to patients. It is clear that

without other treatment, supplements of vitamin D and/or calcium do not help with the

prevention of fractures.

The evidence of this study concluded that there was no evidence that supplements

lowered the risk of fractures in community-dwelling adults. There were many databases that

were researched and many trials performed. Although there were weaknesses, the evidence could

not be clearer that supplementation was not helpful in lowering the risk of fractures in older

adults.

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