1. Vitamin D supplementation with or without calcium did not reduce the risk of falls in a meta-analysis of 20 randomized controlled trials.
2. Future similar trials are unlikely to alter the finding that vitamin D does not reduce the risk of falls.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Vitamin D supplementation has long been recommended for maintaining musculoskeletal health and recently, to prevent risk of falls. However, various trials and meta-analyses have shown conflicting results as to its benefit in reducing falls. This study used a trial sequential meta-analysis to assess the effect of vitamin D supplements on falls from 20 different randomized controlled trials using a risk reduction threshold of 15%. The results showed that vitamin D, with or without calcium, did not alter the relative risk of falls by 15% or more and future trials with similar designs are unlikely to alter these results. The study was limited in that that data used for the analyses reported the proportion of people experiencing at least one fall, but since many elderly individuals may have recurrent falls, previous results did not take this into account and the results should be interpreted with caution. Additionally, some studies with the greatest risk reduction had moderate to high risk of bias. The smaller studies with substantial risk reductions may have increased the statistical heterogeneity of the meta-analyses. The results of this meta-analysis suggest that similar trials are unlikely to alter the finding that vitamin D supplements do not reduce falls risk.
This study was funded by the Health Research Council of New Zealand.
In-Depth [meta-analysis]: This study used data from 20 different studies (n=29,535) that assessed the risk of falls with vitamin D supplementation. All 20 studies were randomized and 17 of these were double-blind, placebo-controlled trials. Additionally, the studies separately measured the effects of vitamin D supplementation as two treatment subgroups: vitamin D alone (16 trials, n=22,291) and vitamin D with calcium (6 trials, n=9,919). The use of a risk reduction of 15%, or futility boundary, was determined to be the smallest clinically relevant treatment effect for an individual. Trial sequential analysis allowed for an estimate of the point at which there would be enough evidence that further trials would be unlikely to alter the results of the study. The results showed that vitamin D with or without calcium risk reduction was within the 15 futility boundary. Sensitivity analysis using a risk reduction threshold of 10% also suggested the same conclusion.
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