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Vol 74, No 5 (2023)
Review paper
Submitted: 2023-05-19
Accepted: 2023-07-14
Published online: 2023-08-17
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The antifracture efficacy of vitamin D in adults — are we assessing it reliably? A systematic review

Jerzy Przedlacki1, Urszula Ołdakowska-Jedynak1
DOI: 10.5603/ep.95639
·
Pubmed: 37779375
·
Endokrynol Pol 2023;74(5):499-510.
Affiliations
  1. Chair and Department of Nephrology, Dialysis, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland

open access

Vol 74, No 5 (2023)
Review Article
Submitted: 2023-05-19
Accepted: 2023-07-14
Published online: 2023-08-17

Abstract

Introduction: The antifracture efficacy of vitamin D is still controversial. The aim of this systematic review was to examine if the vitamin D trials were designed adequately to reliably assess its antifracture activity.

Material and methods: The electronic databases PubMed, Medline, Embase, Web of Science, and Cochrane Library were searched to identify clinical trials evaluating the antifracture efficacy of vitamin D in adults. We compared the protocols of the trials against the opinions of the American Society for Bone and Mineral Research (ASBMR), International Society for Clinical Densitometry (ISCD), National Osteoporosis Foundation (NOF), European Medicines Agency (EMEA) experts, and the consensus statement from the 2nd International Conference on Controversies in Vitamin D, and against the protocols of the trials of the medications with proven antifracture efficacy (bisphosphonates, teriparatide, abaloparatide, raloxifene, denosumab, romosozumab). We assessed the prospective character, study design, group description, number of patients, study duration, and vitamin D (serum examination and dosage) supplementation. A description of the desired characteristics of the study protocol was presented.

Results: Thirteen eligible trials were identified. All but 2 were conducted in the elderly population only. Nine trials were included in the final analysis. Serum 25-hydroxy vitamin D (25OHD) was not measured in a representative number of subjects before (except in 2 studies), during, or after treatment in any study.

Conclusions: The analysed studies did not conclusively assess the vitamin D antifracture efficacy in patients with prestudy low serum vitamin levels, due to the lack of assessment of whether sufficient doses of vitamin D were used. They informed about the relevant doses and preparations of vitamin D in particular groups (specific fracture risk, age, place of residence) only.

Abstract

Introduction: The antifracture efficacy of vitamin D is still controversial. The aim of this systematic review was to examine if the vitamin D trials were designed adequately to reliably assess its antifracture activity.

Material and methods: The electronic databases PubMed, Medline, Embase, Web of Science, and Cochrane Library were searched to identify clinical trials evaluating the antifracture efficacy of vitamin D in adults. We compared the protocols of the trials against the opinions of the American Society for Bone and Mineral Research (ASBMR), International Society for Clinical Densitometry (ISCD), National Osteoporosis Foundation (NOF), European Medicines Agency (EMEA) experts, and the consensus statement from the 2nd International Conference on Controversies in Vitamin D, and against the protocols of the trials of the medications with proven antifracture efficacy (bisphosphonates, teriparatide, abaloparatide, raloxifene, denosumab, romosozumab). We assessed the prospective character, study design, group description, number of patients, study duration, and vitamin D (serum examination and dosage) supplementation. A description of the desired characteristics of the study protocol was presented.

Results: Thirteen eligible trials were identified. All but 2 were conducted in the elderly population only. Nine trials were included in the final analysis. Serum 25-hydroxy vitamin D (25OHD) was not measured in a representative number of subjects before (except in 2 studies), during, or after treatment in any study.

Conclusions: The analysed studies did not conclusively assess the vitamin D antifracture efficacy in patients with prestudy low serum vitamin levels, due to the lack of assessment of whether sufficient doses of vitamin D were used. They informed about the relevant doses and preparations of vitamin D in particular groups (specific fracture risk, age, place of residence) only.

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Keywords

bone; fracture; osteoporosis; systematic review; vitamin D

About this article
Title

The antifracture efficacy of vitamin D in adults — are we assessing it reliably? A systematic review

Journal

Endokrynologia Polska

Issue

Vol 74, No 5 (2023)

Article type

Review paper

Pages

499-510

Published online

2023-08-17

Page views

1147

Article views/downloads

372

DOI

10.5603/ep.95639

Pubmed

37779375

Bibliographic record

Endokrynol Pol 2023;74(5):499-510.

Keywords

bone
fracture
osteoporosis
systematic review
vitamin D

Authors

Jerzy Przedlacki
Urszula Ołdakowska-Jedynak

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