Article Text

Download PDFPDF

Comparison of fracture risk using different supplemental doses of vitamin D, calcium or their combination: a network meta-analysis of randomised controlled trials
  1. Zhi-Chao Hu1,2,3,
  2. Qian Tang1,2,3,
  3. Chang-Min Sang4,
  4. Li Tang1,2,3,
  5. Xiaobin Li1,2,3,
  6. Gang Zheng1,2,3,
  7. Zhen-Hua Feng1,2,3,
  8. Jiang-Wei Xuan1,2,3,
  9. Zhi-Hao Shen1,2,3,
  10. Li-Yan Shen1,2,3,
  11. Wen-Fei Ni1,2,3,
  12. Ai-Min Wu1,2,3
  1. 1 Department of Orthopedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
  2. 2 Department of the Second School of Medicine, Wenzhou Medical University, Wenzhou, China
  3. 3 Department of Bone Research Institute, The Key Orthopaedic Laboratory of Zhejiang Province, Wenzhou, China
  4. 4 Department of Orthopaedics, The Affiliated Hospital of Jiujiang Medical College, Jiujiang, China
  1. Correspondence to Dr Ai-Min Wu; aiminwu{at}; Professor Li-Yan Shen; shenliyan{at}; Dr Wen-Fei Ni; wenfeini{at}; Dr Zhi-Chao Hu; 764455268{at}


Objective Inconsistent findings in regard to association between different concentrations of vitamin D, calcium or their combination and the risk of fracture have been reported during the past decade in community-dwelling older people. This study was designed to compare the fracture risk using different concentrations of vitamin D, calcium or their combination.

Design A systematic review and network meta-analysis.

Data sources Randomised controlled trials in PubMed, Cochrane library and Embase databases were systematically searched from the inception dates to 31 December 2017.

Outcomes Total fracture was defined as the primary outcome. Secondary outcomes were hip fracture and vertebral fracture. Due to the consistency of the original studies, a consistency model was adopted.

Results A total of 25 randomised controlled trials involving 43 510 participants fulfilled the inclusion criteria. There was no evidence that the risk of total fracture was reduced using different concentrations of vitamin D, calcium or their combination compared with placebo or no treatment. No significant associations were found between calcium, vitamin D, or combined calcium and vitamin D supplements and the incidence of hip or vertebral fractures.

Conclusions The use of supplements that included calcium, vitamin D or both was not found to be better than placebo or no treatment in terms of risk of fractures among community-dwelling older adults. It means the routine use of these supplements in community-dwelling older people should be treated more carefully.

PROSPERO registration number CRD42017079624.

  • calcium
  • vitamin D
  • fractures
  • network meta-analysis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Z-CH and QT are joint first authors.

  • L-YS, W-FN and A-MW contributed equally.

  • Contributors Z-CH and A-MW conceived the study. The search strategy was developed by LT and XL. Z-HF, GZ and QT completed electronic search, select publications and assess their eligibility. Z-HS and XL extracted information of the included studies after screening. J-WX checked the data entry for accuracy and completeness. Z-CH and LT gave advice for data analysis and presentation of study result. L-YS and C-MS contributed to the text revision. W-FN and A-MW supervised the overall conduct of the study. All the authors drafted and critically reviewed and approved the final manuscript.

  • Funding This work was funded by the National Natural Science Foundation of China (81501933, 81572214), Zhejiang Provincial Natural Science Foundation of China (LY14H060008), Zhejiang Provincial Medical Technology Foundation of China (2018254309, 2015111494), Wenzhou leading talent innovative project (RX2016004) and Wenzhou Municipal Science and Technology Bureau (Y20170389). The funders had no role in the design, execution or writing of the study.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.