Importance The increased social and economic burdens for osteoporosis-related fractures worldwide make the prevention of such injuries a major public health goal. Previous studies have reached mixed conclusions regarding the association between calcium, vitamin D, or combined calcium and vitamin D supplements and fracture incidence in older adults. Objective To investigate whether calcium, vitamin D, or combined calcium and vitamin D supplements are associated with a lower fracture incidence in community-dwelling older adults. Data Sources The PubMed, Cochrane library, and EMBASE databases were systematically searched from the inception dates to December 24, 2016, using the keywords calcium, vitamin D, and fracture to identify systematic reviews or meta-analyses. The primary randomized clinical trials included in systematic reviews or meta-analyses were identified, and an additional search for recently published randomized trials was performed from July 16, 2012, to July 16, 2017. Study Selection Randomized clinical trials comparing calcium, vitamin D, or combined calcium and vitamin D supplements with a placebo or no treatment for fracture incidence in community-dwelling adults older than 50 years. Data Extraction and Synthesis Two independent reviewers performed the data extraction and assessed study quality. A meta-analysis was performed to calculate risk ratios (RRs), absolute risk differences (ARDs), and 95% CIs using random-effects models. Main Outcomes and Measures Hip fracture was defined as the primary outcome. Secondary outcomes were nonvertebral fracture, vertebral fracture, and total fracture. Results A total of 33 randomized trials involving 51 145 participants fulfilled the inclusion criteria. There was no significant association of calcium or vitamin D with risk of hip fracture compared with placebo or no treatment (calcium: RR, 1.53 [95% CI, 0.97 to 2.42]; ARD, 0.01 [95% CI, 0.00 to 0.01]; vitamin D: RR, 1.21 [95% CI, 0.99 to 1.47]; ARD, 0.00 [95% CI, −0.00 to 0.01]. There was no significant association of combined calcium and vitamin D with hip fracture compared with placebo or no treatment (RR, 1.09 [95% CI, 0.85 to 1.39]; ARD, 0.00 [95% CI, −0.00 to 0.00]). No significant associations were found between calcium, vitamin D, or combined calcium and vitamin D supplements and the incidence of nonvertebral, vertebral, or total fractures. Subgroup analyses showed that these results were generally consistent regardless of the calcium or vitamin D dose, sex, fracture history, dietary calcium intake, and baseline serum 25-hydroxyvitamin D concentration. Conclusions and Relevance In this meta-analysis of randomized clinical trials, the use of supplements that included calcium, vitamin D, or both compared with placebo or no treatment was not associated with a lower risk of fractures among community-dwelling older adults. These findings do not support the routine use of these supplements in community-dwelling older people.

中文翻译：

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社区老年人中钙或维生素 D 补充剂与骨折发生率之间的关联

重要性 全世界骨质疏松相关骨折日益增加的社会和经济负担使预防此类伤害成为一项主要的公共卫生目标。先前的研究就钙、维生素 D 或联合钙和维生素 D 补充剂与老年人骨折发生率之间的关系得出了不同的结论。目的 调查钙、维生素 D 或钙和维生素 D 联合补充剂是否与社区老年人的骨折发生率较低有关。数据来源 PubMed、Cochrane 图书馆和 EMBASE 数据库从开始日期到 2016 年 12 月 24 日进行了系统搜索，使用关键字钙、维生素 D 和骨折来识别系统评价或荟萃分析。确定了系统评价或荟萃分析中包含的主要随机临床试验，并在 2012 年 7 月 16 日至 2017 年 7 月 16 日期间对最近发表的随机试验进行了额外检索。或联合钙和维生素 D 补充剂与安慰剂或不治疗社区居住成人 50 岁以上的骨折发生率。数据提取和综合 两名独立审查员执行数据提取并评估研究质量。进行荟萃分析以使用随机效应模型计算风险比 (RR)、绝对风险差 (ARD) 和 95% CI。主要结果和措施 髋部骨折被定义为主要结果。次要结果是非椎体骨折、椎体骨折和完全骨折。结果 共有 33 项随机试验，涉及 51 145 名受试者符合纳入标准。与安慰剂或不治疗相比，钙或维生素 D 与髋部骨折风险没有显着关联（钙：RR，1.53 [95% CI，0.97 至 2.42]；ARD，0.01 [95% CI，0.00 至 0.01]；维生素 D：RR，1.21 [95% CI，0.99 至 1.47]；ARD，0.00 [95% CI，-0.00 至 0.01]。与安慰剂或不治疗相比，钙和维生素 D 联合与髋部骨折没有显着关联（RR，1.09 [95% CI，0.85 至 1.39]；ARD，0.00 [95% CI，-0.00 至 0.00]）。未发现钙、维生素 D 或联合钙和维生素 D 补充剂与发病率之间存在显着关联非椎体、椎体或全骨折。亚组分析表明，无论钙或维生素 D 的剂量、性别、骨折史、膳食钙摄入量和基线血清 25-羟基维生素 D 浓度如何，这些结果总体上是一致的。结论和相关性 在这项随机临床试验的荟萃分析中，与安慰剂或不治疗相比，使用包括钙、维生素 D 或两者的补充剂与社区老年人骨折风险降低无关。这些发现不支持在社区老年人中常规使用这些补充剂。或两者与安慰剂或不治疗相比，与社区老年人骨折风险降低无关。这些发现不支持在社区老年人中常规使用这些补充剂。或两者与安慰剂或不治疗相比，与社区老年人骨折风险降低无关。这些发现不支持在社区老年人中常规使用这些补充剂。