Calcium, vitamin D, or combined supplementation to prevent fractures and falls: systematic review and meta-analysis.

Methods

Systematic reviewand meta-analysis.

系统评价和荟萃分析。

data_sources

Trials included in systematic reviews from 2014, three databases (Medline, Embase, CENTRAL) to 19 February 2025, clinical trial registries, abstracts from scientific meetings, and references from included studies.

系统综述中包含的试验，从2014年开始，检索了三个数据库（Medline、Embase、CENTRAL）至2025年2月19日，临床试验注册库，科学会议摘要，以及纳入研究的参考文献。

eligibility_criteria

Randomised controlled trials comparing calcium, vitamin D, or combined supplementation with placebo or no treatment in adults (≥18 years) not receiving drug treatment for osteoporosis.

随机对照试验比较了钙、维生素D或联合补充与安慰剂或无治疗在成人（≥18岁）中的效果，这些成人未接受骨质疏松症的药物治疗。

data_extraction_and_synthesis

The primary outcome was the risk of any fracture.

主要结果是任何骨折的风险。

Secondary outcomes included the risk of hip fracture, non-vertebral fracture, vertebral fracture, and falling, as well as the total number of falls.

次要结果包括髋部骨折、非脊椎骨折、脊椎骨折和跌倒的风险，以及跌倒的总次数。

Pairs of reviewers independently screened trials, extracted data, and assessed risk of bias using the second version of Cochrane's risk of bias tool.

成对的审查员独立筛选试验，提取数据，并使用Cochrane偏倚风险工具的第二版评估偏倚风险。

Findings were synthesised using random effects meta-analyses and appraised using Grading of Recommendations Assessment, Development and Evaluation, with application of thresholds for absolute effects considered important.

研究结果通过随机效应的荟萃分析进行综合，并使用推荐分级的评估、发展和评价（GRADE）方法进行评价，同时考虑了被认为重要的绝对效应阈值。

Results

This review included 69 trials involving 153 902 participants.

本综述包括了69项试验，涉及153,902名参与者。

Participants in most of the trials were community dwelling (87%) and not at high risk of fractures or falls (73%).

大多数试验中的参与者是社区居住者（占87%），且不属于骨折或跌倒的高风险人群（占73%）。

For the primary outcome of any fracture, little to no effect was found from use of calcium supplements (11 trials, 9067 participants; risk ratio 0.91, 95% confidence interval0.81 to 1.01; moderate certainty), vitamin D supplements (36 trials, 92 045 participants; 1.00, 0.95 to 1.06; high certainty), or combined supplementation (15 trials, 51 126 participants; 0.91, 0.84 to 0.99; high certainty).

在任何骨折的主要结果方面，使用钙补充剂（11项试验，9067名参与者；风险比0.91，95%置信区间0.81至1.01；中等确定性）、维生素D补充剂（36项试验，92045名参与者；1.00，95%置信区间0.95至1.06；高确定性）或联合补充剂（15项试验，51126名参与者；0.91，95%置信区间0.84至0.99；高确定性）的效果很小或没有发现。

Calcium, vitamin D, or combined supplementation appeared to have little to no effect on other fracture and fall outcomes, based largely on moderate to high certainty of evidence.

基于主要为中等到高确定性的证据，钙、维生素D或联合补充似乎对其他骨折和跌倒结果的影响很小或没有。

The findings remained robust after an extensive exploration of heterogeneity across multiple subgroup analyses.

在对多个亚组进行广泛的异质性探索后，研究结果依然稳健。

Evidence for high risk patients or those requiring residential care was limited for many outcomes for calcium monotherapy and for combined supplementation.

对于高风险患者或需要住院护理的患者，对于钙单药治疗和联合补充的许多结果的证据有限。

Conclusions

Based on absolute risk reductions and thresholds considered clinically meaningful, this review found little to no benefits from use of calcium, vitamin D, or combined supplementation on the prevention of fractures and falls.

基于绝对风险降低和被认为具有临床意义的阈值，本综述发现使用钙、维生素D或联合补充在预防骨折和跌倒方面几乎没有或没有益处。

systematic_review_registration

PROSPERO CRD42023483915.

PROSPERO CRD42023483915。