The effect of cholecalciferol (vitamin D-3) on the risk of fall and fracture: a meta-analysis

We evaluated the effect of supplementation with vitamin D-3 (excluding the potential effect of calcium supplementation) on the risk of fall and fracture, primarily in postmenopausal women, using a systematic literature review of MEDLINE, EMBASE, BIOSIS and the Cochrane Database of Systematic Reviews for the period January 1985 to June 2005. Studies examining the effect of vitamin D versus placebo on the risk of fall or fracture in postmenopausal females were of particular interest. Studies of vitamin D in combination with calcium were also included where the control group was treated with calcium alone. Studies of men and women where results for men and women were not presented separately were included. Nine studies met the inclusion criteria. Our primary meta-analyses examined the effect of vitamin D3 on the risk of fall or fracture; additional analyses examined baseline and difference between baseline and final levels of several serum and urinary biochemical markers. The pooled relative risk (RR) for vitamin D-3 preventing falls was 0.88 (95%Cl 0.78-1.00). For fractures, the pooled RR for vitamin D3 preventing non-vertebral fractures was 0.96 (95%Cl 0.84-1.09) and the pooled RR for vitamin D3 preventing vertebral fractures was 1.22 (95%Cl 0.64-2.31). In a subgroup analysis of postmenopausal women, the pooled RR for vitamin D3 preventing falls was 0.92 (95%Cl 0.75-1.12) and in preventing non-vertebral fractures the pooled RR was 0.81 (95%Cl 0.48-1.34). There is a trend towards a reduction in the risk of fall among patients treated with vitamin D3 alone compared with placebo, suggesting that vitamin D3 should be an integral part of effective osteoporosis management.