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Vitamin D with calcium reduces mortality: patient level pooled analysis of 70,528 patients from eight major vitamin D trials.

Vitamin D with calcium reduces mortality: patient level pooled analysis of 70,528 patients from eight major vitamin D trials.
Vitamin D with calcium reduces mortality: patient level pooled analysis of 70,528 patients from eight major vitamin D trials.
Introduction: Vitamin D may affect multiple health outcomes. If so, an effect on mortality is to be expected. Using pooled data from randomized controlled trials, we performed individual patient data (IPD) and trial level meta-analyses to assess mortality among participants randomized to either vitamin D alone or vitamin D with calcium.

Subjects and Methods: Through a systematic literature search, we identified 24 randomized controlled trials reporting data on mortality in which vitamin D was given either alone or with calcium. From a total of 13 trials with more than 1000 participants each, eight trials were included in our IPD analysis. Using a stratified Cox regression model, we calculated risk of death during 3 yr of treatment in an intention-to-treat analysis. Also, we performed a trial level meta-analysis including data from all studies.

Results: The IPD analysis yielded data on 70,528 randomized participants (86.8% females) with a median age of 70 (interquartile range, 62–77) yr. Vitamin D with or without calcium reduced mortality by 7% [hazard ratio, 0.93; 95% confidence interval (CI), 0.88–0.99]. However, vitamin D alone did not affect mortality, but risk of death was reduced if vitamin D was given with calcium (hazard ratio, 0.91; 95% CI, 0.84–0.98). The number needed to treat with vitamin D plus calcium for 3 yr to prevent one death was 151. Trial level meta-analysis (24 trials with 88,097 participants) showed similar results, i.e. mortality was reduced with vitamin D plus calcium (odds ratio, 0.94; 95% CI, 0.88–0.99), but not with vitamin D alone (odds ratio, 0.98; 95% CI, 0.91–1.06).

Conclusion: Vitamin D with calcium reduces mortality in the elderly, whereas available data do not support an effect of vitamin D alone.

0021-972X
2670-2681
Rejnmark, L.
d3be04fd-4c6f-46fd-9f6a-1a6a19bd547c
Avenell, A.
21d12910-39fb-4fc3-bf29-d748641ac6fd
Masud, T.
c2a91f3a-4dc9-4dc2-9102-0ff8cacdfe53
Anderson, F.
232e2d91-ceef-42b3-befc-6fffab18787e
Meyer, H.E.
77c70973-6115-4cea-9b70-e4c436227a22
Sanders, K.M.
83598fb5-b2d6-405e-810e-05bdfaba307d
Salovaara, K.
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Cooper, C.
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Smith, H.E.
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Jacobs, E.T.
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Torgerson, D.
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Jackson, R.D.
ce1d036b-afc2-4754-bb81-58409444db17
Manson, J.E.
506c94bb-e388-4b4a-88ef-4e5bf5bf8714
Brixen, K.
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Mosekilde, L.
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Robbins, J.A.
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Francis, R.M.
24c83ccf-43d2-4a8d-b3db-7ef2ea0241f7
Abrahamsen, B.
fee8b1eb-c267-4d2a-952a-d1b9f20d0125
Rejnmark, L.
d3be04fd-4c6f-46fd-9f6a-1a6a19bd547c
Avenell, A.
21d12910-39fb-4fc3-bf29-d748641ac6fd
Masud, T.
c2a91f3a-4dc9-4dc2-9102-0ff8cacdfe53
Anderson, F.
232e2d91-ceef-42b3-befc-6fffab18787e
Meyer, H.E.
77c70973-6115-4cea-9b70-e4c436227a22
Sanders, K.M.
83598fb5-b2d6-405e-810e-05bdfaba307d
Salovaara, K.
8a2b1a22-d518-4bec-8c97-b49420d46351
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Smith, H.E.
9acc9970-a37b-4e8f-a917-52bb47c61c2b
Jacobs, E.T.
9f840b1f-f1be-46be-bd3c-7fec558b1ae4
Torgerson, D.
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Jackson, R.D.
ce1d036b-afc2-4754-bb81-58409444db17
Manson, J.E.
506c94bb-e388-4b4a-88ef-4e5bf5bf8714
Brixen, K.
7f1c03f8-e759-42c5-9b20-0d5360944b99
Mosekilde, L.
37ab060a-44d5-44ca-bdca-ec514b40cf8a
Robbins, J.A.
2eb9e38a-c6c2-42f2-b859-4b4c48892edc
Francis, R.M.
24c83ccf-43d2-4a8d-b3db-7ef2ea0241f7
Abrahamsen, B.
fee8b1eb-c267-4d2a-952a-d1b9f20d0125

Rejnmark, L., Avenell, A., Masud, T., Anderson, F., Meyer, H.E., Sanders, K.M., Salovaara, K., Cooper, C., Smith, H.E., Jacobs, E.T., Torgerson, D., Jackson, R.D., Manson, J.E., Brixen, K., Mosekilde, L., Robbins, J.A., Francis, R.M. and Abrahamsen, B. (2012) Vitamin D with calcium reduces mortality: patient level pooled analysis of 70,528 patients from eight major vitamin D trials. Journal of Clinical Endocrinology & Metabolism, 97 (8), 2670-2681. (doi:10.1210/jc.2011-3328). (PMID:22605432)

Record type: Article

Abstract

Introduction: Vitamin D may affect multiple health outcomes. If so, an effect on mortality is to be expected. Using pooled data from randomized controlled trials, we performed individual patient data (IPD) and trial level meta-analyses to assess mortality among participants randomized to either vitamin D alone or vitamin D with calcium.

Subjects and Methods: Through a systematic literature search, we identified 24 randomized controlled trials reporting data on mortality in which vitamin D was given either alone or with calcium. From a total of 13 trials with more than 1000 participants each, eight trials were included in our IPD analysis. Using a stratified Cox regression model, we calculated risk of death during 3 yr of treatment in an intention-to-treat analysis. Also, we performed a trial level meta-analysis including data from all studies.

Results: The IPD analysis yielded data on 70,528 randomized participants (86.8% females) with a median age of 70 (interquartile range, 62–77) yr. Vitamin D with or without calcium reduced mortality by 7% [hazard ratio, 0.93; 95% confidence interval (CI), 0.88–0.99]. However, vitamin D alone did not affect mortality, but risk of death was reduced if vitamin D was given with calcium (hazard ratio, 0.91; 95% CI, 0.84–0.98). The number needed to treat with vitamin D plus calcium for 3 yr to prevent one death was 151. Trial level meta-analysis (24 trials with 88,097 participants) showed similar results, i.e. mortality was reduced with vitamin D plus calcium (odds ratio, 0.94; 95% CI, 0.88–0.99), but not with vitamin D alone (odds ratio, 0.98; 95% CI, 0.91–1.06).

Conclusion: Vitamin D with calcium reduces mortality in the elderly, whereas available data do not support an effect of vitamin D alone.

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Published date: August 2012
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 345419
URI: http://eprints.soton.ac.uk/id/eprint/345419
ISSN: 0021-972X
PURE UUID: b4d314c5-f160-484f-900e-f3e89f9a6c85
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 20 Nov 2012 15:57
Last modified: 18 Mar 2024 02:45

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Contributors

Author: L. Rejnmark
Author: A. Avenell
Author: T. Masud
Author: F. Anderson
Author: H.E. Meyer
Author: K.M. Sanders
Author: K. Salovaara
Author: C. Cooper ORCID iD
Author: H.E. Smith
Author: E.T. Jacobs
Author: D. Torgerson
Author: R.D. Jackson
Author: J.E. Manson
Author: K. Brixen
Author: L. Mosekilde
Author: J.A. Robbins
Author: R.M. Francis
Author: B. Abrahamsen

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