VITAL fracture analysis

Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults

LeBoff MS, Chou SH, Ratliff KA, et al. The New England journal of medicine 2022 · PMID 35939577 · doi:10.1056/nejmoa2202106

Question

Does routine vitamin D3 supplementation reduce fractures in generally healthy midlife and older adults not selected for deficiency or osteoporosis?

Design

Ancillary study of the VITAL nationwide US double-blind placebo-controlled 2x2 factorial RCT.

Patients

Men aged 50 and over and women aged 55 and over in the US, not selected for vitamin D deficiency, low bone mass or osteoporosis.

Intervention

Vitamin D3 2000 IU daily

Comparison

Placebo

Primary outcome

Total, non-vertebral and hip fractures over a median of about 5 years

Key result

Vitamin D3 did not significantly reduce total, non-vertebral or hip fractures compared with placebo.

Limitations

Participants were largely vitamin D replete and low risk, so results do not apply to deficient or osteoporotic patients.

Impact on practice

Argues against routine vitamin D supplementation for fracture prevention in replete community adults; supplementation should target deficiency or accompany osteoporosis treatment.