Research and interventions (current to One pooled analysis found a Quality review March 2011) statistically significant increased risk of hip fracture, but another with many Low risk of bias more participants found a significant reduction in hip fracture One review of 9 studies found statistically significant risk reduction for calcium, greater with higher dose of calcium Cumming & Nevitt Systematic review to No restrictions on Studies had to have fracture as Four RCTs of calcium The main finding was that increased () assess the effectiveness of population described an outcome supplements (mean age of calcium intake postmenopausal calcium supplements and/or participants was older than women appears to be associated with Ecologic studies were excluded dietary calcium for the 70 years in 3 studies, and a small reduction in risk of fracture prevention of fractures in 58 years in 4th); 3 Conclusion is based on consistent postmenopausal women trials of calcium findings of RCTs and a meta-analysis supplements (mean age of 16 observational epidemiologic years); 7 observational studies of dietary calcium and hip Quality appraisal and risk of epidemiologic studies of calcium fractures bias was not reported, supplements; and 23 unclear risk of bias observational epidemiologic studies of dietary calcium (18 concerned with hip fractures) In RCTs number of subjects in each study were 78, 93, 197 and 3,270 Follow-up was 1.5–4.3 National Systematic review of No restrictions on RCTs with a calcium Four RCTs with oral calcium Widely varying results due to Osteoporosis interventions for preventing population described supplementation intervention, supplementation, mean age of differences in populations, treatments Foundation () fracture; covers many and with fracture as an outcome participants was than and sample sizes; while each study interventions 70 years in 3 studies, and suggests an effect in reducing fracture 58.5 years in 4th; 1 study had probabilities, range of uncertainty is too Quality appraisal not men and women, whereas the wide to make a definitive statement reported rest had women only; mix of about magnitude of effect Unclear risk of bias participants with and without previous fractures; follow-up
Research and Quality review interventions (current to March 2011) Low risk of bias One pooled analysis found a statistically significant increased risk of hip fracture, but another with many more participants found a significant reduction in hip fracture One review of 9 studies found statistically significant risk reduction for calcium, greater with higher dose of calcium Cumming & Nevitt () Systematic review to assess the effectiveness of calcium supplements and/or dietary calcium for the prevention of fractures in postmenopausal women Quality appraisal and risk of bias was not reported, unclear risk of bias No restrictions on population described Studies had to have fracture as an outcome Ecologic studies were excluded Four RCTs of calcium supplements (mean age of participants was older than 70 years in 3 studies, and 58 years in 4th); 3 trials of calcium supplements (mean age years); 7 observational epidemiologic studies of calcium supplements; and 23 observational epidemiologic studies of dietary calcium (18 concerned with hip fractures) In RCTs number of subjects in each study were 78, 93, 197 and 3,270 Follow-up was 1.5–4.3 The main finding was that increased calcium intake postmenopausal women appears to be associated with a small reduction in risk of fracture Conclusion is based on consistent findings of RCTs and a meta-analysis of 16 observational epidemiologic studies of dietary calcium and hip fractures National Osteoporosis Foundation () Systematic review of interventions for preventing fracture; covers many interventions Quality appraisal not reported Unclear risk of bias No restrictions on population described RCTs with a calcium supplementation intervention, and with fracture as an outcome Four RCTs with oral calcium supplementation, mean age of participants was than 70 years in 3 studies, and 58.5 years in 4th; 1 study had men and women, whereas the rest had women only; mix of participants with and without previous fractures; follow-up Widely varying results due to differences in populations, treatments and sample sizes; while each study suggests an effect in reducing fracture probabilities, range of uncertainty is too wide to make a definitive statement about magnitude of effect
1162_assessment_report.docx