To the Editor Dr Zhao and colleagues1 concluded that the findings of their review did not support the routine use of calcium or vitamin D supplementation in community-dwelling older adults. This broad conclusion is potentially weakened by several aspects of the study.
One limitation of the study is that it did not consider adherence to supplementation, which could affect fracture incidence. Some of the primary studies had adherence rates as low as 55% to 60%. Furthermore, control patients may have received supplementation outside of their studies, thereby reducing the difference between the control and intervention groups. In a primary study,2 vitamin D supplementation among control patients increased from 3.8% at baseline to 16.1% at the end of the study.
Pundole X, Lopez-Olivo MA, Lu H. Calcium and Vitamin D Supplements and Fractures in Community-Dwelling Adults. JAMA. 2018;319(19):2041–2042. doi:10.1001/jama.2018.3931
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