In Reply Dr Anagnostis and colleagues propose reasons for the lack of association in our meta-analysis, but they do not mention that older people living in the community (our population) vs institutions are different, with the latter having lower BMD, older age, more vitamin D deficiency, and higher risk of fracture. They suggest that vitamin D doses may have been too low to reach sufficient 25(OH)D concentrations, but almost all RCTs reporting posttreatment concentrations showed levels more than 20 ng/mL. Race and ethnicity are unlikely to have affected our results because randomization should have produced equal distributions in the 2 groups.
Zhao J, Zeng X, Wang J. Calcium and Vitamin D Supplements and Fractures in Community-Dwelling Adults—Reply. JAMA. 2018;319(19):2043–2044. doi:10.1001/jama.2018.3947
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