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Myths and facts on bone fracture

The intake of vitamine D supplements and extra calcium from dairy sources are not associated with a lower risk of bone fracture, conclude researchers in The British Medical Journal (or BMJ).

Based on the findings, targeting to increase bone mineral density by improving lifestyle factors, like getting enough exercise, sunshine, and a balanced diet may be more important to reduce fracture risk, than the widespread intake of vitamin D supplements or extra amounts of milk, according to projectleader Dr. Fernando Rivadeneira of Erasmus MC's Endocrinology lab.

The international team of researchers set out to assess the role of 15 clinical risk factors considered to be associated with risk of osteoporotic fractures, including vitamin D levels, fasting glucose levels, diabetes and rheumatoid arthritis. The researchers analyzed the genetic data of more than 500,000 people using data gathered from previous studies from a collaborative network from Europe, United States, East Asia, and Australia, the UK Biobank study and the genetics company 23andMe®. They examined the association of 15 genetic variants, each representing a clinical risk factor for osteoporotic fracture, against fracture risk.

mytheThe results showed that only bone mineral density (BMD) had a clear effect on fracture risk. None of the other well-accepted risk factors tested had a major causal effect on fracture risk. "Strikingly, our analyses indicate that changes in vitamin D levels have no effect on fracture," says Rivadeneira. "Likewise, we found no evidence for a protective effect of sustained intake of dairy derived calcium on fracture risk."

So we can all stop drinking milk? Rivadeneira: "Not necessarily; calcium is important to the bones and very low intake of calcium continues to be a risk factor for bone fractures. We have known for a long time that a balanced diet contains - on top of sources of vitamin D - also the recommended amount of calcium. However, we found no evidence that drinking larger amounts of milk, like many Dutch people do and have done for decennia, lowers the fracture risk.

People taking osteoporosis medication or with confirmed low vitamin D deficiency should not discontinue the use of supplements without consulting their treating physicians, says Rivadeneira. "The findings of our study cannot be extrapolated to this group of high risk individuals where supplementation may still be indicated."

The findings add to the ongoing debate on the benefits of vitamin D supplementation and the intake of dairy derived calcium which is recommended by Dutch clinical guidelines to prevent fractures. The results of the study also back recent clinical trials that have failed to consistently demonstrate a beneficial effect of supplementation.

See also: "Vitamin D: a pseudo-vitamin for a pseudo-disease"

Date published: 27 September 2018.

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