Can Vitamin D Supplementation Reduce the Risk of
Fracture in the Elderly? A Randomized Controlled Trial
HAAKON E. MEYER,1,2GURO B. SMEDSHAUG,1,2ELISABETH KVAAVIK,1,2JAN A. FALCH,3
AAGE TVERDAL,1and JAN I. PEDERSEN2
Randomized controlled trials have shown that a combination of vitamin D and calcium can prevent fragility
fractures in the elderly. Whether this effect is attributed to the combination of vitamin D and calcium or to
one of these nutrients alone is not known. We studied if an intervention with 10 ?g of vitamin D3per day could
prevent hip fracture and other osteoporotic fractures in a double-blinded randomized controlled trial.
Residents from 51 nursing homes were allocated randomly to receive 5 ml of ordinary cod liver oil (n ? 569)
or 5 ml of cod liver oil where vitamin D was removed (n ? 575). During the study period of 2 years, fractures
and deaths were registered, and the principal analysis was performed on the intention-to-treat basis.
Biochemical markers were measured at baseline and after 1 year in a subsample. Forty-seven persons in the
control group and 50 persons in the vitamin D group suffered a hip fracture. The corresponding figures for
all nonvertebral fractures were 76 persons (control group) and 69 persons (vitamin D group). There was no
difference in the incidence of hip fracture (p ? 0.66, log-rank test), or in the incidence of all nonvertebral
fractures (p ? 0.60, log-rank test) in the vitamin D group compared with the control group. Compared with
the control group, persons in the vitamin D group increased their serum 25-hydroxyvitamin D concentration
with 22 nmol/liter (p ? 0.001). In conclusion, we found that an intervention with 10 ?g of vitamin D3alone
produced no fracture-preventing effect in a nursing home population of frail elderly people. (J Bone Miner
Key words: frail elderly, hip fracture, osteoporosis, randomized controlled trial, vitamin D
prone to these fractures.(1,2)Vitamin D deficiency may be
one important contributing risk factor for osteoporotic frac-
ture in old people, partly because of reduced food intake,
reduced sun exposure, and a decline in the capacity of
producing vitamin D in the skin.(3)
IP FRACTURE constitutes a large health problem in the
elderly, and nursing home residents are especially
In observational studies, low vitamin D intake and status
has been associated with increased risk of hip fracture, and
intake of cod liver oil has been associated with reduced risk
of hip fracture.(4,5)It also has been shown that vitamin D
supplementation reduces bone loss from the femoral neck in
postmenopausal women.(6,7)However, the effectiveness of
vitamin D in the prevention of osteoporotic fractures is not
clear.(8)In both a French and an American randomized
controlled trial a combined intervention with vitamin D3
and calcium significantly reduced the number of hip frac-
tures(9)and the number of all nonvertebral fractures,(9,10)
The authors have no conflict of interest.
1National Health Screening Service, Oslo, Norway.
2Institute for Nutrition Research, University of Oslo, Oslo, Norway.
3Hormone Laboratory and Department of Internal Medicine, Aker University Hospital, Oslo, Norway.
JOURNAL OF BONE AND MINERAL RESEARCH
Volume 17, Number 4, 2002
© 2002 American Society for Bone and Mineral Research
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Address reprint requests to:
Haakon Eduard Meyer, M.D., Ph.D.
Norwegian Institute of Public Health
P.O. Box 4404 Nydalen
0403 Oslo, Norway
Received in original form January 2, 2001; in revised form April 9,
2001; accepted June 21, 2001.
715 CAN VITAMIN D SUPPLEMENTATION PREVENT FRACTURE