Contents
Patient wedding
Zero people have been in form the research question or the outcome steps, neither was they active in the framework and utilization of this new investigation.
Investigation possibilities
Provided training were randomised managed products in professionals aged >fifty during the standard having BMD counted by the dual opportunity x ray absorptiometry (DXA) or precursor technical like photon absorptiometry. We provided degree you to definitely reported limbs mineral content (BMC) since BMD is actually received of the splitting BMC by the bones town and you can and also the several was very correlated. Knowledge where really professionals during the standard had a major general pathology aside from weakening of bones, eg renal failure or malignancy, was indeed omitted. We integrated education out-of calcium supplements used in combination with almost every other medication provided that others cures got in order to both arms (such as for instance calcium together with nutritional K in place of placebo and supplement K), and you can degree regarding co-applied calcium and you will vitamin D rencontres pour adultes de plus de 50 ans medications (CaD). Randomised managed products of hydroxyapatite once the a dietary supply of calcium supplements was incorporated since it is produced from bone possesses most other nutritional elements, hormonal, proteins, and you can amino acids along with calcium supplements. You to journalist (WL or MB) processed headings and you will abstracts, and two people (WL, MB, or VT) alone screened an entire text message of potentially associated knowledge. This new circulate out-of blogs is revealed in the figure A beneficial into the appendix 2.
Investigation removal and you can synthesis
I removed pointers of for each study from participants' functions, analysis build, capital provider and you will problems of interest, and BMD from the lumbar spine, femoral neck, total cool, forearm, and you will overall human body. BMD is mentioned in the numerous sites regarding the forearm, even though the 33% (1/3) radius is actually most often made use of. For every data, i utilized the reported research to your forearm, aside from site. In the event the one or more webpages try reported, we made use of the data for the site closest into 33% distance. An individual author (VT) removed data, that have been looked by the an additional blogger (MB). Chance of bias is actually assessed once the required about Cochrane Guide.11 Any inaccuracies was solved courtesy conversation.
The primary endpoints were the percentage changes in BMD from baseline at the five BMD sites. We categorised the studies into three groups by duration: one year was duration <18 months; two years was duration ?18 months and ?2.5 years; and others were studies lasting more than two and a half years. For studies that presented absolute data rather than percentage change from baseline, we calculated the mean percentage change from the raw data and the standard deviation of the percentage change using the approach described in the Cochrane Handbook.11 When data were presented only in figures, we used digital callipers to extract data. In four studies that reported mean data but not measures of spread,12 13 14 15 we imputed the standard deviation for the percentage change in BMD for each site from the average site and duration specific standard deviations of all other studies included in our review. We prespecified subgroup analyses based on the following variables: dietary calcium intake v calcium supplements; risk of bias; calcium monotherapy v CaD; baseline age (<65); sex; community v institutionalised participants; baseline dietary calcium intake <800 mg/day; baseline 25-hydroxyvitamin D <50 nmol/L; calcium dose (?500 v >500 mg/day and <1000 v ?1000 mg/day); and vitamin D dose <800 IU/day.
Statistics
We pooled the data using random effects meta-analyses and assessed for heterogeneity between studies using the I 2 statistic (I 2 >50% was considered significant heterogeneity). Funnel plots and Egger's regression model were used to assess for the likelihood of systematic bias. We included randomised controlled trials of calcium with or without vitamin D in the primary analyses. Randomised controlled trials in which supplemental vitamin D was provided to both treatment groups, so that the groups differed only in treatment by calcium, were included in calcium monotherapy subgroup analyses, while those comparing co-administered CaD with placebo or controls were included in the CaD subgroup analyses. We included all available data from trials with factorial designs or multiple arms. Thus, for factorial randomised controlled trials we included all study arms involving a comparison of calcium versus no calcium in the primary analyses and the calcium monotherapy subgroup analysis, but only arms comparing CaD with controls in the CaD subgroup analysis. For multi-arm randomised controlled trials, we pooled data from the separate treatment arms for the primary analyses, but each treatment arm was used only once. We undertook analyses of prespecified subgroups using a random effects model when there were 10 or more studies in the analysis and three or more studies in each subgroup and performed a test for interaction between subgroups. All tests were two tailed, and P<0.05 was considered significant. All analyses were performed with Comprehensive Meta-Analysis (version 2, Biostat, Englewood, NJ).
