Vitamin D supplementation for improving bone mineral density in children (Intervention Review)
Winzenberg, TM and Powell, S and Shaw, KA and Jones, G, Vitamin D supplementation for improving bone mineral density in children (Intervention Review), Cochrane Database of Systematic Reviews, 2010, (10) Article CD006944. ISSN 1469-493X (2010) [Refereed Article]
Results of randomised controlled trials (RCTs) of vitamin D supplementation to improve bone density in children are inconsistent.
To determine the effectiveness of vitamin D supplementation for improving bone mineral density in children, whether any effect varies
by sex, age or pubertal stage, the type or dose of vitamin D given or baseline vitamin D status, and if effects persist after cessation of
We searched the Cochrane Central Register of Controlled Trials (CENTRAL Issue 3, 2009), MEDLINE (1966 to present), EMBASE
(1980 to present), CINAHL (1982 to present), AMED (1985 to present) and ISIWeb of Science (1945 to present) on 9 August 2009,
and we handsearched key journal conference abstracts.
Placebo-controlled RCTs of vitamin D supplementation for at least three months in healthy children and adolescents (aged from one
month to < 20 years) with bone density outcomes.
Data collection and analysis
Two authors screened references for inclusion, assessed risk of bias, and extracted data. We conducted meta-analyses and calculated
standardised mean differences (SMD) of the percent change from baseline in outcomes in treatment and control groups.We performed
subgroup analyses by sex, pubertal stage, dose of vitamin D and baseline serum vitamin D and considered these as well as compliance
and allocation concealment as possible sources of heterogeneity.
We included six RCTs (343 participants receiving placebo and 541 receiving vitamin D) for meta-analyses. Vitamin Dsupplementation
had no statistically significant effects on total body bone mineral content (BMC), hip bone mineral density (BMD) or forearm BMD.
There was a trend to a small effect on lumbar spine BMD (SMD 0.15, 95% CI -0.01 to 0.31, P = 0.07). There were no differences in effects between high and low serum vitamin D studies at any site though there was a trend towards a larger effect with low vitamin D
for total body BMC (P = 0.09 for difference). In low serum vitamin D studies, significant effects on total body BMC and lumbar spine
BMD were approximately equivalent to a 2.6% and 1.7 % percentage point greater change from baseline in the supplemented group.