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The effect of calcium and vitamin D compounds on bone mineral density in patients undergoing glucocorticoid therapies: a network meta-analysis

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Abstract

Introduction/objectives

The objective of our systematic review and network meta-analysis (NMA) is to investigate which vitamin D and/or calcium regimen would yield the greatest increase in lumbar spine, femoral neck, and total hip bone mineral density (BMD) in adult patients undergoing glucocorticoid therapy.

Method

We performed NMAs based on a prospectively developed protocol. A database search of MEDLINE, EMBASE, Web of Science, CINAHL, CENTRAL and Chinese databases were conducted for relevant randomized controlled trials (RCTs). Outcomes were percentage change in lumbar spine, femoral neck, and total hip BMD from baseline.

Results

We included 16 RCTs containing 1073 eligible patients in our analysis. We found alfacalcidol+calcium to yield the greatest percentage increase in lumbar spine BMD (MD 6.05, 95% credible interval [CrI] − 4.18 to 16.18) compared to no treatment, and calcitriol+calcium to yield the greatest percentage increase in femoral neck BMD (MD 8.46, 95% CrI − 4.74 to 21.51) compared to no treatment. Cholecalciferol+calcium ranked first in terms of its ability to increase total hip BMD; however this finding needs to be interpreted with caution due to low sample sizes in the cholecalciferol+calcium treatment arm. None of the treatment arms ruled out the possibility of no effect for any outcome.

Conclusions

Alfacalcidol and calcitriol were the most efficacious treatment arms for increasing lumbar spine and femoral neck BMD, respectively. Our findings need to be validated by further investigations using larger, better-designed RCTs.

Key Points

•The efficacy of calcium/vitamin D compounds was examined using network meta-analyses.

•Alfacalcidol + calcium yielded the greatest increase in lumbar spine BMD, calcitriol + calcium yielded the greatest increase in femoral neck BMD.

•Future guidelines should place greater emphasis on the efficacy of different vitamin D compounds.

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Acknowledgments

We would like to acknowledge Mr. Wenteng Hou and Mr. Aaron Wen of Faculty of Health Sciences, McMaster University for their assistance during the data extraction portion of this study. Their willingness to donate their time has been very much appreciated.

Availability of data and material

All results from our analyses are published in the supplementary material. Aggregated patient data supplied by the included RCTs and extracted by our investigators is available upon reasonable request. We are happy to provide these data to help validate and replicate the findings of our study. Please contact the corresponding or first authors for data requests.

Code availability

The R code used in this study is available upon reasonable request. Please contact the corresponding or first authors.

Author information

Authors and Affiliations

  1. Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada

    Jiawen Deng & Emma Huang

  2. Faculty of Science, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada

    Zachary Silver & Kyra Kavanagh

  3. Faculty of Applied Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada

    Elena Zheng

  4. Faculty of Science, University of Ottawa, 75 Laurier Ave E, Ottawa, ON, K1N 6N5, Canada

    Jannusha Panicker

Authors
  1. Jiawen Deng
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Contributions

Jiawen Deng: conceptualization, methodology, software, formal analysis, resources, data curation, writing—original draft, visualization, supervision, project administration. Zachary Silver: resources, data curation, writing—review and editing. Emma Huang: resources, data curation, writing—review and editing. Elena Zheng: data curation, writing—review and editing. Kyra Kavanagh: data curation, writing—review and editing. Jannusha Panicker: data curation, writing—review and editing.

Corresponding author

Correspondence to Jiawen Deng.

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Deng, J., Silver, Z., Huang, E. et al. The effect of calcium and vitamin D compounds on bone mineral density in patients undergoing glucocorticoid therapies: a network meta-analysis. Clin Rheumatol 40, 725–734 (2021). https://doi.org/10.1007/s10067-020-05294-y

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