Skip to main content

Advertisement

SpringerLink
Log in

Multivitamins and risk of fragility hip fracture: a systematic review and meta-analysis

  • Review
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Purpose

Hip fracture is a severe complication of osteoporosis and is associated with a significant healthcare burden worldwide. This meta-analysis explores the association between combined multivitamin use and hip fracture risk. Our results provide more patient-centered insight into the impact of supplement use on osteoporosis outcomes.

Methods

We searched three online databases in August 2019 and included studies that reported on multivitamin use in patients with osteoporotic hip fractures. The inclusion criteria were (1) adult patients with osteoporotic hip fractures, (2) availability of full-text articles in English, and (3) at least 1 year of follow-up. No suitable randomized controlled trials could be identified for inclusion in the analysis. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS).

Results

Eight studies containing 80,148 subjects in total were included in this study. Among these, 4237 cases of fragility hip fracture were reported. The average age was 69±5.3 years, and 21% of subjects were male. Multivitamin use was found to be significantly associated with a lower risk of sustaining a fragility hip fracture (OR 0.49, 95%CI: 0.32–0.77). The Begg and Mazumdar test and funnel plot indicated that no significant publication bias was present.

Conclusion

Combined multivitamins are amongst the most widely used supplements and are often preferred over single vitamins. Our meta-analysis indicates that multivitamin use is significantly protective against osteoporotic hip fracture. In the future, randomized controlled trials should be performed to establish multivitamins as effective preventative measures for this injury.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and material

Not applicable

Code availability

Not applicable

References

  1. Fisher ES, Baron JA, Malenka DJ et al (1991) Hip fracture incidence and mortality in New England. Epidemiology. 2(2):116–122. https://doi.org/10.1097/00001648-199103000-00005

    Article  CAS  PubMed  Google Scholar 

  2. Hippisley-Cox J, Coupland C (2012) Derivation and validation of updated QFracture algorithm to predict risk of osteoporotic fracture in primary care in the United Kingdom: prospective open cohort study. BMJ. 344:e3427. https://doi.org/10.1136/bmj.e3427

    Article  PubMed  Google Scholar 

  3. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. https://doi.org/10.1359/jbmr.061113

  4. Finsterwald M, Sidelnikov E, Orav EJ et al (2014) Gender-specific hip fracture risk in community-dwelling and institutionalized seniors age 65 years and older. Osteoporos Int 25(1):167–176. https://doi.org/10.1007/s00198-013-2513-4

    Article  CAS  PubMed  Google Scholar 

  5. Cao W-T, Zeng F-F, Li B-L, Lin J-S, Liang Y-Y, Chen Y-M (2018) Higher dietary carotenoid intake associated with lower risk of hip fracture in middle-aged and elderly Chinese: a matched case-control study. Bone. 111:116–122. https://doi.org/10.1016/j.bone.2018.03.023

    Article  CAS  PubMed  Google Scholar 

  6. Albaba M, Cha SS, Takahashi PY (2012) The elders risk assessment index, an electronic administrative database-derived frailty index, can identify risk of hip fracture in a cohort of community-dwelling adults. In: Mayo Clin Proc. https://doi.org/10.1016/j.mayocp.2012.01.020

  7. FitzGerald G, Compston JE, Chapurlat RD et al (2014) Empirically based composite fracture prediction model from the global longitudinal study of osteoporosis in postmenopausal women (GLOW). J Clin Endocrinol Metab. https://doi.org/10.1210/jc.2013-3468

  8. Fan F, Xue W-Q, Wu B-H et al (2013) Higher fish intake is associated with a lower risk of hip fractures in Chinese men and women: a matched case-control study. PLoS One 8(2). https://doi.org/10.1371/journal.pone.0056849

  9. Mangano KM, Sahni S, Kerstetter JE, Kenny AM, Hannan MT (2013) Polyunsaturated fatty acids and their relation with bone and muscle health in adults. Curr Osteoporos Rep. https://doi.org/10.1007/s11914-013-0149-0

  10. Ahmadieh H, Arabi A (2011) Vitamins and bone health: beyond calcium and vitamin D. Nutr Rev. https://doi.org/10.1111/j.1753-4887.2011.00372.x

  11. Palacios C (2006) The role of nutrients in bone health, from A to Z. Crit Rev Food Sci Nutr. https://doi.org/10.1080/10408390500466174

  12. Rock CL (2007) Multivitamin-multimineral supplements: who uses them? In: Am J Clin Nutr. https://doi.org/10.1093/ajcn/85.1.277s

  13. Ward E (2014) Addressing nutritional gaps with multivitamin and mineral supplements. Nutr J. https://doi.org/10.1186/1475-2891-13-72

  14. Bae JM (2016) A suggestion for quality assessment in systematic reviews of observational studies in nutritional epidemiology. Epidemiol Health. https://doi.org/10.4178/epih.e2016014

  15. Atkins D, Best D, Briss PA et al (2004) Grading quality of evidence and strength of recommendations. GRADE Working Group. BMJ. https://doi.org/10.1136/bmj.328.7454.1490

  16. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics. https://doi.org/10.2307/2533446

  17. Feskanich D, Singh V, Willett WC, Colditz GA (2002) Vitamin A intake and hip fractures among postmenopausal women. JAMA. 287(1):47–54. https://doi.org/10.1001/jama.287.1.47

    Article  CAS  PubMed  Google Scholar 

  18. Melhus H, Michaëlsson K, Holmberg L, Wolk A, Ljunghall S (1999) Smoking, antioxidant vitamins, and the risk of hip fracture. J Bone Miner Res 14(1):129–135. https://doi.org/10.1359/jbmr.1999.14.1.129

    Article  CAS  PubMed  Google Scholar 

  19. Sahni S, Hannan MT, Blumberg J, Cupples LA, Kiel DP, Tucker KL (2009) Protective effect of total carotenoid and lycopene intake on the risk of hip fracture: a 17-year follow-up from the Framingham Osteoporosis Study. J Bone Miner Res. https://doi.org/10.1359/jbmr.090102

  20. Sahni S, Hannan MT, Gagnon D et al (2009) Protective effect of total and supplemental vitamin C intake on the risk of hip fracture-a 17-year follow-up from the Framingham Osteoporosis Study. Osteoporos Int. https://doi.org/10.1007/s00198-009-0897-y

  21. Farina EK, Kiel DP, Roubenoff R, Schaefer EJ, Cupples LA, Tucker KL (2011) Dietary intakes of arachidonic acid and α-linolenic acid are associated with reduced risk of hip fracture in older adults. J Nutr. https://doi.org/10.3945/jn.110.133728

  22. Yetley EA (2007) Multivitamin and multimineral dietary supplements: Definitions, characterization, bioavailability, and drug interactions. In: Am J Clin Nutr. https://doi.org/10.1093/ajcn/85.1.269s

  23. Gjesdal CG, Vollset SE, Ueland PM, Refsum H, Meyer HE, Tell GS (2007) Plasma homocysteine, folate, and vitamin B12 and the risk of hip fracture: the hordaland homocysteine study. J Bone Miner Res. https://doi.org/10.1359/jbmr.070210

  24. Frame B, Jackson CE, Reynolds WA, Umphrey JE (1974) Hypercalcemia and skeletal effects in chronic hypervitaminosis A. Ann Intern Med. https://doi.org/10.7326/0003-4819-80-1-44

  25. Opotowsky AR, Bilezikian JP (2004) Serum vitamin A concentration and the risk of hip fracture among women 50 to 74 years old in the United States: a prospective analysis of the NHANES I follow-up study. Am J Med. https://doi.org/10.1016/j.amjmed.2004.02.045

  26. Sharman IM (1985) Hypercarotenaemia. Br Med J (Clin Res Ed). https://doi.org/10.1136/bmj.290.6462.95

  27. Heywood R, Palmer AK, Gregson RL, Hummler H (1985) The toxicity of beta-carotene. Toxicology. https://doi.org/10.1016/0300-483X(85)90043-5

  28. Rimm EB, Willett WC, Hu FB et al (1998) Folate and vitamin B6 from diet and supplements in relation to risk of coronary heart disease among women. J Am Med Assoc. https://doi.org/10.1001/jama.279.5.359

  29. Giovannucci E, Stampfer MJ, Colditz GA et al (1998) Multivitamin use, folate, and colon cancer in women in the nurses’ health study. Ann Intern Med. https://doi.org/10.7326/0003-4819-129-7-199810010-00002

  30. Zhang S, Hunter DJ, Hankinson SE et al (1999) A prospective study of folate intake and the risk of breast cancer. J Am Med Assoc. https://doi.org/10.1001/jama.281.17.1632

  31. Sun L, Li B, Xie H et al (2014) Associations between the dietary intake of antioxidant nutrients and the risk of hip fracture in elderly Chinese: a case-control study. Br J Nutr 112(10):1706–1714. https://doi.org/10.1017/S0007114514002773

    Article  CAS  PubMed  Google Scholar 

  32. Hwang H-F, Lee H-D, Huang H-H, Chen C-Y, Lin M-R (2011) Fall mechanisms, bone strength, and hip fractures in elderly men and women in Taiwan. Osteoporos Int 22(8):2385–2393. https://doi.org/10.1007/s00198-010-1446-4

    Article  PubMed  Google Scholar 

  33. Jha RM, Mithal A, Malhotra N, Brown EM (2010) Pilot case-control investigation of risk factors for hip fractures in the urban Indian population. BMC Musculoskelet Disord 11:49. https://doi.org/10.1186/1471-2474-11-49

    Article  PubMed  Google Scholar 

  34. Zeng F, Xie H, Fan F et al (2015) Association of dietary fat intake with the risk of hip fractures in an elderly Chinese population: a matched case-control study. Geriatr Gerontol Int 15(10):1171–1178. https://doi.org/10.1111/ggi.12417

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, RN115, Boston, MA, 02215, USA

    Indeevar Beeram, Sharri J. Mortensen, Diana Yeritsyan, Kaveh Momenzadeh & Ara Nazarian

  2. Boston University School of Medicine, Boston, MA, USA

    Indeevar Beeram

  3. Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Arvind von Keudell

  4. Harvard Medical School Orthopaedic Trauma Initiative, Boston, MA, USA

    Arvind von Keudell & Ara Nazarian

  5. Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia

    Ara Nazarian

Authors
  1. Indeevar Beeram
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sharri J. Mortensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Diana Yeritsyan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kaveh Momenzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Arvind von Keudell
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ara Nazarian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ara Nazarian.

Ethics declarations

Ethics approval

Not applicable

Consent to participate

Not applicable

Consent for publication

Not applicable

Conflicts of interest

Indeevar Beeram BA, Sharri J. Mortensen MD, Diana Yeritsyan BS, Kaveh Momenzadeh MD, Arvind von Keudell MD, and Ara Nazarian PhD declare that they have no conflict of interest

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(PDF 220 kb).

Appendix. Search strategy

Appendix. Search strategy

MEDLINE (Ovid)

(((exp hip fractures/ OR ((hip OR hips) adj3 fracture*).ab,ti) AND (exp osteoporosis/ OR osteoporo*.ab,ti)) OR ((exp osteoporotic fractures/ OR (osteoporo* adj3 fracture*).ab,ti OR fragility fracture*.ab,ti) AND (exp hip/ OR exp hip joint/ OR hip.ab,ti OR hips.ab,ti)))

AND

exp risk/ OR exp odds ratio/ OR (risk OR odds ratio OR hazard ratio).ab,ti

Embase (Elsevier)

((('hip fracture'/exp OR ((hip OR hips) NEAR/3 fracture*):ab,ti) AND ('osteoporosis'/exp OR osteoporo*:ab,ti)) OR (('fragility fracture'/exp OR (osteoporo* NEAR/3 fracture*):ab,ti OR (fragility NEXT/1 fracture*):ab,ti) AND ('hip'/exp OR hip:ab,ti OR hips:ab,ti)))

AND

('risk'/exp OR 'odds ratio'/exp OR 'hazard ratio'/exp OR (risk OR 'odds ratio' OR 'hazard ratio'):ab,ti)

Web of Science (Clarivate Analytics)

(TS=((("hip" OR "hips") NEAR/3 "fracture*") AND "osteoporo*")

OR

TS=((("osteoporo*" NEAR/3 "fracture*") OR "fragility fracture*") AND ("hip" OR "hips")))

AND

TS=("risk" OR "odds ratio" OR "hazard ratio")

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Beeram, I., Mortensen, S.J., Yeritsyan, D. et al. Multivitamins and risk of fragility hip fracture: a systematic review and meta-analysis. Arch Osteoporos 16, 29 (2021). https://doi.org/10.1007/s11657-021-00893-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-021-00893-x

Keywords

Search

Navigation