Journal says role of vitamin D, calcium in curing osteoporosis a fallacy – The … – Times of India
The article authored by two endocrinologists — Andrew Grey and Mark Bolland from New Zealand’s University of Auckland – appeared in the latest issue of the journal.
Calcium and vitamin D supplements are big business with global annual sales of calcium supplements in 2013 amounting to $6 billion and sales of vitamin D in the US touching $748 million in 2012. Annual costs of vitamin D testing in Australia increased from about $800,000 in 2001 to over $71 million in 2010.
The main aim of managing osteoporosis is to prevent fracture. From 2002, evidence from randomised trials began to challenge the notion that calcium or vitamin D supplements alone or in combination safely reduce fracture risk. By 2010 end, of 14 large studies with over 1,000 participants each, nine found no benefit, two found increased fracture risk and three found reduced risk. Among 24 smaller randomised trials, 21 found no effect.
Evidence for harm also emerged, including hospital admission for gastrointestinal symptoms, kidney stones, falls, hip fracture, myocardial infarction, and stroke. The United States Preventive Services Task Force had recommended against calcium and vitamin D supplementation for primary fracture prevention in 2013.
Yet, the US National Osteoporosis Foundation (NOF) and the Europe-based International Osteoporosis Foundation (IOF), highly influential advocacy organisations with the stated aim of improving patient outcomes, continue to push these supplements. Their commercial sponsors include supplements manufacturers, companies that produce vitamin D test kits, and the Council for Responsible Nutrition, which describes itself as the “leading trade association representing dietary supplement manufacturers and ingredient suppliers”.
While several therapies previously recommended for osteoporosis (oestrogen, calcitonin, fluoride) have been discarded because of evidence of lack of efficacy or of important harm, calcium and vitamin D supplements continue to be recommended.
The authors suggest that this could be due to the vested interests of industry, advocacy organisations, and academia. In three recent publications of position statements coauthored by bone specialist society academics, 43 authors declared a total of 270 financial conflicts of interests.
The authors of the BMJ article recommend that the emerging requirements that drug companies declare payments to health practitioners “should be broadened to include supplements and food manufacturers.” Advocacy organisations and specialist societies “should eschew corporate sponsorship,” they add, “and academics should not engage with advocacy organisations until it is clear that such commercial ties have been severed.”
In the interaction between commercial entities, advocacy organisations and academics, all parties seem to benefit– industry gains scientific credibility, which protects or enhances sales of its products, and indirect marketing through advocacy groups, advocacy organisations and specialist societies get funding and academics get access to research funds and career enhancing publications and presentations.
The party that may lose or be harmed due to overtreatment or even suffer potential harm is the public, warned the authors.