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

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.

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Correspondence to Ara Nazarian.

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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

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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")

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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

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Keywords

  • Fracture risk
  • Hip fracture
  • Multivitamin
  • Supplement
  • Fragility fracture