Patient wedding
Zero people had been involved in form the research matter or even the result strategies, nor were it mixed up in design and utilization of brand new research.
Analysis alternatives
Incorporated degree have been randomised regulated examples from inside the people aged >fifty from the baseline that have BMD counted by the dual energy x-ray absorptiometry (DXA) otherwise precursor technical eg photon absorptiometry. We provided training one to advertised bones mineral stuff (BMC) once the BMD was gotten by isolating BMC from the bone area and you can plus the a couple of try very correlated. Training where very members within baseline had a major general pathology except that weakening of bones, such as for instance kidney inability otherwise most cancers, was in fact excluded. I incorporated knowledge out-of calcium supplements used in combination with almost every other cures provided additional therapy obtained to both of your arms (such as for instance calcium and supplement K versus placebo along with vitamin K), and you may education of co-given calcium supplements and you may nutritional D capsules (CaD). Randomised controlled examples of hydroxyapatite just like the a dietary supply of calcium was indeed included since it is created from bones and has other nutrients, hormone, healthy protein, and you may proteins also calcium supplements. That blogger (WL or MB) screened headings and abstracts, and two article authors (WL, MB, or VT) alone screened a full text message away from potentially relevant studies. The move away from content is found from inside the shape A beneficial in the appendix dos.
Study removal and you can synthesis
I removed pointers of for each study from participants’ characteristics, investigation design, financing source and you may disputes interesting, and you can BMD at lumbar lower back, femoral neck, overall hip, forearm, and overall looks. BMD will likely be mentioned from the multiple sites on the forearm, even though the 33% (1/3) radius try most frequently put. For each investigation, we utilized the claimed study into the forearm, no matter what website. If the several web site is actually claimed, i used the research into the site nearest to your 33% distance. A single publisher (VT) removed studies, which have been seemed because of the one minute writer (MB). Chance of bias was reviewed just like the needed in the Cochrane Handbook.11 People inaccuracies was basically resolved through dialogue.
The primary endpoints were the percentage changes in BMD from baseline at the five BMD sites. We categorised the studies into three groups by duration: one year was duration <18 months; two years was duration ?18 months and ?2.5 years; and others were studies lasting more than two and a half years. For studies that presented absolute data rather than percentage change from baseline, we calculated the mean percentage change from the raw data and the standard deviation of the percentage change using the approach described in the Cochrane Handbook.11 When data were presented only in figures, we used digital callipers to extract data. In four studies that reported mean data but not measures of spread,12 13 14 15 we imputed the standard deviation for the percentage change in BMD for each site from the average site and duration specific standard deviations of all other studies included in our review. We prespecified subgroup analyses based on the following variables: dietary calcium intake v calcium supplements; risk of bias; calcium monotherapy v CaD; baseline age (<65); sex; community v institutionalised participants; baseline dietary calcium intake <800 mg/day; baseline 25-hydroxyvitamin D <50 nmol/L; calcium dose (?500 v >500 mg/day and <1000 v ?1000 mg/day); and vitamin D dose <800 IU/day.
Analytics
We pooled the data using random effects meta-analyses and assessed for heterogeneity between studies using the I 2 statistic (I 2 >50% was considered significant heterogeneity). Funnel plots and Egger’s regression model were used to assess for the likelihood of systematic bias. We included randomised controlled trials of calcium with or without vitamin D https://datingranking.net/cs/loveroulette-recenze/ in the primary analyses. Randomised controlled trials in which supplemental vitamin D was provided to both treatment groups, so that the groups differed only in treatment by calcium, were included in calcium monotherapy subgroup analyses, while those comparing co-administered CaD with placebo or controls were included in the CaD subgroup analyses. We included all available data from trials with factorial designs or multiple arms. Thus, for factorial randomised controlled trials we included all study arms involving a comparison of calcium versus no calcium in the primary analyses and the calcium monotherapy subgroup analysis, but only arms comparing CaD with controls in the CaD subgroup analysis. For multi-arm randomised controlled trials, we pooled data from the separate treatment arms for the primary analyses, but each treatment arm was used only once. We undertook analyses of prespecified subgroups using a random effects model when there were 10 or more studies in the analysis and three or more studies in each subgroup and performed a test for interaction between subgroups. All tests were two tailed, and P<0.05 was considered significant. All analyses were performed with Comprehensive Meta-Analysis (version 2, Biostat, Englewood, NJ).