Patient engagement
No clients was in fact in means the analysis matter or perhaps the consequences procedures, neither was it active in the structure and you may implementation of brand new research.
Data choices
Incorporated degree have been randomised managed samples in the players aged >50 during the standard which have BMD counted because of the dual time x-ray absorptiometry (DXA) otherwise forerunner technical eg photon absorptiometry. We included knowledge you to definitely claimed bone mineral articles (BMC) once the BMD was obtained by the separating BMC by limbs town and you can together with one or two was extremely coordinated. Studies in which very users in the baseline had a primary systemic cystic besides osteoporosis, instance renal incapacity or cancer malignancy, have been excluded. We provided degree off calcium used with other treatment provided additional treatment received in order to both arms (instance calcium including supplement K instead of placebo and nutritional K), and knowledge out-of co-applied calcium supplements and vitamin D supplements (CaD). Randomised regulated trials out-of hydroxyapatite while the a diet supply of calcium were included because it’s produced from limbs and has other minerals, hormones, proteins, and you may proteins also calcium. You to definitely writer (WL otherwise MB) screened headings and you can abstracts, and two article writers (WL, MB, otherwise VT) on their own screened a complete text of probably related studies. Brand new disperse from stuff try revealed during the profile A beneficial inside the appendix 2.
Data removal and you can synthesis
We extracted pointers out of for every single study on participants‘ qualities, analysis framework, investment origin and you will issues of interest, and you will BMD at the lumbar lower back, femoral neck, full stylish, forearm, and you may total muscles. BMD shall be mentioned at several internet from the forearm, even though the 33% (1/3) radius are most commonly used. For each and every research, i made use of the said investigation towards the forearm, despite site. In the event that several site is claimed, i utilized the investigation for the site nearest with the 33% distance. An individual blogger (VT) extracted research, that have been featured because of the the next writer (MB). Chance of prejudice is actually assessed since the needed regarding Cochrane Handbook.eleven Any inaccuracies had been fixed thanks to 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.
Statistics
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 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 kostenlose arabische Dating-Seite 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).