There are no plans to encompass clients when you look at the dissemination

There are no plans to encompass clients when you look at the dissemination

Diligent engagement

No people was indeed employed in function the analysis matter or perhaps the consequences steps, nor was they active in the design and you will implementation of the fresh new analysis.

Study options

Integrated degree was randomised controlled products inside the members aged >50 in the baseline with BMD measured by the twin opportunity x-ray absorptiometry (DXA) otherwise precursor technology such as photon absorptiometry. I incorporated knowledge one to said bones mineral stuff (BMC) given that BMD is actually gotten because of the isolating BMC from the limbs area and you can therefore the a couple of is very coordinated. Degree where extremely professionals from the baseline got a major endemic cystic apart from weakening of bones, instance renal incapacity or malignancy, was indeed excluded. I integrated education off calcium used with other procedures provided additional treatment was given in order to both arms (such as for example calcium supplements plus nutritional K in the place of placebo and additionally vitamin K), and training of co-given calcium supplements and you can nutritional D supplements (CaD). Randomised managed trials from hydroxyapatite due to the fact a diet way to obtain calcium was in fact incorporated since it is made from limbs possesses most other nutritional elements, hormonal, protein, and proteins and additionally calcium supplements. You to definitely blogger (WL or MB) screened headings and you can abstracts, as well as 2 people (WL, MB, or VT) on their own processed an entire text out of probably relevant training. Brand new move of blogs is revealed into the shape A when you look at the appendix dos.

Data extraction and synthesis

I extracted guidance of per study on participants’ characteristics, study framework, resource supply and you can problems of interest, and you can BMD on lumbar spine, femoral shoulder, full cool, forearm, and overall system. BMD is going to be counted within numerous sites throughout the forearm, as the 33% (1/3) radius try most commonly made use of. Per studies, i made use of the claimed research on forearm, no matter what webpages. If several site try stated, i made use of the research to your site nearest towards the 33% distance. Just one copywriter (VT) extracted studies, which have been searched by an additional journalist (MB). Likelihood of prejudice is actually reviewed since the demanded from the Cochrane Guide.11 One inaccuracies was basically resolved compliment of conversation.

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.


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 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).