Patient involvement
Zero clients was indeed involved in function the study matter or even the result strategies, neither was it active in the build and you will implementation of the fresh new data.
Investigation choice
Incorporated training were randomised controlled trials during the professionals old >fifty from the baseline having BMD counted by the dual time x ray absorptiometry (DXA) otherwise precursor tech such as for instance photon absorptiometry. We provided degree that claimed bones mineral stuff (BMC) as BMD was obtained by the breaking up BMC by the bones area and and a couple of are very synchronised. Education where extremely users from the baseline had a major general cystic other than osteoporosis, eg renal failure otherwise most cancers, was omitted. We integrated degree from calcium supplements combined with almost every other medication so long as one other therapy was given to help you both of your arms (eg calcium along with vitamin K rather than placebo including vitamin K), and you will degree from co-given calcium supplements and you may vitamin D drugs (CaD). Randomised regulated examples regarding hydroxyapatite since the a diet source of calcium supplements have been included because it’s made kostenlose Dating-Seiten fГјr Musik of bone possesses almost every other vitamins, hormone, proteins, and you may amino acids also calcium. You to creator (WL otherwise MB) processed headings and you will abstracts, and two people (WL, MB, otherwise VT) by themselves processed the full text out of potentially associated degree. The fresh new flow from stuff is shown from inside the profile An effective during the appendix dos.
Research extraction and you can synthesis
We extracted suggestions out of each learn from participants’ qualities, analysis design, resource source and you will conflicts of great interest, and you may BMD at lumbar spine, femoral shoulder, full cool, forearm, and you will overall muscles. BMD might be counted in the numerous websites on forearm, although the 33% (1/3) distance is actually most often made use of. For every analysis, i used the said study towards the forearm, aside from site. In the event the multiple website is claimed, we used the analysis for the web site closest on 33% radius. One author (VT) extracted studies, which were appeared of the one minute author (MB). Likelihood of prejudice try examined while the needed throughout the Cochrane Manual.eleven People inaccuracies was resolved using discussion.
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 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).
