Diligent engagement
No patients were working in mode the research concern or the consequences tips, neither have been it mixed up in construction and you may utilization of the fresh data.
Studies alternatives
Integrated training were randomised controlled samples for the participants old >50 at the baseline having BMD measured by the dual time x-ray absorptiometry (DXA) or predecessor tech including photon absorptiometry. We included knowledge one advertised bones mineral content (BMC) because BMD try acquired of the splitting BMC from the limbs urban area and together with one or two are highly coordinated. Knowledge in which really people at standard had a major systemic pathology apart from osteoporosis, such kidney incapacity otherwise malignancy, was omitted. I included knowledge off calcium supplements used with other cures provided that the other treatment gotten to help you both arms (particularly calcium supplements and additionally vitamin K instead of placebo together with supplement K), and you will knowledge from co-applied calcium and you will vitamin D products (CaD). Randomised regulated samples off hydroxyapatite because a dietary source of calcium was indeed included since it is made of bones and has now most other nutritional elements, hormone, proteins, and you can amino acids including calcium. That blogger (WL or MB) processed headings and abstracts, as well as 2 authors (WL, MB, otherwise VT) on their own processed a complete text message out-of probably associated studies. The fresh flow of stuff are found in profile A beneficial within the appendix 2.
Research removal and you will synthesis
I removed suggestions of each study from participants’ characteristics, data structure, investment origin and you may conflicts interesting, and you may BMD from the lumbar lower back, femoral shoulder, full stylish, forearm, and total system. BMD are going to be counted during the several web sites in the forearm, even though the 33% (1/3) radius is actually most commonly used. Per studies, we made use of the reported investigation into the forearm, no matter webpages. If the more than one site are reported, we made use of the data towards web site nearest with the 33% distance. One copywriter (VT) extracted investigation, that happen to be looked by an additional writer (MB). Danger of prejudice was analyzed just like the necessary on Cochrane Manual.eleven People inaccuracies have been solved because 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.
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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 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).