There aren’t any intentions to include clients in the dissemination

There aren’t any intentions to include clients in the dissemination

There aren’t any intentions to include clients in the dissemination

Diligent engagement

Zero patients was indeed involved in setting the analysis matter or even the result procedures, nor was in fact it active in the build and you can utilization of the fresh new study.

Investigation alternatives

Integrated knowledge was in fact randomised controlled products within the users aged >50 in the standard having BMD measured because of the twin opportunity x-ray absorptiometry (DXA) otherwise forerunner tech like photon absorptiometry. We incorporated studies one advertised limbs nutrient content (BMC) as BMD is acquired from the breaking up BMC by bone city and and the one or two is highly synchronised. Education where most members at the standard got a primary general cystic besides osteoporosis, including kidney incapacity otherwise most cancers, was excluded. We integrated education out of calcium supplements used in combination with other procedures provided that the other cures received so you’re able to both arms (such calcium together with nutritional K in the place of placebo including nutritional K), and you may degree of co-administered calcium and you may supplement D tablets (CaD). Randomised regulated samples from hydroxyapatite since a diet source of calcium supplements was indeed incorporated because it is created from bone features almost every other nutrients, hormones, proteins, and you will proteins and calcium supplements. You to definitely copywriter (WL otherwise MB) processed titles and you will abstracts, and two article writers (WL, MB, otherwise VT) on their own screened a full text message out-of potentially associated degree. The fresh circulate of content is revealed when you look at the profile A beneficial into the appendix 2.

Studies removal and synthesis

We extracted suggestions regarding for each study from participants’ properties, research build, money source and you may problems interesting, and you will BMD at lumbar spine, femoral shoulder, total cool, forearm, and full muscles. BMD are going to be measured in the numerous websites on forearm, whilst the 33% (1/3) distance is most commonly utilized. For each and every data, we used the reported investigation toward forearm, despite web site. If the several web site was claimed, i used the research with the web site nearest towards the 33% radius. An individual copywriter (VT) extracted studies, that have been appeared from the an additional publisher (MB). Risk of bias is actually examined because demanded regarding Cochrane Manual.11 People discrepancies was fixed due to talk.

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 habbo desktop 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).

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