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Melanie KF, Gabriele A, Stephanie G, Robert T, Renè R, Bess DH, Kanis John A, Hofbauer Lorenz C, Schimmer Ralph C, Bruno V, Da Silva José AP, John OE, Kressig Reto W, Andreas E, Wei L, Wanner Guido A, Bischoff-Ferrari Heike A. Effects of vitamin D3, omega-3 s and a simple strength training exercise program on bone health: the DO-HEALTH randomized controlled trial. J Bone Miner Res 2024:zjae054. [PMID: 38613445 DOI: 10.1093/jbmr/zjae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/13/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION Evidence on the effects of Vitamin D, omega-3 s and exercise on aBMD in healthy older adults is limited. We examined whether vitamin D3, omega-3 s, or a simple home-based exercise program (SHEP), alone or in combination, over three years, improve lumbar spine (LS), femoral neck (FN) or total hip (TH) aBMD assessed by DXA. METHODS aBMD was a secondary outcome in DO-HEALTH, a 3-year, multicenter, double-blind, randomized 2 × 2 × 2 factorial design trial in generally healthy older adults age ≥ 70 years. The study interventions were vitamin D3 (2000IU/d), omega-3 s (1 g/d), and SHEP (3 × 30 min/wk), applied alone or in combination in 8 treatment arms. Mixed effect models were used adjusting for age, sex, BMI, prior fall, study site and baseline level of the outcome. Main effects were assessed in the absence of an interaction between the interventions. Subgroup analyses by sex, physical activity level, dietary calcium intake, serum 25(OH)D levels, and fracture history were conducted. RESULTS DXA scans were available for 1493 participants (mean age 75 years; 80.4% were physically active, 44% had 25(OH)D levels <20 ng/ml). At the LS and FN sites, none of the treatments showed a benefit. At the TH, vitamin D vs. no vitamin D treatment showed a significant benefit across 3 years (difference in adjusted means [AM]: 0.0035 [95% CI 0.0011, 0.0059] g/cm2). Furthermore, there was a benefit for vitamin D vs. no vitamin D treatment on LS aBMD in the male subgroup of (interaction P = 0.003; ∆AM: 0.0070 [95% CI 0.0007, 0.0132] g/cm2). CONCLUSIONS Omega-3 and SHEP had no benefit on aBMD in healthy, active and largely vitamin D replete older adults. Our study suggests a small benefit of 2000 IU vitamin D daily on TH aBMD overall and LS aBMD among men, however, effect sizes were very modest and the clinical impact of these findings is unclear.
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Affiliation(s)
- Kistler-Fischbacher Melanie
- Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland
- Centre on Aging and Mobility, University of Zurich and Stadtspital Zurich Waid, Zurich, Switzerland
| | - Armbrecht Gabriele
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Gängler Stephanie
- Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland
- Centre on Aging and Mobility, University of Zurich and Stadtspital Zurich Waid, Zurich, Switzerland
| | - Theiler Robert
- Centre on Aging and Mobility, University of Zurich and Stadtspital Zurich Waid, Zurich, Switzerland
| | - Rizzoli Renè
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Dawson-Hughes Bess
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - A Kanis John
- Center for Metabolic Diseases, University of Sheffield Medical School, Sheffield, England
| | - C Hofbauer Lorenz
- Centre for Healthy Aging, Department of Medicine III, TU Dresden Medical Centre, Dresden, Germany
| | - C Schimmer Ralph
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Vellas Bruno
- IHU HealthAge, Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - A P Da Silva José
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Orav E John
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - W Kressig Reto
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
| | - Egli Andreas
- Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland
- Centre on Aging and Mobility, University of Zurich and Stadtspital Zurich Waid, Zurich, Switzerland
| | - Lang Wei
- Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland
- Centre on Aging and Mobility, University of Zurich and Stadtspital Zurich Waid, Zurich, Switzerland
| | - A Wanner Guido
- Spine Clinic and Traumatology, Private Hospital Bethanien, Zurich, Switzerland
| | - A Bischoff-Ferrari Heike
- Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland
- Centre on Aging and Mobility, University of Zurich and Stadtspital Zurich Waid, Zurich, Switzerland
- IHU HealthAge, Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR INSERM 1027, University of Toulouse III, Toulouse, France
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