Medications for Irritable Bowel Syndrome
A recent Tools for Practice review on the use of antidepressants for IBS concluded that TCAs (14 RCTs, n=1,290) improved overall symptoms and abdominal pain in most patients in an approximately 2 to 6 month timeline when compared to placebo (~55% versus ~35%, NNT=5). TCAs were associated with greater adverse effects (e.g., dry mouth) compared to placebo (25–55% versus 5–35%).
- SSRIs and SNRIs produced similar levels of pain relief; however, consistent overall improvement was lacking.
- The evidence supporting differences in efficacy by IBS subtype is limited.
Related Module: The module Irritable Bowel Syndrome: Adults (November 2019) contains information on both pharmacologic and nonpharmacologic interventions, including TCAs and SSRIs. In the module, the suggestion was made to consider using TCAs for IBS with diarrhea and SSRIs for IBS with constipation given typical side effects of those classes of medications, based on limited evidence.
Supplements and the Prevention of Fracture and Falls
The BMJ recently published a systematic review of the role of calcium, vitamin D, and their combination as supplements in preventing falls and fractures. Study participants were adults (69 RCTs, n=153,902) and most were community dwelling and not considered high risk for falls or fractures; studies involving adults on osteoporosis medication were excluded. Evidence for many outcomes of calcium or combined supplementation in adults requiring residential care or deemed high risk was limited. High risk populations included those ≥ age 80 with a history of a fracture or fall, diagnosed osteoporosis, or a mean baseline vitamin D deficiency.
Key Findings
| Any Fracture Outcome | Risk of Falling | |
|---|---|---|
| Calcium supplements | Little to no effect (RR 0.91; moderate certainty) | Little to no effect (RR 0.91; moderate certainty) |
| Vitamin D supplements | Little to no effect (RR 1.00; high certainty) | Little to no effect (RR 1.01; high certainty) |
| Combined supplements | Little to no effect (RR 0.91; high certainty) | Little to no effect (RR 0.92; moderate certainty) |
| (RR=risk ratio) | ||
- Most trials were determined to have a high risk of bias.
- Study control group participants may have personally taken calcium and vitamin D supplements and possibly biased the results.
Bottom Line
- The routine use of calcium, vitamin D, or combined supplements does not appear to reduce the risk of fractures and falls in low-risk community-dwelling individuals.
Related Module: The Osteoporosis module (February 2024) includes the Osteoporosis Canada perspective that adults not on osteoporosis medication and consuming a balanced diet are unlikely to benefit from calcium and vitamin D supplements for fracture prevention.