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This VITamin D and OmegA-3 TriaL (VITAL) ancillary study investigated effects of marine omega-3 (1\u00a0g\/d; EPA+DHA in a 1.2:1 ratio) vs placebo supplements on fracture risk and bone density\/structure. VITAL is a 2\u2009\u00d7\u20092 factorial randomized placebo-controlled trial that studied effects of supplemental marine omega-3 fatty acids and\/or vitamin D3 vs placebo on cancer and cardiovascular events. The intervention took place from November 2011 through December 2017; median follow-up was 5.3\u00a0yr. The study included 25\u2009871\u00a0U.S. men (aged \u226550) and women (aged \u226555) without baseline cancer or cardiovascular disease, not selected for low bone density or fracture history. Primary outcomes were adjudicated incident total, nonvertebral, and hip fractures in the overall cohort. In a subcohort of 771 individuals, we measured 2-yr changes in areal BMD (aBMD) by DXA, and volumetric BMD (vBMD), cortical thickness, and bone strength indices at the radius and tibia by peripheral QCT. Supplemental omega-3 vs placebo had no effect on total (HR, 1.02; 95% CI, 0.92-1.13; p\u2009=\u2009.73), nonvertebral (HR, 1.01; 95% CI, 0.91-1.12; p\u2009=\u2009.80), or hip fractures (HR, 0.89; 95% CI, 0.61-1.30; p\u2009=\u2009.55). In the subcohort, omega-3 supplementation resulted in a small increase in whole body aBMD (+0.03% vs \u22120.41%, p\u2009=\u2009.006) and no effect on aBMD at the spine or hip, or vBMD or bone strength indices at the radius or tibia. No serious adverse effects were observed. Supplementation with marine omega-3 fatty acids did not reduce incident fracture risk. It led to a small increase in whole body aBMD but had no other effects on BMD or bone strength measures compared to placebo in generally healthy midlife and older adults.<\/jats:p>","DOI":"10.1093\/jbmr\/zjaf172","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T12:42:58Z","timestamp":1767789778000},"page":"242-250","source":"Crossref","is-referenced-by-count":3,"title":["The effects of marine fatty acid omega-3 supplements on incident fractures and bone mineral density in generally healthy adults"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5797-4947","authenticated-orcid":false,"given":"Meryl S","family":"LeBoff","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women\u2019s Hospital , Boston, MA 02115 ,","place":["United States"]},{"name":"Harvard Medical School , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2582-050X","authenticated-orcid":false,"given":"Sharon H","family":"Chou","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women\u2019s Hospital , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana M","family":"Ratnarajah","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women\u2019s Hospital , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy R","family":"Cook","sequence":"additional","affiliation":[{"name":"Harvard Medical School , Boston, MA 02115 ,","place":["United States"]},{"name":"Division of Preventive Medicine, Department of Medicine, Brigham and Women\u2019s Hospital , Boston, MA 02115 ,","place":["United States"]},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bharti","family":"Khurana","sequence":"additional","affiliation":[{"name":"Harvard Medical School , Boston, MA 02115 ,","place":["United States"]},{"name":"Department of Radiology, Brigham and Women\u2019s Hospital , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunjung","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Preventive Medicine, Department of Medicine, Brigham and Women\u2019s Hospital , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Kotler","sequence":"additional","affiliation":[{"name":"Division of Preventive Medicine, Department of Medicine, Brigham and Women\u2019s Hospital , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peggy M","family":"Cawthon","sequence":"additional","affiliation":[{"name":"California Pacific Medical Center Research Institute , San Francisco, CA 94107 ,","place":["United States"]},{"name":"Department of Epidemiology and Biostatistics, University of California at San Francisco , San Francisco, CA 94158 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas C","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California at San Francisco , San Francisco, CA 94158 ,","place":["United States"]},{"name":"Department of Medicine, University of California at San Francisco , San Francisco, CA 94143 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Black","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California at San Francisco , San Francisco, CA 94158 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Christopher","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Creighton University School of Medicine , Omaha, NE 68122 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I-Min","family":"Lee","sequence":"additional","affiliation":[{"name":"Harvard Medical School , Boston, MA 02115 ,","place":["United States"]},{"name":"Division of Preventive Medicine, Department of Medicine, Brigham and Women\u2019s Hospital , Boston, MA 02115 ,","place":["United States"]},{"name":"Department of Epidemiology, Harvard T.H. 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