Osteoporosis International

, Volume 4, Issue 5, pp 245–252 | Cite as

Effects of calcium supplements on femoral bone mineral density and vertebral fracture rate in vitamin-D-replete elderly patients

  • T. Chevalley
  • R. Rizzoli
  • V. Nydegger
  • D. Slosman
  • C. -H. Rapin
  • J. -P. Michel
  • H. Vasey
  • J. -P. Bonjour
Original Article


The efficacy of calcium (Ca) in reducing bone loss is debated. In a randomized placebo-controlled double-masked study, we investigated the effects of oral Ca supplements on femoral shaft (FS), femoral neck (FN) and lumbar spine (LS) bone mineral density (BMD), and on the incidence of vertebral fracture in vitamin-D-replete elderly. Ninety-three healthy subjects (72.1±0.6 years) were randomly allocated to three groups receiving 800 mg/day Ca in two different forms or a placebo for 18 months. Sixty-three patients (78.4±1.0 years) with a recent hip fracture were allocated to two groups receiving the two forms of Ca without placebo. FS BMD changes in Ca-supplemented non-fractured women were significantly different from those in the placebo group (+0.6±0.5% v −1.2±0.7%,p<0.05). There was no difference in effect between the two forms of Ca. The changes of +0.7±0.8% v −1.7±1.6% in FN BMD of Ca-supplemented women and the placebo group did not reach statistical significance. In fractured patients, FS, FN and LS BMD changes were −1.3±0.8, +0.3±1.6 and +3.1±1.2% (p<0.05 for the last). The rate of new vertebral fractures was 74.3 and 106.2 fractures per 1000 patient-years in Ca-supplemented non-fractured subjects and in the placebo group, respectively, and 144.0 in Ca-supplemented fractured patients. Thus, oral Ca supplements prevented a femoral BMD decrease and lowered vertebral fracture rate in the elderly.


Bone mineral density Calcium Elderly Femoral neck Fracture Osteoporosis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kanis JA, Passmore R. Calcium supplementation of the diet: not justified by present evidence. BMJ 1989;298:137–40, 205-8.Google Scholar
  2. 2.
    Nordin BEC, Heaney RP. Calcium supplementation of the diet: justified by present evidence. BMJ 1990;300:1056–9.Google Scholar
  3. 3.
    Matkovic V. Calcium and peak bone mass. J Intern Med 1992;231:151–60.Google Scholar
  4. 4.
    Johnston CC, Miller JZ, Slemenda CW, et al. Calcium supplementation and increases in bone mineral density in children. N Engl J Med 1992;327:82–7.Google Scholar
  5. 5.
    Dawson-Hughes B. Calcium supplementation and bone loss: a review of controlled clinical trials. Am J Clin Nutr 1991;54:S274-S280.Google Scholar
  6. 6.
    Dawson-Hughes B, Dallal GE, Krall EA, Sadowski L, Sahyoun N, Tannenbaum S. A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med 1990;323:878–83.Google Scholar
  7. 7.
    Elders PJM, Netelenbos JC, Lips P, et al. Calcium supplementation reduces vertebral bone loss in perimenopausal women: a controlled trial in 248 women between 46 and 55 years of age. J Clin Endocrinol Metab 1991;73:533–40.Google Scholar
  8. 8.
    Reid IR, Ames RW, Evans MC, Gamble GD, Sharpe SJ. Effect of calcium supplementation on bone loss in postmenopausal women. N Engl J Med 1993;328:460–4.Google Scholar
  9. 9.
    Riis B, Thomsen K, Christiansen C. Does calcium supplementation prevent postmenopausal bone loss? N Engl J Med 1987;316:173–7.Google Scholar
  10. 10.
    Barrett-Connor E. The RDA for calcium in the elderly: too little, too late. Calcif Tissue Int 1989;44:303–7.Google Scholar
  11. 11.
    Delmi M, Rapin CH, Bengoa JM, Delmas PD, Vasey H, Bonjour JP. Dietary supplementation in elderly patients with fractured neck of the femur. Lancet 1990;335:1013–6.Google Scholar
  12. 12.
    Bullamore JR, Wilkinson R, Gallagher JC, Nordin BEC. Effect of age on calcium absorption. Lancet 1970;ii:535–7.Google Scholar
  13. 13.
    Smith EL, Reddan W, Smith PE. Physical activity and calcium modalities for bone mineral increase in aged women. Med Sci Sports Exerc 1981;13:60–4.Google Scholar
  14. 14.
    Fujita T, Fukase M, Miyamoto H, Matsumoto T, Ohue T. Increase of bone mineral density by calcium supplement with oyster shell electrolysate. Bone Miner 1990;11:85–91.Google Scholar
  15. 15.
    Lau EMC, Woo J, Leung PC, Swaminathan R, Leung D. The effects of calcium supplementation and exercise on bone density in elderly Chinese women. Osteoporosis Int 1992;2:168–73.Google Scholar
  16. 16.
    Chapuy MC, Arlot ME, Dubceuf F, et al. Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 1992;327:1637–42.Google Scholar
  17. 17.
    Chapuy MC, Durr F, Chapuy P. Age-related changes in parathyroid hormone and 25-hydroxycholecalciferol levels. J Gerontol 1983;38:19–22.Google Scholar
  18. 18.
    Tkatch LJ, Rapin CH, Rizzoli R, et al. Benefits of oral protein supplementation in elderly patients with fracture of the proximal femur. J Am Coll Nutr 1992;11:519–525.Google Scholar
  19. 19.
    Slosman DO, Rizzoli R, Buchs B, Piana F, Donath A, Bonjour JP. Comparative study of the performances of X-ray and gadolinium-153 bone densitometers at the level of the spine, femoral neck and femoral shaft. Eur J Nucl Med 1990;17:3–9.Google Scholar
  20. 20.
    Smith-Bindman R, Cummings SR, Steiger P, Genant HK. A comparison of morphometric definitions of vertebral fracture. J Bone Miner Res 1991;6:25–34.Google Scholar
  21. 21.
    Watts NB, Harris ST, Genant HK, et al. Intermittent cyclical etidronate treatment of postmenopausal osteoporosis. N Engl J Med 1990;323:73–9.Google Scholar
  22. 22.
    Riggs BL, Hodgson SF, O'Fallon WM, et al. Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. N Engl J Med 1990;322:802–9.Google Scholar
  23. 23.
    Ross PD, Wasnich RD, Davis JW, Vogel JM. Vertebral dimension differences between Caucasian populations, and between Caucasians and Japanese. Bone 1991;12:107–12.Google Scholar
  24. 24.
    Bonjour JP, Philippe J, Guelpa G, et al. Bone and renal components in hypercalcemia of malignancy and responses to a single infusion of clodronate. Bone 1988;9:123–30.Google Scholar
  25. 25.
    Bijvoet OLM, Morgan DB, Fourman P. The assessment of phosphate reabsorption. Clin Chim Acta 1969;26:15–24.Google Scholar
  26. 26.
    Buchs B, Rizzoli R, Slosman D, Nydegger V, Bonjour JP. Densité minérale osseuse de la colonne lombaire, du col et de la diaphyse fémoraux d'un échantillon de la population genevoise. Schweiz Med Wochenschr 1992;122:1129–36.Google Scholar
  27. 27.
    Chevalley T, Rizzoli R, Nydegger V, et al. Preferential low bone mineral density of the femoral neck in patients with a recent fracture of the proximal femur. Osteoporosis Int 1991;1:147–54.Google Scholar
  28. 28.
    Nordin BEC, Need AG, Morris HA, Horowitz M, Robertson WG. Evidence for a renal calcium leak in postmenopausal women. J Clin Endocrinol Metab 1991;72:401–7.Google Scholar
  29. 29.
    Obrant KJ, Merle B, Bejui J, Delmas PD. Serum bone-Gla protein after fracture. Clin Orthop 1990;258:300–3.Google Scholar
  30. 30.
    Ross PD, Wasnich RD, Vogel JM. Detection of prefracture spinal osteoporosis using bone mineral absorptiometry. J Bone Miner Res 1988;3:1–12.Google Scholar
  31. 31.
    Melton JL, Kan SH, Frye MA, Wahner HW, O'Fallon WM, Riggs BL. Epidemiology of vertebral fractures in women. Am J Epidemiol 1989;129:1000–11.Google Scholar

Copyright information

© European Foundation for Osteoporosis 1994

Authors and Affiliations

  • T. Chevalley
    • 1
  • R. Rizzoli
    • 1
  • V. Nydegger
    • 1
  • D. Slosman
    • 2
  • C. -H. Rapin
    • 4
  • J. -P. Michel
    • 4
  • H. Vasey
    • 3
  • J. -P. Bonjour
    • 1
  1. 1.Division of Clinical Pathophysiology (World Health Organization Collaborating Center for Osteoporosis and Bone Disease)University Hospital of GenevaGenevaSwitzerland
  2. 2.Department of Medicine, Division of Nuclear MedicineUniversity Hospital of GenevaGenevaSwitzerland
  3. 3.Department of Radiology, Orthopaedic Clinic, Department of SurgeryUniversity Hospital of GenevaGenevaSwitzerland
  4. 4.University Geriatrics InstitutionsGenevaSwitzerland

Personalised recommendations