When discussing the use of calcium and vitamin D in the prevention and the treatment of osteoporosis one can make a distinction between the use as dietary supplementation to correct or prevent deficiencies, and the pharmacologic use of higher doses, whether or not in association with other drugs. However, in practical terms it is not always possible to clearly make this distinction.
Available evidence suggests that increasing the calcium intake can favourably affect the build-up of bone mass in adolescence. In this population, the daily consumption of calcium in the diet should, optimally, be at least 1200 mg/day. In view of the lack of data pertaining to the effect on the final peak bone mass, there is at present time no basis for the systematic administration of calcium supplements to healthy children and adolescents.
Calcium supplementation, aiming at a total calcium intake of at least 1500 mg/day, has a partial protective effect on postmenopausal bone loss, this effect being documented mainly in women more than 5 years after menopause.
In the present state of our knowledge, there is no established role for vitamin D supplementation in the prevention of postmenopausal osteoporosis, except in elderly patients presenting with a higher risk for relative vitamin D deficiency and with low calcium intake. The results of a controlled trial suggest that in institutionalised elderly patients, systematic administration of calcium and vitamin D supplements can substantially reduce the risk of hip fracture.
In the treatment of established postmenopausal osteoporosis, calcium supplementation has only a role as a general adjuvant therapeutic measure and as a specific complement to the treatment with other active compounds. There are indications that treatment with α-calcidol or calcitriol has a positive effect on the evolution of bone mass, but awaiting further confirmation of a favourable effect on the incidence of osteoporotic fractures, treatment with these drugs remains experimental.
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Riggs, B.L., Melton, L.J. III. Involutional osteoporosis. N Eng J Med 1986, 314, 1676–1686.
Gallagher, J.C. The pathogenesis of osteoporosis. Bone Miner 1990, 9, 215–227.
Schaafsma, G. The scientific basis of recommended dietary allowances for calcium. J Intern Med 1992, 231, 187–194.
Kanis, J.A., Passmore, R. Calcium supplementation of the diet—I. BMJ 1989, 298, 137–140.
Kanis, J.A., Passmore, R. Calcium supplementation of the diet—II. BMJ 1989, 298, 205–208.
Nordin, B.E.C., Heaney, R.P. Calcium supplementation of the diet: justified by present evidence. Br Med J 1990, 300, 1056–1060.
Heany, R.P. Calcium supplements: practical considerations. Osteoporosis Int 1991, 1, 65–71.
Charles, P. Calcium absorption and calcium bioavailability J Intern Med 1992, 231, 161–168.
Nicar, M.J., Pak, C.Y.C. Calcium bioavailability from calcium carbonate and calcium citrate. J Clin Endocrinol Metab 1985, 61, 391–393.
Reginster, J.Y., Denis, D., Bartsch, V., Deroisy, R., Zegers, B., Franchimont, P. Acute biochemical vriations induced by four different calcium salts in healthy male volunteers. Osteoporosis Int 1993, 3, 271–275.
Dawson-Hughes, B., Dallal, G.E., Krall, E.A., 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, 878–883.
Bell N.H. Vitamin D-endocrine system J Clin Invest 1985, 76, 1–6.
Gallagher JC. Vitamin D metabolism and therapy in elderly subjects. Southern Med J 1992, 85 (suppl 2), S43-S47.
National Research Council. Recommended dietary allowances. 10th Edition. Washington DC, National Academy Press, 1989, 92–98.
Kelly P., Eisman J, Sambrook P. Interaction of genetic and environmental influences on peak bone density. Osteoporosis Int 1990, 1,56–60
Kanders B, Dempster DW, Lindsay R. Interaction of calcium, nutrition, and physical activity on bone mass in young women. J Bone Miner Res 1988, 3, 145–149.
Halioua L, Anderson J J. Lifetime calcium intake and physical activity habits: independent and combined effects on the radial bone of healthy premenopausal caucasian women. Am J Clin Nutr 1989, 49, 534–541.
Tylavsky FA, Anderson JJB, Talmage RV, Taft TN. Are calcium intakes and physical activity patterns during adolescence related to radial bone mass of white college-age females? Osteoporosis Int 1992, 2,232–240.
Matkovic, V., Fontana, D., Tominac, C., Goel, P., Chesnut, C.H. III. Factors that influence peak bone mass formation: a study of calcium balance and the inheritance of bone mass in adolescent females. Am J Clin Nutr 1990, 52, 878–888.
Recker, R.R., Davies, K.M., Hinders, S.M., Heaney, R.P., Stegman, M.R., Kimmel, D.B. Bone gain in young adult women. JAMA 1992, 268, 2403–2408.
Johnston, C.C., Miller, J.Z., Slemenda, C.W., Reister, T.K., Hui, S., Christian, J.C., Peacock, M. Calcium supplementation and increases in bone mineral density in children. N Engl J Med 1992, 327, 82–87.
Baran, D., Sorensen, A., Grimes, J., Lew, R., Karellas, A., Johnson, B., Roche, J. Dietary modification with dairy products for preventing vertebral bone los in premenopausal women: a three-year prospective study. J Clin Endocrinol Metab 1989, 70, 264–270.
Heaney, R.P. Thinking straight about calcium. N Engl J Med 1993, 328, 503–505.
Riis, B., Thomsen, K., Christiansen, C. Does calcium supplementation prevent postmenopausal bone loss? N Engl J Med 1987, 316, 173–177.
Elders, P.J.M., Netelenbos, J.C., Lips, P., van Ginkel, F.C., Khoe, E., Leeuwenkamp, O.R., Hackeng, W.H.L., Van Der Stelt, P.F. 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, 533–540.
Prince, R.L., Smith, M., Dick, I.M., Price, R.I., Webb, P.G., Henderson, N.K., Harris, M.M. Prevention of postmenopausal osteoporosis. N Engl J Med 1991, 325, 1189–1195.
Lau, E.M.C., Woo, J., Leung, P.C., Swaminathan, R., Leung, D. The effects of calcium supplementation and exercise on bone density in elderly chinese women. Osteoporosis Int 1992, 2, 168–173.
Reid, I.R., Ames, R.W., Evans, M.C., Gamble, G.D., Sharpe, S.J. Effect of calcium supplementation on bone loss in postmenopausal women. N Engl J Med 1993, 328, 460–464.
Elders, P.J.M., Lips, P., Netelenbos, J.C., Van Ginkel, F.C., Khoe, E., Van Der Vijgh, W.J.F., Van Der Stelt, P.F. Long-term effect of calcium supplementation on bone loss in perimenopausal women. J Bone Miner Res 1994, 9, 963–970.
Aloia, J.F., Vaswani, A., Yeh, J.K., Ross, P.L., Flaster, E., Dilmanian, F.A. Calcium supplementation with and without hormone replacement therapy to prevent postmenopausal bone loss. Ann Int Med 1994, 120, 97–103.
Ettinger, B., Genant, H.K., Cann, C.E. Postmenopausal bone loss is prevented by treatment with low dosage estrogen with calcium. Ann Intern Med, 1987, 106, 40–45.
Christiansen, C., Lindsay, R. Estrogens, bone loss and preservation. Osteoporosis Int 1990, 1, 7–13.
Conference Report. Consensus development conference: prophylaxis and treatment of osteoporosis. BMJ 1987, 295, 914–915.
Holbrook, T.L., Barrett-Connor, E. Wingard, D.L. Dietary calcium and risk of hip fracture: 14-year prospective population stydy. Lancet 1988, 1046–1049.
Wickham, C.A.C., Walsh, K., Cooper, C., Barker, D.J.P., Margetts, B.M., Morris, J., Bruce, S.A. Dietary calcium, physical activity, and risk of hip fracture: a prospective study. BMJ 1989, 299, 889–892.
Pouilles, J.M., Tremollieres, F., Ribot, C. Prevention of post-menopausal bone loss with 1 α-hydroxy vitamin D3. A three-year prospective study. Clin Rheumatol 1992, 11, 492–497.
Chapuy, M.C., Chapuy, P., Meunier, P.J. Calcium and vitamin D supplements: effects on calcium metabolism in elderly people. Am J Clin Nutr 1987, 46, 324–328.
Chapuy, M.C., Arlot, M.E., Duboeuf, F., Brun, J., Crouzet, B., Arnaud, S., Delmas, P.D., Meunier, P.J. Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 1992, 327, 1637–1642.
Chapuy, M.C., Arlot ME, Delmas PD, Meunier PJ. Effect of calcium and cholecalciferol treatment for three years on hip fractures in elderly women. B M J 1994, 308, 1082–1082.
Lips, P, Graafmans, W.C., Ooms, M.E., Bezemer, P.D., Bouter, L.M. The effect of vitamin D supplementation on the incidence of hip fractures in elderly people. J Bone Miner Res 9 (supplement 1) abstract 118.
Aloia, J.F., Vaswani, A., Yeh, J.K., Ellis, K., Yasumura S., Cohn, S.H.. Calcitriol in the treatment of postmenopausal osteoporosis. Amer J Med 1988, 84, 401–408.
Gallagher, J.C., Goldgar, D. Treatment of postmenopausal osteoporosis with high doses of synthethic calcitriol. Ann Intern Med 1990, 113, 649–655.
Ott, S.M., Chesnut, C.H. III. Calcitriol treatment is not effective in postmenopausal osteoporosis. Ann Intern Med 1989, 110, 267–274.
Orimo, H., Shiraki, M., Hayashi, Y., Nakomura, T. Reduced occurrence of vertebral crush fractures in senile osteoporosis treated with 1-α (OH)—vitamine D3. Bone Miner 1987, 3, 47–52.
Orimo, H., Shiraki, M., Hayashi, Y., Hoshino, T., Onaya, T., Miyazaki, S., Kurosawa, H., Nakamura, T., Ogawa, N. Effects of 1 α-hydroxyvitamin D3 on lumbar bone mineral density and vertebral fractures in patients with postmenopausal osteoporosis. Calcif Tissue Int 1994, 54, 370–376.
Tilyard, M.W., Spears, F.S., Thomson, J., Dovey, S. Treatment of postmenopausal osteoporosis with calcitriol or calcium. N Engl J Med 1992, 326, 357–362.
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Kaufman, J.M. Role of calcium and vitamin D in the prevention and the treatment of postmenopausal osteoporosis: An overview. Clin Rheumatol 14, 9–13 (1995). https://doi.org/10.1007/BF02210681
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