Osteoporosis International

, Volume 15, Issue 4, pp 290–294 | Cite as

Comparison of the effects of calcium loading with calcium citrate or calcium carbonate on bone turnover in postmenopausal women

  • Anne M. KennyEmail author
  • Karen M. Prestwood
  • Bradley Biskup
  • Bertha Robbins
  • Enid Zayas
  • Alison Kleppinger
  • Joseph A. Burleson
  • Lawrence G. Raisz
Original Article


Calcium supplementation is known to increase bone mineral density and decrease fractures, but the relative efficacy of different forms of calcium supplementation is not established. We compared the effects of calcium carbonate and calcium citrate on markers of bone resorption in older postmenopausal women in an open-labeled crossover study. Forty women were randomized to receive 1000 mg/day of either calcium citrate or calcium carbonate for 12 weeks, followed by a 2-week washout without calcium supplements and 12 weeks treatment with the alternate calcium supplement. All women received vitamin D (900 IU/day). Thirty-four women (25 Caucasian, nine Hispanic) completed the study. No significant differences in the decrease in parathyroid hormone (PTH) or bone specific alkaline phosphatase or the increase in urinary calcium/creatinine were detected between the two treatments. However, calcium citrate supplementation decreased the collagen cross-link resorption markers, urinary N-telopeptide (−30%), C-telopeptide (−31%), free deoxypyridinoline (19%) and serum N-telopeptide (−8%), compared to no significant change following calcium carbonate supplementation (+2%, +3%, +2% and +2%, respectively; P<0.05). Calcium citrate decreased markers of bone resorption significantly more than calcium carbonate in postmenopausal women, although no differences in their effects in calcium excretion or PTH were detected.


Calcium carbonate Calcium citrate Markers of bone formation Markers of bone resorption 



This work has been supported by the General Clinical Research Center (MO1-RR06192), Claude Pepper OAIC (5P60-AG13631) and Mission Pharmacal. Dr. Kenny has been supported by the Paul Beeson Faculty Scholar Program. In addition, we wish to thank Pamela Fall and Christine Abreu for assistance in the biochemical assays.


  1. 1.
    Scopacasa F, Horowitz M, Wishart JM, Need AG, Morris HA, Wittert G, Nordin BE (1998) Calcium supplementation suppresses bone resorption in early postmenopausal women. Calcif Tissue Int 62:8–12CrossRefPubMedGoogle Scholar
  2. 2.
    Dawson-Hughes B, Dallal GE, Krall EA, Sadowski L, Sahoyoun N, Tannebaum S (1990) A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med 323:878–883PubMedGoogle Scholar
  3. 3.
    Dawson Hughes B, Harris SS, Krall EA, Dallai GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1337:670–676CrossRefGoogle Scholar
  4. 4.
    Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327:1637–1642PubMedGoogle Scholar
  5. 5.
    Recker RR (1985) Calcium absorption and achlorhydria. N Engl J Med 313:70–33PubMedGoogle Scholar
  6. 6.
    Prestwood KM, Thompson DL, Kenny AM, Seibel MJ, Pilbeam CC, Raisz LG (1999) Low dose estrogen and calcium have an additive effect on bone resorption in older women. J Clin Endocrinol Metab 84:179–183PubMedGoogle Scholar
  7. 7.
    Prestwood KM, Pannullo AM, Kenny AM, Pilbeam CC, Raisz LG (1996) The effect of a short course of calcium and vitamin D on bone turnover in older women. Osteoporos Int 6:314–319PubMedGoogle Scholar
  8. 8.
    Prestwood KM, Kenny AM, Unson C, Kulldorff M (2000) The effect of low dose micronized 17ss-estradiol on bone turnover, sex hormone levels, and side effects in older women: a randomized, double blind, placebo-controlled study. J Clin Endocrinol Metab 85:4462–4469PubMedGoogle Scholar
  9. 9.
    Reid IR, Ames RW, Evans MC, Gamble GD, Sharpe SJ (1993) Effect of calcium supplementation on bone loss in postmenopausal women. N Engl J Med 328:460–464CrossRefPubMedGoogle Scholar
  10. 10.
    Riggs BL, O’Fallon WM, Muhs J, O’Connor MK, Kumar R, Melton LJ 3rd (1998) Long-term effects of calcium supplementation on serum parathyroid hormone level, bone turnover, and bone loss in elderly women. J Bone Miner Res 13:168–174PubMedGoogle Scholar
  11. 11.
    Peacock M, Liu G, Carey M et al. (2000) Effect of calcium or 25OH vitamin D3 dietary supplementation on bone loss at the hip in men and women over the age of 60. J Clin Endocrinol Metab 85:3011–3019PubMedGoogle Scholar
  12. 12.
    Martini L, Wood RJ (2002) Relative bioavailability of calcium-rich dietary sources in the elderly. Am J Clin Nutr 76:1345–1350PubMedGoogle Scholar
  13. 13.
    Bell NH, Bilezikian JP, Bone HG 3rd, Kaur A, Maragoto A, Santora AC and the MK-063 Study Group (2002) Alendronate increases bone mass and reduces bone markers in postmenopausal African-American women. J Clin Endocrinol Metab 87:2792–2797PubMedGoogle Scholar
  14. 14.
    Delmas PD, Ensrud KE, Adachi JD, Harper KD, Sarkar S, Gennari C, Reginster JY, Pols HA, Recker RR, Harris ST, Wu W, Genant HK, Black DM, Eastell R (2002) Outcomes of raloxifene evaluation investigators. Efficacy of raloxifene on fracture risk reduction in women with osteoporosis: four-year results from a clinical trial. J Clin Endocrinol Metab 87:3609–3617Google Scholar
  15. 15.
    Johnell O, Scheele WH, Lu Y, Reginster JY, Need AG, Seeman E (2002) Additive effects of raloxifene and alendronate on bone density and biochemical markers of bone remodeling in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 87:985–992PubMedGoogle Scholar
  16. 16.
    Heaney RP, Dowell SD, Bierman J, Hale CA, Bendich A (2002) Absorbability and cost effectiveness in calcium supplementation. J Am Coll Nutr 20:239–246Google Scholar
  17. 17.
    Bo-Linn GW, Davis GR, Buddrus DJ, Morawaski SG, Santa Ana C, Fordtran JS (1984) An evaluation of the importance of gastric acid secretion in the absorption of dietary calcium. J Clin Invest 73:640–647PubMedGoogle Scholar
  18. 18.
    Nicar MJ, Pak CYC (1985) Calcium bioavailability from calcium carbonate and calcium citrate. J Clin Endocrinol Metab 61:391–393PubMedGoogle Scholar
  19. 19.
    Harvey JA, Zobitz MM, Pak CYC (1988) Dose dependency of calcium absorption: a comparison of calcium carbonate and calcium citrate. J Bone Miner Res 3:253–258PubMedGoogle Scholar
  20. 20.
    Heller HJ, Greer LG, Sharon BA, Haynes SD, Poindexter JR, Pak CYC (2000) Pharmacokinetic and pharmacodynamic comparison of two calcium supplements in postmenopausal women. J Clin Pharmacol 40:1237–1244PubMedGoogle Scholar
  21. 21.
    Heller HJ, Greer LG, Haynes SD, Pointdexter JR, Pak CYC (2000) Pharmaacokinetics and pharmacodynamic comparison of two calcium supplements in postmenopausal women. J Clin Pharmacol 40:1237–1244PubMedGoogle Scholar
  22. 22.
    Heaney, RP, Dowell MS, Barger-Lux MJ (1999) Absorption of calcium as the carbonate and citrate salts, with some observations on method. Osteoporos Int 9:19–23CrossRefPubMedGoogle Scholar
  23. 23.
    Hurwitz A, Brady DA, Schaal SE, Samloff IM, Dedon J, Ruhl CE (1997) Gastric acidity in older adults. JAMA 278:659–662CrossRefPubMedGoogle Scholar
  24. 24.
    Fall PM, Kennedy D, Smith A, Seibel MJ, Raisz LG (2000) Comparison of serum and urine assays for biochemical markers of bone resorption in postmenopausal women with and without hormone replacement therapy and in men. Osteoporos Int 11:481–485CrossRefPubMedGoogle Scholar
  25. 25.
    Favus MJ, Pak C (2001) Evidence for absorption of ionic calcium and soluble calcium complexes by the duodenum and cecum in the rat. Am J Ther 8:425–431CrossRefPubMedGoogle Scholar
  26. 26.
    Brown EM (2000) Calcium receptor and regulation of parathyroid hormone secretion. Rev Endocr Metab Disord 1:307–315CrossRefPubMedGoogle Scholar
  27. 27.
    Recker RR, Hinders S, Davies KM, Heaney RP, Stegman MR, Lappe JM, Kimmel DB (1996) Correcting calcium nutritional deficiency prevents spine fractures in elderly women. J Bone Miner Res 11:1961–1966PubMedGoogle Scholar
  28. 28.
    Cumming RG, Nevitt MC (1997) Calcium for prevention of osteoporotic fractures in postmenopausal women. J Bone Miner Res 12:1321–1329PubMedGoogle Scholar
  29. 29.
    Ruml LA, Sakhaee K, Peterson R, Adams-Huet B, Pak CY (1999) The effect of calcium citrate on bone density in the early and mid-postmenopausal period: a randomized placebo-controlled study. Am J Ther 6:303–311PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004

Authors and Affiliations

  • Anne M. Kenny
    • 1
    Email author
  • Karen M. Prestwood
    • 1
  • Bradley Biskup
    • 1
  • Bertha Robbins
    • 3
  • Enid Zayas
    • 1
  • Alison Kleppinger
    • 1
  • Joseph A. Burleson
    • 2
  • Lawrence G. Raisz
    • 3
  1. 1.Center on Aging, MC-5215University of Connecticut Health CenterFarmingtonUSA
  2. 2.Department of Community MedicineUniversity of Connecticut Health CenterFarmingtonUSA
  3. 3.Lowell P. Weicker General Clinical Research CenterUniversity of Connecticut Health CenterFarmingtonUSA

Personalised recommendations