Osteoporosis International

, Volume 22, Issue 2, pp 489–498 | Cite as

Calcium and vitamin-D supplementation on bone structural properties in peripubertal female identical twins: a randomised controlled trial

  • D. A. GreeneEmail author
  • G. A. Naughton
Original Article



A randomised controlled trial was used in assessing the impact of 6 months of daily calcium and vitamin-D supplementation on trabecular and cortical bone acquisition at distal tibial and radial sites using peripheral quantitative computed tomography (pQCT). Daily supplementation was associated with increased bone density and bone strength at the distal tibia and radius.


pQCT has not been used to assess bone responses to calcium and vitamin-D supplementation on peripubertal children. This randomised controlled trial aimed to assess the impact of a 6-month daily calcium and vitamin-D supplementation on trabecular and cortical bone acquisition at distal tibial and radial sites using pQCT.


Twenty pairs of peripubertal female identical twins, aged 9 to 13 years, were randomly assigned to receive either 800 mg of calcium and 400 IU of vitamin D3, or a matched placebo. Bone structural properties at the distal tibia and distal radius were acquired at baseline and 6 months.


The calcium-supplemented group showed greater gains in trabecular density, trabecular area and strength strain index at the 4% of distal tibial and radial sites compared with the placebo group (p = 0.001). Greater gains in cortical area at the 38% and 66% of tibial sites were also found in twins receiving the calcium supplement (p = 0.001).


Daily supplementation for a period of 6 months was associated with increased trabecular area, trabecular density and strength strain index at the ultra-distal tibia and radius and increased cortical area at tibial mid-shaft.


Bone strength Calcium pQCT Supplementation Trabecular 



We would like to acknowledge all participants and their respective families for assisting with this project. Recruitment of participants was only possible with the great support of the Australian Twin Registry. Supplements were kindly supplied by USANA Health Sciences (Australia).


This project was supported by Faculty of Health Sciences funding from the Australian Catholic University.

Conflicts of interest



  1. 1.
    MacKelvie K, Khan K, McKay H (2002) Is there a critical period for bone response to weight-bearing exercise in children and adolescents? A systematic review. Br J Sports Med 36:250–257PubMedCrossRefGoogle Scholar
  2. 2.
    Bass SL (2000) The prepubertal years: a uniquely opportune stage of growth when the skeleton is most responsive to exercise? Sports Med 30:73–78PubMedCrossRefGoogle Scholar
  3. 3.
    Bailey DA, McKay HA, Mirwald RL et al (1999) A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: the University of Saskatchewan bone mineral accrual study. J Bone Miner Res 14:1672–1679PubMedCrossRefGoogle Scholar
  4. 4.
    Hernandez CJ, Beaupre GS, Carter DR (2003) A theoretical analysis of the relative influences of peak BMD, age-related bone loss and menopause on the development of osteoporosis. Osteoporos Int 14(10):843–847PubMedCrossRefGoogle Scholar
  5. 5.
    Bonjour JP, Carrie AL, Ferrari S et al (1997) Calcium-enriched foods and bone mass growth in prepubertal girls: a randomized, double-blind, placebo-controlled trial. J Clin Invest 99:1287–1294PubMedCrossRefGoogle Scholar
  6. 6.
    Lehtonen-Veromaa MK, Mottonen TT, Nuotio IO et al (2002) Vitamin D and attainment of peak bone mass among peripubertal Finnish girls: a 3-y prospective study. Am J Clin Nutr 76:1446–1453PubMedGoogle Scholar
  7. 7.
    Outila TA, Karkkainen MU, Lamberg-Allardt CJ (2001) Vitamin D status affects serum parathyroid hormone concentrations during winter in female adolescents: associations with forearm bone mineral density. Am J Clin Nutr 74:206–210PubMedGoogle Scholar
  8. 8.
    Moyer-Mileur LJ, Xie B, Ball SD et al (2003) Bone mass and density response to a 12-month trial of calcium and vitamin D supplement in preadolescent girls. J Musculoskelet Neuronal Interact 3:63–70PubMedGoogle Scholar
  9. 9.
    Nowson CA, Green RM, Hopper JL et al (1997) A co-twin study of the effect of calcium supplementation on bone density during adolescence. Osteoporos Int 7:219–225PubMedCrossRefGoogle Scholar
  10. 10.
    Ianc D, Serbescu C, Membea M et al (2006) Effects of an exercise program and calcium supplementation on bone in children: a randomized controlled trial. Int J Sport Nutr Exerc Metabol 16:580–596Google Scholar
  11. 11.
    Chevalley T, Bonjour JP, Ferrari S et al (2005) Skeletal site selectivity in the effects of calcium supplementation on area bone mineral density gain: a randomized, double-blind, placebo-controlled trial in prepubertal boys. J Clin Endocrinol Metab 90:3342–3349PubMedCrossRefGoogle Scholar
  12. 12.
    Cameron MA, Paton LM, Nowson CA et al (2004) The effect of calcium supplementation on bone density in premenarcheal females: a co-twin approach. J Clin Endocrinol Metab 10:4916–4922CrossRefGoogle Scholar
  13. 13.
    Dibba B, Prentice A, Ceesay M et al (2000) Effect of calcium supplementation on bone mineral accretion in Gambian children accustomed to low calcium diet. Am J Clin Nutr 71:544–549PubMedGoogle Scholar
  14. 14.
    Johnson CC, Miller JZ, Slemenda CW et al (1992) Calcium supplementation and bone mineral density in children. N Engl J Med 327:82–87CrossRefGoogle Scholar
  15. 15.
    Cadogan J, Eastell R, Jones N et al (1997) Milk intake and bone mineral acquisition in adolescent girls: randomised, controlled intervention trial. BMJ 315:1255–1260PubMedGoogle Scholar
  16. 16.
    Bass SL, Naughton G, Saxon L et al (2007) Exercise and calcium combined results in a greater osteogenic effect than either factor alone: a blinded randomized placebo-controlled trial in boys. J Bone Miner Res 3:458–464Google Scholar
  17. 17.
    Iuliano-Burns S, Wang XF, Evans A et al (2006) Skeletal benefits from calcium supplementation in children with calcium intakes near 800 mg daily. Osteoporos Int 12:1794–1800CrossRefGoogle Scholar
  18. 18.
    Winzenberg TM, Shaw K, Fryer J et al (2006) Calcium supplementation for improving bone mineral density in children. Cochrane Database Syst Rev 2:CD005119PubMedGoogle Scholar
  19. 19.
    Bonjour JP, Chavelley T, Ammann P et al (2001) Gain in bone mineral mass in prepubertal girls 3.5 years after discontinuation of calcium supplementation: a follow-up study. Lancet 358:1208–1212PubMedCrossRefGoogle Scholar
  20. 20.
    Hopper JL, Green R, Nowson C et al (1998) Genetic, common environment and individual specific components of variance for bone mineral density in 10–26 year-old females: a twin study. Am J Epidemiol 147:17–29PubMedGoogle Scholar
  21. 21.
    Ward KA, Roberts SA, Adams JE et al (2007) Calcium supplementation and weight bearing physical activity—do they have a combined effect on the bone density of pre-pubertal children? Bone 41:496–504PubMedCrossRefGoogle Scholar
  22. 22.
    Specker B, Binkley T (2003) Randomized trial of physical activity and calcium supplementation on bone mineral content in 3- to 5-year-old children. J Bone Miner Res 18:885–892PubMedCrossRefGoogle Scholar
  23. 23.
    Tanner TM (1968) Growth at adolescence, 2nd edn. Blackwell Scientific Publications, Oxford, pp 85–87Google Scholar
  24. 24.
    Duke PM, Litt IF, Gross RT (1980) Adolescent’s self assessment of sexual maturation. Pediatrics 66:918–920PubMedGoogle Scholar
  25. 25.
    Bouchard C, Tremblay A, Leblanc C (1983) A method to assess energy expenditure in children and adults. Am J Clin Nutr 37:461–467PubMedGoogle Scholar
  26. 26.
    Heaney RP (2007) Bone health. Am J Clin Nutr 85:300S–303SPubMedGoogle Scholar
  27. 27.
    Lloyd T, Andon MB, Rollings N et al (1993) Calcium supplementation and bone mineral density in adolescent girls. JAMA 270:841–844PubMedCrossRefGoogle Scholar
  28. 28.
    Papadimitropoulos E, Wells G, Shea B et al (2002) Meta-analyses of therapies for postmenopausal osteoporosis. VIII: meta-analyses of the efficacy of vitamin D treatment in preventing osteoporosis in postmenopausal women. Endocr Rev 23:560–569PubMedCrossRefGoogle Scholar
  29. 29.
    Matkovic V, Landoll JD, Badenhop-Stevens NE et al (2004) Nutrition influences skeletal development from childhood to adulthood: a study of hip, spine, and forearm in adolescent females. J Nutr 134:701S–705SPubMedGoogle Scholar
  30. 30.
    Heaney RP (1994) The bone remodelling transient: implications for the interpretation of clinical studies of bone mass change. J Bone Miner Res 9:1511–1523Google Scholar
  31. 31.
    Kelly PJ, Eisman JA, Sambrook PN (1990) Interaction of genetic and environmental influences on peak bone density. Osteoporos Int 1:56–60PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  1. 1.Centre of Physical Activity Across the Lifespan (CoPAAL), School of Exercise ScienceAustralian Catholic UniversityStrathfieldAustralia

Personalised recommendations