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The effect of calcium supplementation and tanner stage on bone density, content and area in teenage women

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Abstract

One hundred and twelve Caucasian girls, 11.9±0.5 years of age at entry, were randomized into a 24-month, double-masked, placebo-controlled trial to determine the effect of calcium supplementation on bone mineral content, bone area and bone density. Supplementation was 500 mg calcium as calcium citrate malate (CCM) per day. Controls received placebo pills, and compliance of both groups averaged 72%. Bone mineral content, bone mineral area and bone mineral density of the lumbar spine and total body were measured by dual energy X-ray absorptiometry (DXA). Calcium intake from dietary sources averaged 983 mg/day for the entire study group. The supplemented group received, on average, an additional 360 mg calcium/day from CCM. At baseline and after 24 months, the two groups did not differ with respect to anthropometric measurements, urinary reproductive hormone levels or any measurement of pubertal progression. The supplemented group had greater increases of total body bone measures: content 39.9% versus 35.7% (p=0.01), area 24.2% versus 22.5% (p=0.15) and density 12.2% versus 10.1% (p=0.005). Region-of-interest analyses showed that the supplemented group had greater gains compared with the control group for bone mineral density, content and area. In particular, in the lumbar spine and pelvis, the gains made by the supplemented group were 12%–24% greater than the increases made by the control group. Bone acquisition rates in the two study groups were further compared by subdividing the groups into those with below- or above-median values for Tanner score and dietary calcium intake. In subjects with below-median Tanner scores, bone acquisition was not affected by calcium supplementation or dietary calicum level. However, the calcium supplemented subjects with above-median Tanner had higher bone acqusition rates than the placebo group with above-median Tanner scores. Relative to the placebo group, the supplemented group had increased yearly gains of bone content, area and density which represented about 1.5% of adult female values. Such increases, if held to adult skeletal maturity, could provide protection against future risk of osteoporotic fractures.

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References

  1. Heaney RP. The natural history of vertebral osteoporosis. Is low bone mass an epiphenomenom? Bone 1992;13:S23–6.

    Google Scholar 

  2. Johnston CC, Slemenda CW. Determinants of peak bone mass. Osteoporosis Int 1992;Suppl 1:S54–5.

    Google Scholar 

  3. Kanis JA, McCloskey EV. Epidemiology of vertebral osteoporosis. Bone 1992;13:S1–10.

    Google Scholar 

  4. Dempster DW, Lindsay R. Pathogenesis of osteoporosis. Lancet 1993;341:797–805.

    Google Scholar 

  5. Katzman DK, Bachrach LK, Carter DR, Marcus R. Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls. J Clin Endocrinol Metab 1991;73:1332–9.

    Google Scholar 

  6. Bonjour JP, Theintz G, Buchs B, Slosman D, Rizzoli R. Critical years and stages of puberty for spinal and femoral bone mass accumulation during adolescence. J Clin Endocrinol Metab 1991;73:555–63.

    Google Scholar 

  7. Glastre C, Braillon P, David L, Cochat P, Meunier PJ, Delmas PD. Measurement of bone mineral content of the lumbar spine by dual energy x-ray absorptiometry in normal children: correlations with growth parameters. J Clin Endocrinol Metab 1990;70:1330–3.

    Google Scholar 

  8. Gilsanz V, Roe TF, Mora S, Costin G, Goodman WG. Changes in vertebral bone density in black girls and white girls during childhood and puberty. N Engl J Med 1991;325:1597–600.

    Google Scholar 

  9. Fleming KH, Heimbach JT. Consumption of calcium in the United States: food sources and intake levels. J Nutr 1994;124:S1426–30.

    Google Scholar 

  10. Lloyd T, Andon MA, Rollings N, et al. Calcium supplementation and bone mineral density in adolescent girls. JAMA 1993;270:841–4.

    Google Scholar 

  11. Lloyd T, Rollings N, Andon MB, et al. Determinants of bone density in young women. I. Relationships among pubertal development, total body bone mass, and total body bone density in premenarchal females. J Clin Endocrinol Metab 1992;75:383–7.

    Google Scholar 

  12. Demers LM, Lipton A, Harvey HA, et al. The efficacy of CGS 20267 in suppressing estrogen biosynthesis in patients with advanced stage breast cancer. J Steroid Biochem Mol Biol 1993;44:687–91.

    Google Scholar 

  13. Lloyd T, Eggli DF. Measurement of bone mineral content and bone density in healthy twelve-year-old white females. J Nucl Med 1992;33:1143–5.

    Google Scholar 

  14. Johnson CC, Slemenda CW, Melton LJ. Clinical use of bone densitometry. N Engl J Med 1991;324:1105–9.

    Google Scholar 

  15. Smith KT, Heaney RP, Flora L, Hinders SM. Calcium absorption from a new calcium delivery system (CCM). Calcif Tissue Int 1987;41:351–2.

    Google Scholar 

  16. Miller JZ, Smith DL, Flora L, Slemenda C, Jiang XY, Johnston CC. Calcium absorption from calcium carbonate and a new form of calcium (CCM) in healthy male and female adolescents. Am J Clin Nutr 1988;48:1291–4.

    Google Scholar 

  17. Nutritionist III (Version 7.0) Salem, OR; N-squared computing analytical software.

  18. SAS Institute. SAS/STAT user guide, release 6.03. Cary, NC: SAS Institute, 1988.

    Google Scholar 

  19. Vonesh EF, Carter RL. Mixed effects nonlinear regression for unbalanced repeated measures. Biometrics 1992;48:1–17.

    Google Scholar 

  20. Marshall WA, Tanner JM. Variations in patterns in pubertal changes in girls. Arch Dis Child 1969;44:291–303.

    Google Scholar 

  21. Hamill PW, Drizd TA, Johnson CL. Physical growth: national center for health statistics percentiles. Am J Clin Nutr 1979;32:706–629.

    Google Scholar 

  22. Wright HS, Guthrie HA, Wang MQ, Bernardo V. The 1987–86 nationwide food consumption survey: an update on the nutrient intake of respondents. Nutr Today 1991;26:21–7.

    Google Scholar 

  23. Johnston CC Jr, Miller JZ, Slemenda C, et al. Calcium supplementation and increases in bone mineral density in children. N Engl J Med 1992;327:82–7.

    Google Scholar 

  24. Theintz G, Buchs B, Rizzoli R, et al. Longitudinal monitoring of bone mass accumulation in healthy adolescents: evidence of a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects. J Clin Endocrinol Metab 1992;75:1060–5.

    Google Scholar 

  25. Recker RR, Davies M, Hinders SM, Heaney RP, Stegman MR, Kimmel D. Bone gain in young adult women. JAMA 1992;268:2403–8.

    Google Scholar 

  26. Einhorn T. Bone strength: the bottom line [editorial]. Calcif Tissue Int 1992;51:333–9.

    Google Scholar 

  27. Gilsanz V, Boechat MI, Roe TF, Loro ML, Sayre JW, Goodman WG. Gender differences in vertebral body sizes in children and adolescents. Radiology 1994;190:673–7.

    Google Scholar 

  28. Faulkner KG, McClung M, Cummings SR. Automated evaluation of hip axis length for predicting hip fracture. J Bone Miner Res 1994;9:1065–70.

    Google Scholar 

  29. Nakamura T, Turner CH, Yoshikawa T, et al. Do variations in hip goemetry explain differences in hip fracture risk between Japanese and white Americans? J Bone Miner Res 1994;9:1071–6.

    Google Scholar 

  30. Bouxsein ML, myburgh KH, van der Meulen MCH, Lindenberger E, Marcus T. Age-related differences in cross-sectional geometry of the forearm bones in healthy women. Calcif Tissue Int 1994;54:113–8.

    Google Scholar 

  31. Martin B. Aging and strength of bone as a structural material. Calcif Tissue Int 1993:53:534–40.

    Google Scholar 

  32. Heaney RP. The bone-remodeling transient: implications for the interpretation of clinical studies of bone mass change. J Bone Miner Res 1994;9:1515–23.

    Google Scholar 

  33. Slemenda C, Reister TK, Peacock M, Johnston CC. Bone strength in children following the cessation of calcium supplementation. J Bone Miner Res 1993;8:S154.

    Google Scholar 

  34. Rosenthal DI, Mayo-Smith W, Hayes CW, et al. Age and bone mass in premenopausal women. J Bone Miner Res 1989;4:533–8.

    Google Scholar 

  35. Matkovic V, Kostial K, Simononic I, Bugina R, Brodarec A, Nordin BEC. Bone status and fracture rates in two regions of Yugoslavia. Am J Clin Nutre 1979;32:540–9.

    Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, College of Medicine and University Hospital, Pennsylvania State University, Hershey, Pennsylvania

    H. Kulin

  2. Department of Radiology, College of Medicine and University Hospital, Pennsylvania State University, Hershey, Pennsylvania

    D. F. Eggli

  3. Department of Pathology, College of Medicine and University Hospital, Pennsylvania State University, Hershey, Pennsylvania

    L. M. Demers

  4. Department of Clinical Nutrition, College of Medicine and University Hospital, Pennsylvania State University, Hershey, Pennsylvania

    K. Kieselhorst

  5. The Center for Biostatistics and Epidemiology, College of Medicine and University Hospital, Pennsylvania State University, Hershey, Pennsylvania

    J. K. Martel & V. M. Chinchilli

  6. The Procter and Gamble Company, Sharon Woods Technical Center, Cincinnati, Ohio, USA

    M. B. Andon

  7. Department of Obstetrics and Gynecology, College of Medicine and University Hospital, The Milton S. Hershey Medical Center, 17033, Hershey, PA, USA

    T. Lloyd PhD & N. Rollings

Authors
  1. T. Lloyd PhD
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  2. J. K. Martel
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  3. N. Rollings
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  4. M. B. Andon
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  5. H. Kulin
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  6. L. M. Demers
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  7. D. F. Eggli
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  8. K. Kieselhorst
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  9. V. M. Chinchilli
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Lloyd, T., Martel, J.K., Rollings, N. et al. The effect of calcium supplementation and tanner stage on bone density, content and area in teenage women. Osteoporosis Int 6, 276–283 (1996). https://doi.org/10.1007/BF01623385

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  • DOI: https://doi.org/10.1007/BF01623385

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