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The effect of calcium supplementation on bone loss in 32 controlled trials in postmenopausal women

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Abstract

Summary

In 32 controlled trials of calcium supplementation (700–2000 mg) in 3,169 postmenopausal women, mean bone loss in the controls was 1.07% p.a. and in the treated subjects 0.27% p.a. (P for difference <0.001). The effect was similar at all measured sites and at all doses of 700 mg or more but became weaker after 4 years.

Introduction

We have reviewed 32 trials of calcium supplementation in 3,169 postmenopausal women.

Methods

We found 24 publications reporting 32 controlled trials lasting at least 1 year, which provided annual percentage changes in bone mass or density at one or more sites in the calcium-treated and control subjects.

Results

The median calcium supplement was 1,000 mg, median duration of the trials 2 years and total number of sites measured 79. The average of the mean rates of change in bone mass or density was 1.07% p.a. (P < 0.001) in the controls and 0.27% p.a. (ns) in the treated subjects (P for difference < 0.001). The effect of calcium was much the same at all measured sites (forearm/hand, proximal femur, spine, and total body and others). Supplements of less than 700 mg were not effective, but there was no significant beneficial effect of higher doses. There was significantly faster bone loss at total calcium intakes below 1,150 mg than on intakes over 1,350 mg. The effect of calcium appeared to be lost after 4 years of treatment.

Conclusion

Calcium supplementation of about 1,000 mg daily has a significant preventive effect on bone loss in postmenopausal women for at least 4 years.

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References

  1. Wu DD, Boyd RD, Fix TJ, Burr DB (1990) Regional patterns of bone loss and altered bone remodelling in response to calcium deprivation in laboratory rabbits. Calcif Tissue Int 47:18–23

    Article  CAS  PubMed  Google Scholar 

  2. Shen V, Birchman R, Xu R, Lindsay R, Dempster DW (1995) Short-term changes in histomorphometric and biochemical turnover markers and bone mineral density in estrogen- and/or dietary calcium-deficient rats. Bone 16:149–156

    Article  CAS  PubMed  Google Scholar 

  3. Baldock PAJ (2001) Regional variation in oophorectomy induced trabecular bone osteopenia in the distal femur of the rat. Thesis submitted to the University of Adelaide for the degree of Doctor of Philosphy

  4. Boonen S, Lips P, Bouillon R, Bischoff-Ferrari HA, Vanderschueren D, Haentjens P (2007) Need for additional calcium to reduce the risk of hip fracture with vitamin D supplementation: evidence from a comparative meta-analysis of randomized controlled trials. J Clin Endocrinol Metab 92:1415–1423

    Article  CAS  PubMed  Google Scholar 

  5. Tang BMP, Eslick GD, Nowson C, Smith C, Bensoussan A (2007) Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 370:657–666

    Article  CAS  PubMed  Google Scholar 

  6. Nordin BEC (1997) Calcium and osteoporosis. Nutrition 13:664–686

    Article  CAS  PubMed  Google Scholar 

  7. Recker RR, Saville PD, Heaney RP (1997) Effect of estrogens and calcium carbonate on bone loss in postmenopausal women. Ann Intern Med 87:649–655

    Google Scholar 

  8. Horsman A, Gallagher JC, Simpson M, Nordin BEC (1977) Prospective trial of estrogen and calcium in postmenopausal women. BMJ 2:789–792

    Article  CAS  PubMed  Google Scholar 

  9. Smith EL, Reddan W, Smith PE (1981) Physical activity and calcium modalities for bone mineral content in aged women. Med Sci Sports Exer 13:60–64

    CAS  Google Scholar 

  10. Recker RR, Heaney RP (1985) The effect of milk supplements on calcium metabolism, bone metabolism and calcium balance. Am J Clin Nutr 41:254–263

    CAS  PubMed  Google Scholar 

  11. Ettinger B, Genant HK, Cann CE (1987) Postmenopausal bone loss is prevented by treatment with low-dosage estrogen with calcium. Ann Intern Med 106:40–45

    CAS  PubMed  Google Scholar 

  12. Hansson T, Roos B (1987) The effect of fluoride and calcium on spinal bone content: a controlled, prospective (3 years) study. Calcif Tissue Int 40:315–317

    Article  CAS  PubMed  Google Scholar 

  13. Riis B, Thomsen K, Christiansen C (1987) Does calcium supplementation prevent postmenopausal bone loss? N Engl J Med 316:173–177

    CAS  PubMed  Google Scholar 

  14. Smith EL, Gilligan C, Smith PE, Sempos C (1989) Calcium supplementation and bone loss in middle-aged women. Am J Clin Nutr 50:833–842

    CAS  PubMed  Google Scholar 

  15. Dawson-Hughes B, Dallal GE, Krall EA, Sadowski L, Sahyoun N, Tannenbaum S (1990) A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med 323:878–883

    CAS  PubMed  Google Scholar 

  16. Prince RL, Smith M, Dick IM, Price RI, Webb PG, Henderson K, Harris MM (1991) Prevention of postmenopausal osteoporosis. A comparative study of exercise, calcium supplementation, and hormone-replacement therapy. N Engl J Med 325:1189–1195

    CAS  PubMed  Google Scholar 

  17. Elders PJM, Lips P, Netelenbos JC et al (1994) Long-term effect of calcium supplementation on bone loss in perimenopausal women. J Bone Miner Res 9:963–970

    Article  CAS  PubMed  Google Scholar 

  18. Chevalley T, Rizzoli R, Nydegger V et al (1994) Effects of calcium supplements on femoral bone mineral density and vertebral fracture rate in vitamin-D-replete elderly patients. Osteoporos Int 4:245–252

    Article  CAS  PubMed  Google Scholar 

  19. Strause L, Saltman P, Smith KT, Bracker M, Andon MB (1994) Spinal bone loss in postmenopausal women supplemented with calcium and trace minerals. J Nutr 124:1060–1064

    CAS  PubMed  Google Scholar 

  20. Aloia JF, Vaswani A, Yeh JK, Ross PL, Flaster E, Dilmanian FA (1994) Calcium supplementation with and without hormone replacement therapy to prevent postmenopausal bone loss. Ann Intern Med 120:97–103

    CAS  PubMed  Google Scholar 

  21. Prince R, Devine A, Dick I et al (1995) The effects of calcium supplementation (milk powder or tablets) and exercise on bone density in postmenopausal women. J Bone Miner Res 10:1068–1075

    Article  CAS  PubMed  Google Scholar 

  22. Reid IR, Ames RW, Evans MC, Gamble GD, Sharpe SJ (1995) Long-term effects of calcium supplementation on bone loss and fractures in postmenopausal women: a randomized controlled trial. Am J Med 98:331–335

    Article  CAS  PubMed  Google Scholar 

  23. Recker RR, Hinders S, Davies KM et al (1996) Correcting calcium nutritional deficiency prevents spine fractures in elderly women. J Bone Miner Res 11:1961–1966

    Article  CAS  PubMed  Google Scholar 

  24. Riggs BL, O’Fallon WM, Muhs J, O’Connor MK, Kumar R, Melton LJ (1998) Long-term effects of calcium supplementation on serum parathyroid hormone level, bone turnover, and bone loss in elderly women. J Bone Miner Res 13:168–174

    Article  CAS  PubMed  Google Scholar 

  25. Storm B, Eslin R, Porter ES et al (1998) Calcium supplementation prevents seasonal bone loss and changes in biochemical markers of bone turnover in elderly New England women: a randomized placebo-controlled trial. J Clin Endocrinol Metab 83:3817–3825

    Article  CAS  PubMed  Google Scholar 

  26. Cleghorn DB, O’Loughlin PD, Schroeder BJ, Nordin BEC (2001) An open, crossover trial of calcium-fortified milk in prevention of early postmenopausal bone loss. MJA 175:242–245

    CAS  PubMed  Google Scholar 

  27. Fujita TK, Ohue M, Fujii Y, Miyauchi A, Takagi Y (2004) Reappraisal of Katsuragi calcium study, a prospective, double-blind, placebo-controlled study of the effect of active absorbable algal calcium (AAACa) on vertebral deformity and fracture. J Bone Miner Metab 22:32–38

    Article  CAS  PubMed  Google Scholar 

  28. Reid IR, Mason B, Horne A et al (2006) Randomized controlled trial of calcium in healthy older women. Am J Med 119:777–785

    Article  CAS  PubMed  Google Scholar 

  29. Prince RL, Devine A, Satvinder S, Dhaliwal SS, Dick IM (2006) Effects of calcium supplementation on clinical fracture and bone structure. Arch Intern Med 166:869–875

    Article  CAS  PubMed  Google Scholar 

  30. Zhu K, Devine A, Dick IM, Wilson SG, Prince RL (2008) Effects of calcium and vitamin D supplementation on hip bone mineral density and calcium-related analytes in elderly ambulatory Australian women: a five-year randomized controlled trial. J Clin Endocrinol Metab 93:743–749

    Article  CAS  PubMed  Google Scholar 

  31. Need AG, Nordin BEC (2008) Misconceptions—vitamin D insufficiency causes malabsorption of calcium. Bone 42:1021–1024

    Article  CAS  PubMed  Google Scholar 

  32. Bischoff-Ferrari HA, Rees JR, Grau MV, Barry E, Gui J, Baron J (2008) Effect of calcium supplementation on fracture risk: a double-blind randomized controlled trial. Am J Clin Nutr 87:1945–1951

    CAS  PubMed  Google Scholar 

  33. Markowitz ME, Arnaud S, Rosen JF, Thorpy M, Laximinarayan S (1988) Temporal interrelationships between the circadian rhythms of serum parathyroid hormone and calcium concentrations. Clin Endocrinol Metab 67:1068–1073

    Article  CAS  Google Scholar 

  34. Scopacasa F, Need AG, Horowitz JM, Morris HA, Nordin BEC (2002) Effects of dose and timing of calcium supplementation on bone resorption in early menopausal women. Hormone Metab Res 34:44–47

    Article  CAS  Google Scholar 

  35. Human vitamin and mineral requirements. Report of a joint FAO/WHO expert consultation. Bangkok, Thailand. World Health organization, Food and Agriculture Organization of the United Nations, Rome, 2002

  36. Nordin BEC (2008) Reflections on osteoporosis. In: Marcus R, Feldman D, Nelson DA, Rosen CJ (eds) Osteoporosis, vol 1, Third edn. Elsevier Academic Press, San Diego, pp 47–6937

    Google Scholar 

  37. Heaney RP, Matkovic V (1995) Inadequate peak bone mass. In: Riggs BL, Melton LJ (eds) Osteoporosis: etiology, diagnosis, and management, Second edn. Lippincott-Raven, Philadelphia, pp 115–131

    Google Scholar 

  38. Thomas SDC, Need AG, Tucker G, Slobodian P, O’Loughlin PD, Nordin BEC (2008) Suppression of parathyroid hormone and bone resorption by calcium carbonate and calcium citrate in postmenopausal women. Calcif Tissue Int 83:81–84

    Article  CAS  PubMed  Google Scholar 

  39. Heaney RP (2003) Is the paradigm shifting? Bone 33:457–465

    Article  PubMed  Google Scholar 

  40. Need AG, O'Loughlin PD, Morris HA, Horowitz M, Nordin BEC (2004) The effects of age and other variables on serum parathyroid hormone in postmenopausal women attending an osteoporosis center. J Clin Endocrinol Metab 89:1646–1649

    Article  CAS  PubMed  Google Scholar 

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Correspondence to B. E. C. Nordin.

Appendix 1

Appendix 1

Table 7 Summary of 32 trials of the effect of calcium supplementation on bone status in postmenopausal women (single or dual photon densitometry unless otherwise indicated)

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Nordin, B.E.C. The effect of calcium supplementation on bone loss in 32 controlled trials in postmenopausal women. Osteoporos Int 20, 2135–2143 (2009). https://doi.org/10.1007/s00198-009-0926-x

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