Calcium plus Vitamin D Supplementation and the Risk of Fractures

Division of Endocrinology, Ohio State University, 485 McCampbell, 1581 Dodd Dr., Columbus, OH 43210, USA.
New England Journal of Medicine (Impact Factor: 55.87). 02/2006; 354(7):669-83. DOI: 10.1056/NEJMoa055218
Source: PubMed


The efficacy of calcium with vitamin D supplementation for preventing hip and other fractures in healthy postmenopausal women remains equivocal.
We recruited 36,282 postmenopausal women, 50 to 79 years of age, who were already enrolled in a Women's Health Initiative (WHI) clinical trial. We randomly assigned participants to receive 1000 mg of elemental [corrected] calcium as calcium carbonate with 400 IU of vitamin D3 daily or placebo. Fractures were ascertained for an average follow-up period of 7.0 years. Bone density was measured at three WHI centers.
Hip bone density was 1.06 percent higher in the calcium plus vitamin D group than in the placebo group (P<0.01). Intention-to-treat analysis indicated that participants receiving calcium plus vitamin D supplementation had a hazard ratio of 0.88 for hip fracture (95 percent confidence interval, 0.72 to 1.08), 0.90 for clinical spine fracture (0.74 to 1.10), and 0.96 for total fractures (0.91 to 1.02). The risk of renal calculi increased with calcium plus vitamin D (hazard ratio, 1.17; 95 percent confidence interval, 1.02 to 1.34). Censoring data from women when they ceased to adhere to the study medication reduced the hazard ratio for hip fracture to 0.71 (95 percent confidence interval, 0.52 to 0.97). Effects did not vary significantly according to prerandomization serum vitamin D levels.
Among healthy postmenopausal women, calcium with vitamin D supplementation resulted in a small but significant improvement in hip bone density, did not significantly reduce hip fracture, and increased the risk of kidney stones. ( number, NCT00000611.).

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Available from: Tamsen Lynn Bassford
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    • "However, similarly to fall prevention, the benefit on fracture prevention depends on the dose of vitamin D. Fracture prevention required a received dose (treatment dose*adherence) of more than 482 IU vitamin D per day. The primary use of received dose (dose*adherence) as opposed to treatment dose from double-blind RCTs allowed for the assessment of anti-fracture efficacy by a dose that accounts for the low adherence in several recent large trials [24, 25]. Any lower received dose than 482 IU per day did not reduce fracture risk at either any non-vertebral site or the hip. "
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    ABSTRACT: Besides its well-known effect on bone metabolism, recent researches suggest that vitamin D may also play a role in the muscular, immune, endocrine, and central nervous systems. Double-blind RCTs support vitamin D supplementation at a dose of 800 IU per day for the prevention of falls and fractures in the senior population. Ecological, case-control and cohort studies have suggested that high vitamin D levels were associated with a reduced risk of autoimmune diseases, type 2 diabetes, cardio-vascular diseases and cancer but large clinical trials are lacking today to provide solid evidence of a vitamin D benefit beyond bone health. At last, the optimal dose, route of administration, dosing interval and duration of vitamin D supplementation at a specific target dose beyond the prevention of vitamin D deficiency need to be further investigated.
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    • "Future studies are needed to better define the optimal use of vitamin D supplements in promoting bone health and preventing osteoporotic fractures. Some previous studies have failed to demonstrate a significant benefit for vitamin D supplementation on fracture risk.22,23 For example, in a study of postmenopausal women recruited to a Women’s Health Initiative trial with or without osteoporosis, calcium plus vitamin D supplementation increased hip bone mineral density.21 "
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    Full-text · Article · Jul 2014 · Pakistan Journal of Medical Sciences Online
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    • "This shows that unloading might lead to a decrease in serum levels of 1, 25 vitamin D. Hence, vitamin D supplementation results in the recovery of bone formation, suggesting a correlation between the bone response to unloading and vitamin D levels (26, 27). It has been documented that vitamin D supplementation can significantly increase bone mass and decrease the risk of bone fracture (12, 28, 29). Kumei et al. revealed that microgravity can alter gene expression, where stromal cells of 1, 25 vitamin D treated rats had altered gene expression despite the presence of microgravity conditions (30). "
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    ABSTRACT: Background: Revealing data on the role of vitamin D and calcium supplementation in bone health has led some to suggest that vitamin D and calcium treatment could also play a role in protecting bone against microgravity-induced mineral loss. Objectives: The aim of the present study was to investigate the effects of vitamin D and calcium administration on microscopic and densitometric changes of rat femur in a Microgravity Simulator Model. Materials and Methods: After designing a Microgravity Simulator Model, 14 rats were placed in the cages as follows: seven rats as osteoporosis group and seven rats received oral supplement of calcium/vitamin D as the treatment group. Animals were sacrificed after eight weeks and then both femurs were removed. Bone mineral density was measured for one femur from each animal, and morphologic studies were evaluated for the contralateral femur. Results: Bone mineral density of the whole femur in the treatment group was significantly higher than the osteoporosis group (0.168 ± 0.005 vs. 0.153 ± 0.006, P = 0.003). Also, bone mineral content of the whole femur was significantly higher in treatment group (0.415 ± 0.016 vs. 0.372 ± 0.019, P = 0.003). However, resorption eroded surface percentage was higher in the osteoporosis group (18.86 ± 3.71% vs. 9.71 ± 1.61%, P = 0.002). Conclusions: According to the results of this study, vitamin D and calcium administration might have protective effects against microgravity-induced mineral loss in a Rat Microgravity Simulator Model. Keywords: Weightlessness; Bone Density; Osteoporosis; Dietary Supplements; Calcium; Vitamin D
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