[Optimization of calcium intake for the prevention of osteoporosis and osteoporotic fractures: a review of the evidence]. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care Milk, dietary calcium, and bone fractures in women: a 12-year prospective study. Calcium supplementation suppresses bone turnover during weight reduction in postmenopausal women. Dietary calcium and vitamin D intake in relation to osteoporotic fracture risk. Effect of calcium and vitamin D supplementation on bone mineral density in women aged 65–71 years: a 3-year randomized population-based trial (OSTPRE-FPS) Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Skeletal site-dependent response of bone mineral density and quantitative ultrasound parameters following a 12-month dietary intervention using dairy products fortified with calcium and vitamin D: the Postmenopausal Health Study. An open, crossover trial of calcium-fortified milk in prevention of early postmenopausal bone loss. Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. Calcium-vitamin D3 supplementation is cost-effective in hip fractures prevention. Dietary calcium intake protects women consuming oral contraceptives from spine and hip bone loss. Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study Calcium supplementation provides an extended window of opportunity for bone mass accretion after menarche. Calcium supplementation prevents seasonal bone loss and changes in biochemical markers of bone turnover in elderly New England women: a randomized placebo-controlled trial. Is dietary counselling effective in increasing dietary calcium, protein and energy intake in patients with osteoporotic fractures? A randomized controlled clinical trial.
One of the main focuses of lifestyle modification for the prevention of osteoporosis and osteoporotic fractures  in Japan is improvement in dietary calcium intake . However , virtually no r and omized controlled trial to assess the preventive effects of administration of calcium on the risk of fractures has been conducted in Japan . In this study , we review ed all the scientific papers currently available from medical literature data bases to propose evidence -based recommendations on the preventive procedures for osteoporosis . The result of the present systematic review gives the evidence showing that calcium supplementation or optimal dietary calcium intake increases bone density in childhood and adolescence and reduces the risk of fracture due to osteoporosis in the elderly people regardless of the gender . The evidence also supports the current health policy guiding the elderly to increase their dietary calcium intake in daily life BACKGROUND Short trials of calcium supplementation show that it reduces loss of bone density in postmenopausal women ; longer observational studies do not generally find a lower risk of hip fracture with higher-calcium diets . Fewer studies have focused on vitamin D in preventing postmenopausal osteoporosis or fractures . OBJECTIVE We assessed relations between postmenopausal hip fracture risk and calcium , vitamin D , and milk consumption . DESIGN In an 18-y prospect i ve analysis in 72 337 postmenopausal women , dietary intake and nutritional supplement use were assessed at baseline in 1980 and up date d several times during follow-up . We identified 603 incident hip fractures result ing from low or moderate trauma .  Relative risks ( RRs ) from proportional hazards models were controlled for other dietary and nondietary factors . RESULTS Women consuming > or = 12.5 microg vitamin D/d from food plus supplements had a 37 % lower risk of hip fracture ( RR = 0.63 ; 95 % CI : 0.42 , 0.94 ) than did women consuming < 3.5 microg/d . Total calcium intake was not associated with hip fracture risk ( RR = 0.96 ; 95 % CI : 0.68 , 1.34 for > or = 1200 compared with < 600 mg/d ) . Milk consumption was also not associated with a lower risk of hip fracture ( P for trend = 0.21 ) . CONCLUSIONS An adequate vitamin D intake is associated with a lower risk of osteoporotic hip fractures in postmenopausal women . Neither milk nor a high-calcium diet appears to reduce risk . Because women commonly consume less than the recommended intake of vitamin D , supplement use or dark fish consumption may be prudent Abstract Objective To assess whether supplementation with calcium and cholecaliferol ( vitamin D3 ) reduces the risk of fracture in women with one or more risk factors for fracture of the hip . Design Pragmatic open r and omised controlled trial . Setting Practice nurse led clinics in primary care . Participants 3314 women aged 70 and over with one or more risk factors for hip fracture : any previous fracture , low body weight ( < 58 kg ) , smoker , family history of hip fracture , or fair or poor self reported health . Intervention Daily oral supplementation using 1000 mg calcium with 800 IU cholecaliferol and information leaflet on dietary calcium intake and prevention of falls , or leaflet only ( control group ) . Main outcome measures Primary outcome measure was all clinical fractures and secondary outcome measures were adherence to treatment , falls , and quality of life ( measured with the SF-12 ) . Results 69 % of the women who completed the follow-up question naire at 24 months were still taking supplements ( 55 % with inclusion of r and omised participants known to be alive ) . After a median follow-up of 25 months ( range 18 to 42 months ) , clinical fracture rates were lower than expected in both groups but did not significantly differ for all clinical fractures ( odds ratio for fracture in supplemented group 1.01 , 95 % confidence interval 0.71 to 1.43 ) . The odds ratio for hip fracture was 0.75 ( 0.31 to 1.78 ) . The odds of a woman having a fall at six and 12 months was 0.99 and 0.98 , respectively . Quality of life did not significantly differ between the groups . Conclusion We found no evidence that calcium and vitamin D supplementation reduces the risk of clinical fractures in women with one or more risk factors for hip fracture . Registration IS RCT N26118436 , controlled trials registry OBJECTIVES This study examined whether higher intakes of milk and other calcium-rich foods during adult years can reduce the risk of  osteoporotic fractures .  METHODS This was a 12-year prospect i ve study among 77761 women , aged 34 through 59 years in 1980 , who had never used calcium supplements .  Dietary intake was assessed with a food-frequency question naire in 1980 , 1984 , and 1986 . Fractures of the proximal femur ( n = 133 ) and distal radius ( n = 1046 ) from low or moderate trauma were self-reported on biennial question naires . RESULTS We found no evidence that higher intakes of milk or calcium from food sources reduce fracture incidence . Women who drank two or more glasses of milk per day had relative risks of 1.45 for hip fracture ( 95 % confidence interval [ CI ] = 0.87 , 2.43 ) and 1.05 for forearm fracture ( 95 % CI = 0.88 , 1.25 ) when compared with women consuming one glass or less per week . Likewise , higher intakes of total  dietary calcium or calcium from dairy foods were not associated with decreased risk of hip or forearm fracture . CONCLUSIONS These data do not support the hypothesis that higher consumption of milk or other food sources of calcium  by adult women protects against hip or forearm fractures Bone mobilization , lowering of bone mineral density ( BMD ) , and osteoporotic fractures are recognized in postmenopausal women with weight loss . Because a high-calcium intake suppresses bone loss in peri- and postmenopausal women , the present r and omized , double-blind , placebo-controlled study was design ed to test the hypothesis that calcium supplementation prevents net bone mobilization and consequent bone mineral loss during voluntary weight reduction in obese postmenopausal women . Subjects were placed on a moderate energy-restricted diet and either calcium supplementation ( 1 g/day ) or placebo for 6 months . Body weight , bone turnover markers ( pyridinium cross-links ) , osteocalcin , and parathyroid hormone ( PTH ) were measured at treatment weeks 1 - 5 , 7 , 10 , 13 , 16 , 20 , and 25 . Total body BMD , insulin-like growth factor , 25-hydroxyvitamin D , and sex hormone binding globulin ( SHBG ) were measured at baseline and week 25 . The calcium supplemented ( n = 15 ; age 60.9 + /- 9.4 years , body mass index [ BMI ] 33.2 + /- 4.6 kg/m2 ) and placebo ( n = 16 ; age 55.8 + /- 8.3 years , BMI 32.9 + /- 4.5 kg/m2 ) groups lost similar amounts of weight over the study interval ( 10.2 + /- 5.3 % vs. 10.0 + /- 5.2 % ) and both groups increased SHBG ( p < 0.001 ) . There was a statistical effect of calcium supplementation during weight loss to suppress pyridinium cross-links , osteocalcin , and PTH ( p < 0.05 , < 0.01 , and < 0.05 , respectively ) . Loss of BMD tended to be greater in the placebo group by 1.4 % ( p < 0.08 ) after weight loss . One gram per day calcium supplementation normalizes the increased calcium-PTH axis activity and the elevated bone turnover rate observed during moderate voluntary energy restriction in postmenopausal women The etiologic role of dietary calcium and vitamin D intake in primary prevention of  osteoporotic fractures is uncertain , despite considerable research efforts . With the aim to examine these associations with an improved precision , we used data from a large population -based prospect i ve cohort study in central Sweden . We estimated nutrient intake from a self-administered food-frequency question naire filled in by 60,689 women , aged 40 - 74 years at baseline during 1987 - 1990 . During follow-up , we observed 3986 women with a fracture at any site and 1535 with a hip fracture .  Rate ratio of fractures ( RR ) and 95 % CI were estimated using Cox proportional hazards models . We found no dose-response association between dietary calcium intake and fracture risk . The age-adjusted RR of hip fracture was 1.01 ( 95 % CI 0.96 - 1.06 ) per 300 mg calcium/day and the corresponding risk of any osteoporotic fracture was 0.99 ( 95 % CI 0.96 - 1.03 ) . Furthermore , women with an estimated calcium intake below 400 mg/day and those with a calcium intake higher than 1200 mg/day both had a similar age-adjusted hip fracture risk as those with intermediate calcium intakes : RR 1.07 ( 95 % CI 0.92 - 1.24 ) and RR 1.00 ( 95 % CI 0.79 - 1.27 ) , respectively . Vitamin D intake was not associated with fracture risk . Furthermore , women in the highest quintiles compared to the lowest quintiles of both calcium and vitamin D intake had an age-adjusted RR of 1.02 for all fractures ( 95 % CI 0.88 - 1.17 ) . Dietary calcium or vitamin D intakes estimated at middle and older age do not seem to be of major importance for the primary prevention of osteoporotic fractures in women Summary The Osteoporosis Risk Factor and Prevention-Fracture Prevention Study ( OSTPRE-FPS ) was a r and omized population -based open trial ( n = 593 ) . The supplementation group ( n = 287 ) received daily cholecalciferol 800 IU + calcium 1,000 mg for 3 years while the control group ( n = 306 ) received neither supplementation nor placebo . Daily vitamin D and calcium supplementation have a positive effect on the skeleton in ambulatory postmenopausal women . Introduction Vitamin D deficiency is common in the elderly , and vitamin D levels are associated with low bone mineral density ( BMD ) . The working hypothesis was that vitamin D and calcium supplementation could prevent bone loss in ambulatory postmenopausal women . Methods The OSTPRE-FPS was a r and omized population -based open trial with a 3-year follow-up in 3,432 women ( aged 66 to 71 years ) . A r and omly selected sub sample of 593 subjects underwent BMD measurements . The supplementation group ( n = 287 ) received daily cholecalciferol 800 IU + calcium 1,000 mg for 3 years while the control group ( n = 306 ) received neither supplementation nor placebo . Results In the intention-to-treat analysis , total body BMD ( n = 362 ) increased significantly more in the intervention group than in the control group ( 0.84 % vs. 0.19 % , p = 0.011 ) . The BMD change differences at the lumbar spine ( p = 0.372 ) , femoral neck ( p = 0.188 ) , trochanter ( p = 0.085 ) , and total proximal femur ( p = 0.070 ) were statistically nonsignificant . Analyses in compliant women ( ≥80 % of use ) result ed in stronger and statistically significant effects at the total body and femoral regions . Conclusion Daily vitamin D and calcium supplementation have a positive effect on the skeleton in ambulatory postmenopausal women with adequate nutritional calcium intake BACKGROUND Increased dietary calcium intake has been proposed as a population -based public health intervention to prevent osteoporotic fractures . We have examined whether calcium supplementation decreases clinical fracture risk in elderly women and its mechanism of action . METHODS Five-year , double-blind , placebo-controlled study of 1460 women recruited from the population and older than 70 years ( mean age , 75 years ) who were r and omized to receive calcium carbonate , 600 mg twice per day , or identical placebo .  The primary end points included clinical incident osteoporotic fractures , vertebral deformity , and adverse events ascertained in 5 years . Bone structure was also measured using dual x-ray absorptiometry of the hip and whole body , quantitative ultrasonography of the heel , and peripheral quantitative computed tomography of the distal radius . RESULTS Among our patients , 16.1 % sustained 1 or more clinical osteoporotic fractures . In the intention-to-treat analysis , calcium supplementation did not significantly reduce fracture risk ( hazard ratio , 0.87 ; 95 % confidence interval , 0.67 - 1.12 ) . However , 830 patients ( 56.8 % ) who took 80 % or more of their tablets ( calcium or placebo ) per year had reduced fracture incidence in the calcium compared with the placebo groups ( 10.2 % vs 15.4 % ; hazard ratio , 0.66 ; 95 % confidence interval , 0.45 - 0.97 ) . Calcium-treated patients had improved quantitative ultrasonography findings of the heel , femoral neck and whole-body dual x-ray absorptiometry data , and bone strength compared with placebo-treated patients . Of the 92 000 adverse events recorded , constipation was the only event increased by the treatment ( calcium group , 13.4 % ; placebo group , 9.1 % ) . CONCLUSION Supplementation with calcium carbonate tablets supplying 1200 mg/d is ineffective as a public health intervention in preventing clinical fractures in the ambulatory elderly population owing to poor long-term compliance , but it is effective in those patients who are compliant The aim of the current study was to examine whether calcium supplementation could prevent bone loss in postmenopausal women or more favourable outcomes could be obtained via the consumption of dairy products fortified with calcium and vitamin D3 . For this purpose changes in bone mineral density ( BMD ) at different skeletal sites , assessed by dual-energy X-ray absorptiometry , as well as in quantitative ultrasound ( QUS ) parameters of the calcaneus over 12 months were estimated . A population of 101 postmenopausal women ( 55 - 65 years old ) was r and omized into a dairy group ( DG : n 39 ) , receiving approximately 1200 mg calcium/d and 7.5 microg vitamin D3/d through fortified dairy products ; a calcium-supplemented group ( CaG : n 26 ) provided with a calcium supplement of 600 mg/d ; and a control group ( CG : n 36 ) . Over the intervention period the DG was found to have more favourable changes in pelvis ( P=0.040 ) , total spine ( P<0.001 ) and total body BMD ( P<0.001 ) than the other groups . A significant increase was also observed for DG in lumbar spine BMD ( 2.0 % ; 95 % CI 0.5 , 3.5 ) although it did not differentiate significantly compared to the other groups . No significant differences were observed with respect to the changes in QUS parameters . The current study revealed that recommended intakes of vitamin D3 and calcium via fortified dairy products for 12 months can induce favourable changes in pelvis , total spine and total body BMD in postmenopausal women but not in QUS parameters . No such favourable changes were observed via supplementation of calcium alone OBJECTIVE To establish whether calcium-enriched milk reduces bone loss in women who are within five years of the menopause and have a basal calcium intake < or = 1,250 mg . DESIGN Two-year open , crossover study . SETTING A community-based study carried out in Adelaide , South Australia , between September 1997 and June 2000 . PARTICIPANTS 115 women recruited by newspaper advertisement , who were less than five years postmenopausal , were not taking hormone or other therapy that could affect bone and had a usual calcium intake < or = 1,250 mg daily . INTERVENTION Participants were r and omly allocated to Group 1 ( who received a supplement of 3 L of calcium-fortified milk weekly in the first year ) or Group 2 ( who followed their usual diets in the first year ) . In the second year , Group 1 reverted to their usual diets , and Group 2 received the milk supplement . MAIN OUTCOME MEASURES Difference in loss of bone mineral density ( BMD ) at the spine and forearm in the same individuals on and off the milk supplement ;  urinary excretion of bone resorption markers in a subset of 72 participants in the first year . RESULTS With each woman serving as her own control , the rate of bone loss from the spine was 1.76 percentage points less when the women were taking the milk supplement than when they were on their usual diet ( 95 % CI , 0.54%-2.98 % ; P=0.006 ) . However , there was no significant difference in bone loss in the forearm . Fasting urine levels of two markers of bone resorption ( hydroxyproline and deoxypyridinoline ) were significantly lower in 36 women in the milk group than in 36 women in the usual-diet group ( P=0.03 for both markers ) . CONCLUSION Supplementing the diet with calcium-fortified milk early in the postmenopausal period delays bone loss at the spine but not at the forearm , and reduces the excretion of bone resorption markers UNLABELLED This study of 9605 community-dwelling residents supports that vitamin D and calcium supplementation may prevent  osteoporotic fractures in elderly in a northern European region known to be deficient in vitamin D , especially during winter periods . INTRODUCTION We evaluated the effect of two programs for the prevention of osteoporotic fractures leading to acute hospital admission in a population of elderly community-dwelling residents . MATERIAL S AND METHODS This was a factorial , cluster-r and omized , pragmatic , intervention study . We included 9605 community-dwelling residents aged 66 + years . We offered a prevention program of a daily supplement of 1000 mg of elemental calcium as calcium carbonate and 400 IU ( 10 microg ) of vitamin D3 to a total of 4957 participants . Another program with evaluation and suggestions for the improvement of the domestic environment was offered to a total of 5063 participants . Both programs included revision of the resident 's current pharmaceutical treatment . We achieved information on osteoporotic fractures in the study population from the Danish Hospital Registration Data base . We defined osteoporotic fractures as low energy fractures of the proximal humerus , distal forearm , vertebral column , pelvis , cervical femur , and intertrochanteric femur . RESULTS Active participation was 50.3 % in the Calcium and Vitamin D Program and 46.4 % in the Environmental and Health Program . We observed a 16 % reduction in fracture incidence rate ( relative risk [ RR ] , 0.84 ; CI , 0.72 - 0.98 ; p < 0.025 ) among male and female residents offered the Calcium and Vitamin D Program ( intention-to-prevent analysis ) . CONCLUSIONS This study supports that vitamin D and calcium supplementation may prevent osteoporotic fractures in community-dwelling elderly people in a northern European region known to be deficient in vitamin D , especially during winter periods OBJECTIVE To assess the cost implication s for a preventive treatment strategy for institutionalised elderly women with a combined 1200 mg/day calcium and 800 IU/day vitamin D(3 ) supplementation in seven European countries . DESIGN Retrospective cost effectiveness analysis based on a prospect i ve placebo-controlled r and omised clinical trial . DATA SOURCES Recently published cost studies in seven European countries . Clinical results from Decalyos , a 3-year placebo-controlled study in elderly institutionalised women . TRIALS Decalyos study , with 36 months follow-up of 3270 mobile elderly women living in 180 nursing homes , allocated to two groups . One group received 1200 mg/day elemental calcium in the form of tricalcium phosphate together with 800 IU/day ( 20 microg ) of cholecalciferol ( vitamin D(3 ) ) , the other placebo . RESULTS In the 36 months analysis of the Decalyos study , 138 hip fractures occurred in the group of 1176 women , receiving supplementation  and 184 hip fractures in the placebo group of 1127 women . The mean duration of treatment was 625.4 days . Adjusted to 1000 women , 46 hip fractures were avoided by the calcium and vitamin D(3 ) supplementation . For all countries , the total costs in the placebo group were higher than in the group receiving supplementation , result ing in a net benefit of 79000 - 711000 per 1000 women . CONCLUSION This analysis suggests that the supplementation strategy is cost saving . The results may underestimate the net benefits , as this treatment has also shown to be effective in decreasing the incidence of other non-vertebral fractures in elderly institutionalised women CONTEXT It is estimated that 80 % of all women have used oral contraceptives ( OCP ) , but OCP use may prevent attainment of maximal peak bone mass in young women and thus increase the risk of osteoporosis later in life . OBJECTIVE This study examined whether increased calcium intake could reduce the detrimental effects of OCP use on bone mass in young women . DESIGN The study design was a 1-yr intervention . SETTING The study was performed in a general community setting . SUBJECTS One hundred fifty-four young ( 18 - 30 yr old ) healthy women with a dietary calcium intake of less than 800 mg/d began the study , and 135 completed the trial . INTERVENTION Subjects were r and omly assigned to one of three diet intervention groups : 1 ) control , continuous established ( < 800 mg/d ) dietary calcium intake ; 2 ) medium dairy , increase calcium intake to approximately 1000 - 1100 mg/d ; and 3 ) high dairy , increase calcium intake to approximately 1200 - 1300 mg/d . R and omization was stratified by OCP use . MAIN OUTCOME MEASURES The main outcome measures were total body bone mineral density ( BMD ) and content ( BMC ) ; total hip BMD , BMC , and bone area ; and spine BMD , BMC , and bone area . RESULTS Dairy product intervention positively impacted the percentage change in total hip BMD and BMC . In addition , dairy product intake prevented a negative percentage change in total hip and spine BMD in OCP users . CONCLUSION Dairy product intake , at levels necessary to achieve the recommended intakes of calcium , protected the total hip BMD and spine BMD from loss observed in young healthy women with low calcium intakes who were using OCP Objective To investigate associations between long term dietary intake of calcium and risk of fracture of any type , hip fractures , and osteoporosis . Design A longitudinal and prospect i ve cohort study , based on the Swedish Mammography Cohort , including a subcohort , the Swedish Mammography Cohort Clinical . Setting A population based cohort in Sweden established in 1987 . Participants 61 433 women ( born between 1914 and 1948 ) were followed up for 19 years . 5022 of these women participated in the subcohort . Main outcome measures Primary outcome measures were incident fractures of any type and hip fractures , which were identified from registry data . Secondary outcome was osteoporosis diagnosed by dual energy x ray absorptiometry in the subcohort . Diet was assessed by repeated food frequency question naires . Results During follow-up , 14 738 women ( 24 % ) experienced a first fracture of any type and among them 3871 ( 6 % ) a first hip fracture . Of the 5022 women in the subcohort , 1012 ( 20 % ) were measured as osteoporotic . The risk patterns with dietary calcium were non-linear . The crude rate of a first fracture of any type was 17.2/1000 person years at risk in the lowest quintile of calcium intake , and 14.0/1000 person years at risk in the third quintile , corresponding to a multivariable adjusted hazard ratio of 1.18 ( 95 % confidence interval 1.12 to 1.25 ) . The hazard ratio for a first hip fracture was 1.29 ( 1.17 to 1.43 ) and the odds ratio for osteoporosis was 1.47 ( 1.09 to 2.00 ) . With a low vitamin D intake , the rate of fracture in the first calcium quintile was more pronounced . The highest quintile of calcium intake did not further reduce the risk of fractures of any type , or of osteoporosis , but was associated with a higher rate of hip fracture , hazard ratio 1.19 ( 1.06 to 1.32 ) . Conclusion Gradual increases in dietary calcium intake above the first quintile in our female population were not associated with further reductions in fracture risk or osteoporosis BACKGROUND High calcium intakes during adolescence may increase bone acquisition . The magnitude of the effect of dietary calcium supplementation and the timing of its administration to achieve significant effects on bone health are still incompletely defined . OBJECTIVE The objective of this study was to assess the effect of calcium supplementation on bone mass accretion in postmenarcheal adolescent girls with low calcium intakes . DESIGN A double-blind , placebo-controlled calcium supplementation study was implemented . One hundred girls with a mean ( + /- SD ) age of 14 + /- 0.5 y with habitual calcium intakes < 800 mg/d completed a 12-mo protocol . The treatment group received a daily supplement containing 1000 mg elemental calcium .  Bone mineral density ( BMD ) and bone mineral content ( BMC ) of the total body , lumbar spine , and femoral neck were determined at inclusion , 6 mo , and 12 mo . Also measured were serum concentrations of biochemical markers of bone turnover ( osteocalcin and deoxypyridinoline ) , parathyroid hormone , and vitamin D. RESULTS The calcium-supplemented group had greater accretion of total-body BMD and lumbar spine BMD but not BMC than did the control group . Calcium supplementation appeared selectively beneficial for girls who were 2 y postmenarcheal . Calcium supplementation significantly decreased bone turnover and decreased serum parathyroid hormone concentrations . CONCLUSION Calcium supplementation of postmenarcheal girls with low calcium intakes enhances bone mineral acquisition , especially in girls > 2 y past the onset of menarche Elderly women are at increased risk for bone loss and fractures . In previous cross-sectional and longitudinal studies of women residing in northern latitudes , bone loss was most pronounced during winter months and in those consuming less than 1 g calcium per day . In this study we sought to test the hypothesis that calcium supplementation by either calcium carbonate or dietary means would prevent seasonal bone loss and preserve bone mass . Sixty older postmenopausal women without osteoporosis were r and omized to one of three treatment arms : Dietary milk supplementation ( D-4 glasses of milk/day ) , Calcium carbonate ( CaCO3 - 1000 mg/day in two divided doses ) , or placebo ( P ) . After 2 yr , placebo-treated women consumed a mean of 683 mg/day of calcium and lost 3.0 % of their greater trochanteric ( GT ) bone mineral density ( BMD ) ( P < 0.03 vs. baseline ) ; Dietary supplemented women averaged a calcium intake of 1028 mg/day and sustained minimal loss from the GT ( -1.5 % ; P = 0.30 ) , whereas CaCO3-treated women ( total Ca intake , 1633 mg/day ) suffered no bone loss from the GT and showed a significant increase in spinal and femoral neck BMD ( P < 0.05 ) . Femoral bone loss occurred exclusively during the two winters of the study ( i.e. total loss , -3.2 % ; P < 0.02 in placebo-treated women ) with virtually no change in GT BMD during summer . Serum 25-OH vitamin D declined by more than 20 % ( P < 0.001 ) in all groups during the winter months but returned to baseline in summer ; PTH levels rose approximately 20 % ( P < 0.001 ) during winter but did not return to baseline during the summers . Urine N-telopeptide and osteocalcin levels increased significantly but only in the P-treated women and only during winter . Serum insulin growth factor binding protein 4 , an inhibitory insulin growth factor binding protein , rose 15 % ( P < 0.03 ) from summer to winter , but this increase was significant only in those women consuming < 1000 mg/day of calcium . By multivariate analysis , total calcium intake was the strongest predictor of bone loss from the hip . Urinary N-telopeptide also closely correlated with GT BMD but only during winter ( P = 0.003 ) . We conclude that calcium supplementation prevents bone loss  in elderly women by suppressing bone turnover during the winter when serum 25-OH vitamin D declines and serum PTH increases . The precise amount of calcium necessary to preserve BMD in elderly women requires further studies , although in this study , at least 1000 mg/day of supplemental calcium was adequate prophylaxis against femoral bone loss To determine the feasibility of increasing the calcium , protein and calorie intake of osteoporotic fracture patients by repeated dietary counselling delivered by a dietitian , a r and omized controlled trial was conducted . Among 189 patients presenting with osteoporotic fractures to an Orthopaedics and Traumatology Department of a large regional hospital , 98 patients were r and omized to the intervention group and 91 were r and omized to the control group ( with usual care ) . Intervention group received three sessions of dietary counselling with tailored made recommendations over a period of 4 months , while the control group only received dietary assessment and pamphlets on the prevention of osteoporosis . Almost all subjects in both intervention and control groups had calcium intake below the recommended level of 1000 mg at baseline . Half and 60 % of subjects in both groups had total energy and protein intake below recommended levels respectively . The mean weights of control and intervention groups at baseline were 51.5 and 50.9 kg respectively , while the body mass index ( BMI ) were 22.6 ( kg m(-2 ) ) and 22.6 ( kg m(-2 ) ) respectively . After dietary intervention , significant increase of intake was seen in calcium intake ( P = 0.0095 by t-test ) in the intervention group . No significant increase was seen in protein or calorie intake . No significant change was observed in the body weight or BMI although there was a positive trend in the intervention group for all these parameters . We concluded that there was general malnutrition in Chinese elderly who presented with osteoporotic fractures . Dietary calcium could be increased by repeated professional dietary counselling . Future studies with longer duration and more objective clinical outcomes will be helpful to further demonstrate the long-term effects of dietary intervention on osteoporosis and other chronic diseases
Calcium was more effective than placebo in reducing rates of bone loss after two or more years of treatment .
REVIEW ER 'S CONCLUSIONS Calcium supplementation alone has a small positive effect on bone density .
The data show a trend toward reduction in vertebral fractures , but it is unclear if calcium reduces the incidence of non vertebral fractures
BACKGROUND Although calcium is one the simplest and least expensive strategies for preventing osteoporotic fractures calcium supplementation is nevertheless not without controversy ( Kanis 1989 ; Nordin 1990 ) .
The Food and Drug Administration in the US has permitted a bone health cl aim for calcium-rich foods , and the NIH in its Consensus Development Process approved a statement that high calcium intake reduces the risk of osteoporosis .
OBJECTIVES To assess the effects of calcium on bone density and fractures in postmenopausal women .