BONE HEALTH IN THE ELDERLY
Location: Human Nutrition Research Center on Aging
Title: Calcium intake and risk of hip fracture in men and women a meta-analysis of prospective cohort studies and randomized controlled trials
| Bischoff-Ferrari, Heike - UNI HOSP, ZURICH |
| Dawson-Hughes, Bess |
| Baron, John - DARTMOUTH MEDICAL SCHOOL |
| Burckhardt, Peter - CLINIQUE BOIS CERF, SWIT |
| Spiegelman, Donna - HARVARD SCH PUB HEALTH |
| Specker, Bonny - S DAKOTA STATE UNIV |
| Orav, E. John - HARVARD SCH PUB HEALTH |
| Wong, John - TUFTS-NEMC |
| Staehelin, Hannes - UNIV HOSP, BASEL |
| O'Rielly, Eilis - HARVARD SCH PUB HEALTH |
| Kiel, Douglas - HEBREW REHAB CENTER |
| Willett, Walter - HARVARD SCH PUB HEALTH |
Submitted to: American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: June 28, 2007
Publication Date: December 1, 2007
Citation: Bischoff-Ferrari, H.A., Dawson-Hughes, B., Baron, J.A., Burckhardt, P., Spiegelman, D., Specker, B., Orav, E., Wong, J.B., Staehelin, H.B., O'Rielly, E., Kiel, D., Willett, W.C. 2007. Calcium intake and risk of hip fracture in men and women a meta-analysis of prospective cohort studies and randomized controlled trials. American Journal of Clinical Nutrition. 86:1780-90.
Interpretive Summary: Calcium supplementation is commonly recommended for the prevention of osteoporosis and fractures. These recommendations are based primarily on evidence from randomized controlled trials (RCTs) with bone density as the outcome. We conducted this analysis of published studies to determine the effect of calcium on hip and other non-vertebral fracture rates. Based on extensive evidence, supplemental calcium did not significantly lower hip fracture risk in men. Results from randomized trials showed no reduction and a possible increased risk of hip fracture with calcium supplementation in women. For any non-vertebral fractures, there was a neutral effect in the randomized trials in men and women. These results do not support an overall benefit of greater calcium intake on hip fracture risk. It is possible that among the frail individuals at risk for hip fractures, other deficiencies, such as vitamin D deficiency and phosphate deficiency, need correction along with adequate calcium intake.
The role of total calcium intake for the prevention of hip fracture risk has not been well established. The objective of this analysis was to assess the relation of calcium intake to risk of hip fracture based on meta-analyses of cohort studies and clinical trials. In cohort studies in women (7 studies, 170,991 women, 2954 hip fractures), there was no association between total calcium intake and hip fracture risk (pooled RR per 300 mg of total calcium = 1.01; 95% CI: 0.97, 1.05). In men (5 studies, 68,606 men, 214 hip fractures), the pooled RR per 300 mg of total calcium was 0.92 (95% CI: 0.82, 1.03). In clinical trials based on 5 studies (5666 primarily postmenopausal women plus 1074 men) with 814 non-vertebral fractures, the pooled RR for non-vertebral fractures comparing calcium supplementation (800-1600 mg/day) with placebo was 0.92 (95% CI: 0.81, 1.05). Based on 4 trials with separate results for hip fracture (6504 individuals with 139 hip fractures), the pooled RR comparing calcium with placebo was 1.64 (95% CI:1.02, 2.64). Sensitivity analyses including 2 additional small trials with less than 100 participants or per protocol results did not substantially alter results.
In conclusion, pooled results from cohort studies suggest that calcium intake is not appreciably associated with hip fracture risk in women or men. Pooled results from randomized trials show no reduction in hip fracture risk with calcium supplementation, and an increased risk is possible. For any non-vertebral fractures, there was a neutral effect in the randomized trials.