Working Group: Australian and New Zealand Bone and Mineral Society and Osteoporosis Australia. Calcium and bone health: position statement (original) (raw)
Related papers
Role of Calcium in Bone Health During Childhood
Nutrition Reviews, 2009
A discussion of observational and longitudinal studies examining the effect of early-life calcium intake on bone health is provided. A critical analysis of pediatric calcium supplementation trials is conducted by determining annualized percent changes in bone mineral density (BMD). The focus of the analysis is to identify consistent findings at specific bone sites, determine whether effects differed by the age of children studied, and establish the relationship between bone changes and baseline calcium intake. We found ttiat increases in BMD owing to higher calcium intake among children appear to occur primarily in cortical bone sites, are most apparent among populations with low baseline calcium intakes, and do not seem to persist beyond the calcium supplementation period. Older (e.g., pubertal) children appear to have greater annual increases in lumbar BMD than younger (e.g., prepubertal) children. The annual percent increase in midradius BMD appears to be greater at higher intakes among the older children, but such a relationship is less apparent among the younger children.
BMJ, 2006
Objectives To assess the effectiveness of calcium supplementation for improving bone mineral density in healthy children and to determine if any effect is modified by other factors and persists after supplementation stops. Design Meta-analysis. Data sources Electronic bibliographic databases, hand searching of conference proceedings, and contacting authors for unpublished data. Review methods We included randomised placebo controlled trials of calcium supplementation in healthy children that lasted at least three months and had bone outcomes measured after at least six months of follow-up. Two reviewers independently extracted data and assessed quality. Meta-analyses predominantly used fixed effects models with outcomes given as standardised mean differences.
Calcium Supplementation Increases Bone Density in Adolescent Girls
Nutrition Reviews, 2009
In a longitudinal calcium intervention study, bone density was assessed in pubertal girls for 18 months. Significant additional increases in total body bone mineral density (1.3%) and spine bone mineral density (2.9%) and content (4.7%) were noted in the calcium-supplemented group. Increasing bone mass during adolescence with adequate calcium intake, if maintained into adulthood, could decrease the risk of osteoporosis later in life. Osteoporosis is a disease characterized by reduced bone density. A low bone density is a risk factor for osteoporosis, as demonstrated by the fact that the incidence of vertebral fractures is inversely proportional to bone mineral content in women over the age of 50.' Small differences in bone mass can be physiologically important; for example, there is a large difference in hip fracture rates between matched populations who differed in peak bone mass by only 6%.* Bone mineral density and content in later years is determined by both peak mass and the subsequent rate of bone mineral loss. Thus development of optimal peak mass is an important influence in reducing the incidence of osteoporosis. An individual's bone mass is primarily genetically controlled.' However, a variety of lifestyle factors can contribute to variations in bone mineral measures, such as dietary intake, smoking, and physical activity. Of the dietary factors, calcium has received the most attention. Most studies have examined the relationship between calcium intake and bone density in adults. A meta-analysis of these studies has shown a significant positive correlation between calcium intake and bone density, with a stronger relationship in premenopausal than in postmenopausal women.4 However, adequate calcium intake may have an even greater impact during development of peak bone mass. For adolescents who are in linear growth, a calcium balance of intake equaling losses is not sufficient to meet the needs of growth. These individuals need to be in positive balance to meet skeletal demands. Determining the calcium requirements to optimize attainment of peak bone mass is therefore important to reduce the risk of low bone mass in later years. There are sev-This review was prepared by
Calcium Supplementation Trials and Bone Mass Development in Children, Adolescents, and Young Adults
Nutrition Reviews, 2006
The development of bone mass during childhood through young adulthood is an important determinant of bone health later in life, and calcium is the major building block. Most randomized, double-blind, placebo-controlled trials of calcium supplementation have been done in girls; however, calcium supplementation in boys has been investigated in recent studies. Positive short-term effects on bone measures during growth has been shown in boys and girls, particularly in weight-bearing appendicular bone, although the lifelong effect is not certain.
The Lancet, 2001
Calcium supplementation during childhood and adolescence increases bone-mass accrual. Whether or not this benefit persists after discontinuation of supplementation is not known. We previously showed a favourable effect of milk-extracted calcium phosphate incorporated in various foods on accumulation of bone mineral mass in 8-year-old girls. We now report the results of a follow-up study undertaken more than 3 years after the end of calcium supplementation. Anthropometric and bone variables were measured in 116 of the 144 girls whose data had been studied at the end of the supplementation period. The mean time elapsed between the end of the intervention period and this follow-up measurement was 3.5 years. Areal bone mineral density was measured by dual-energy X-ray absorptiometry at the same six skeletal sites as those studied during the intervention phase. We were able to remeasure 62 and 54 girls of the calcium-supplemented and placebo groups, respectively. The increase from baseline in the overall mean bone mineral density of the six skeletal sites was still highly significant (calcium-supplemented group 179 mg/cm(2) [SE 8] vs placebo group 151 mg/cm(2) [7], p=0.012). A significant difference in favour of the supplemented group was also seen with respect to mean bone mineral content (p=0.031) and mean bone area (p=0.04). Difference in pubertal maturation did not seem to account for the recorded differences. Our results suggest that this form of milk-extracted calcium phosphate taken during the prepubertal period can modify the trajectory of bone mass growth and cause a long-standing increase in bone mass accrual, which lasts beyond the end of supplementation.
Clinical nutrition (Edinburgh, Scotland), 2017
Bone mineralization can be influenced by genetic factors, hormonal status, nutrition, physical activity and body composition. The association of higher calcium (Ca) intake or Ca supplementation with better bone mineral density (BMD) remains controversial. Furthermore, it has been speculated that maintaining long-term adequate Ca intake rather than having a brief supplementation period is more effective. The aim of the study was to prospectively analyse the influence of adequate Ca intake on BMD at 7 years of age in European children. Data from the Childhood Obesity Project were analysed in a prospective longitudinal cohort trial. Dietary intake was recorded using 3-day food records at 4, 5 and 6 years of age. The probability of adequate intake (PA) of Ca was calculated following the American Institute of Medicine guidelines for individual assessments, with FAO, WHO and United Nations University joint expert consultation dietary recommendations. Children were categorised as having hi...
2005
Background: Little is known about the relative effectiveness of calcium supplementation from food or pills with or without vitamin D supplementation for bone mass accrual during the rapid growth period. Objective: The purpose was to examine the effects of both foodbased and pill supplements of calcium and vitamin D on bone mass and body composition in girls aged 10-12 y. Design: This placebo-controlled intervention trial randomly assigned 195 healthy girls at Tanner stage I-II, aged 10Ҁ12 y, with dietary calcium intakes 900 mg/d to 1 of 4 groups: calcium (1000 mg) ѿ vitamin D 3 (200 IU), calcium (1000 mg), cheese (1000 mg calcium), and placebo. Primary outcomes were bone indexes of the hip, spine, and whole body by dual-energy X-ray absorptiometry and of the radius and tibia by peripheral quantitative computed tomography. Results: With the use of intention-to-treat or efficacy analysis, calcium supplementation with cheese resulted in a higher percentage change in cortical thickness of the tibia than did placebo, calcium, or calcium ѿ vitamin D treatment (P ҃ 0.01, 0.038, and 0.004, respectively) and in higher whole-body bone mineral density than did placebo treatment (P ҃ 0.044) when compliance was 50%. With the use of a hierarchical linear model with random effects to control for growth velocity, these differences disappeared. Conclusions: Increasing calcium intake by consuming cheese appears to be more beneficial for cortical bone mass accrual than the consumption of tablets containing a similar amount of calcium. Diverse patterns of growth velocity may mask the efficacy of supplementation in a short-term trial of children transiting through puberty.
2008
Background: A recent meta-analysis raised doubt as to whether calcium supplementation in children benefits spine and hip bone mineral density (BMD). Objective: We used state-of-the-art measures of bone (fan-beam dual-energy X-ray absorptiometry and 4 bone turnover markers) to determine whether girls with low habitual calcium intake benefited from supplementation with a soluble form of calcium (calcium citrate malate dissolved in a fruit drink). Design: The trial was an 18-mo randomized trial of calcium supplementation (792 mg/d) with follow-up 2 y after supplement withdrawal. Subjects were 96 girls (mean age: 12 y) with low calcium intakes (mean: 636 mg/d). The main outcome measure was change in total-body, lumbar spine, and total hip bone mineral content (BMC) during supplementation and 2 y after supplement withdrawal. Changes in BMD and bone turnover markers were secondary outcome measures. Results: The mean additional calcium intake in the supplemented group was 555 mg/d. Compared with the control group, the supplemented group showed significantly (P 0.05) greater gains in BMC (except at the total hip site) over the 18-mo study. BMD change was significantly (P 0.05) greater for all skeletal sites, and concentrations of bone resorption markers and parathyroid hormone were significantly (P 0.01) lower in the supplemented group than in the control group after 18 mo. After 42 mo, gains in BMC and BMD and differences in bone resorption were no longer evident. Conclusions: Calcium supplementation enhances bone mineral accrual in teenage girls, but the effect is short-lived. The likely mechanism for the effect of the calcium is suppression of bone turnover, which is reversed upon supplement withdrawal.
The American Journal of Clinical Nutrition, 2005
Background: The effect of short-term calcium supplementation on peak bone mass in adolescent girls is not completely defined. In our previous double-blind, placebo-controlled, calcium-supplementation study (1000 mg calcium carbonate/d), we showed that calcium supplementation of postmenarcheal girls with low calcium intakes enhances bone mineral acquisition. Objective: The objective of this follow-up study, conducted 3.5 y after the end of calcium supplementation, was to investigate the sustained effect of calcium supplementation on bone mineral mass. Design: Anthropometric data, nutrient intakes, and bone variables were reassessed in 96 of the 100 adolescent girls whose data had been studied at the end of the supplementation period. Bone mineral content and bone mineral density (BMD) of the total body, lumbar spine, and femoral neck were determined by dual-energy X-ray absorptiometry. Results: The calcium-supplemented group tended to have a greater accretion of total-body BMD (TBBMD) than did the control group 3.5 y after the end of supplementation. The finding was statistically significant in the active-treatment cohort (n ҃ 17 in the calciumsupplemented group and 28 in the placebo group), who had a compliance rate of ͧ75% during the intervention study. In a multivariate linear-regression analysis, TBBMD accretion from the beginning of the intervention study to the follow-up study in the active-treatment cohort was attributed to calcium supplementation and to the time since inclusion in the initial study. Conclusion: Calcium supplementation for 1 y in postmenarcheal girls with low calcium intakes may provide a sustained effect on the basis of TBBMD measurements in participants with compliance rates of ͧ75%.