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Calcium plus vitamin D may slash hip fracture rates: WHI data

3 commentsBy Stephen DANIELLS , 06-Feb-2013
Last updated on 06-Feb-2013 at 19:24 GMT

Calcium plus vitamin D may slash hip fracture rates: WHI data

Supplements of calcium and vitamin D may reduce the rate of hip fracture by almost 40%, says a new analysis of data from the Women's Health Initiative (WHI).

The WHI was the largest randomized, double-blind, placebo-controlled clinical trial of these nutrients, and involved 36,282 postmenopausal women in the US. The women were randomly assigned to receive 1,000 mg elemental calcium carbonate plus 400 IU of vitamin D3 daily, or placebo, for an average if seven years.

The initial analysis of the data, published in 2006 in the New England Journal of Medicine (Vol. 354, pp. 669-683), concluded: “Among healthy postmenopausal women, calcium with vitamin D supplementation resulted in a small but significant improvement in hip bone density, and did not significantly reduce hip fracture.”

However, in the 59% of the participants who actually adhered to the supplementation program (assuming 80% or more compliance with taking the supplements) the number of fractures was 29% lower, leading this publication to run with the headline: Calcium/ vitamin D supplements good for bones – if you take them (NutraIngredients-USA, Feb 16, 2006).

Hip fracture benefits

The new analysis, published in Osteoporosis International , reports that, among women not taking calcium or vitamin D supplements at the start of the study, the risk of hip fracture occurrence was 38% lower, compared to the placebo group.

In addition, when data from the WHI clinical trial and the WHI prospective observational study were combined, the risk was 35% lower.

Though based primarily on a subset analysis, long-term use of calcium and vitamin D appears to confer a reduction that may be substantial in the risk of hip fracture among postmenopausal women,” wrote the researchers, led by Dr Ross Prentice from the Fred Hutchinson Cancer Research Center in Seattle.

The researchers also cautiously reported that there was a suggestion of a lower risk of breast cancer and total cancer among supplement users.

Concerns? No concerns…

In addition, there was no link observed between vitamin D and calcium supplementation and cardiovascular outcomes, which challenges concerns raised by other studies, most recently .

Earlier this week , researchers from the National Cancer Institute, Bethesda reported in JAMA Internal Medicine that high intakes of calcium from supplements may increase the risk of cardiovascular disease for men, but not women.

Source: Osteoporosis International
February 2013, Volume 24, Issue 2, pp 567-580,
“Health risks and benefits from calcium and vitamin D supplementation: Women's Health Initiative clinical trial and cohort study”
Authors: R. L. Prentice, M. B. Pettinger, R. D. Jackson, et al. 

3 comments (Comments are now closed)

We were dead wrong about calcium supplements!

For decades we docs were ‘taught’ to push calcium pills to counter patient’s fears of osteopenia. We were dead wrong!
Supplemental calcium can cause kidney stones. Now an even greater concern is that calcium supplements may cause
sudden high blood levels of calcium. High levels may increase blood clotting, vasoconstriction and deposition of calcium
into artery-clogging plaques, thereby accelerating arteriosclerosis -- the cause of most deadly heart attacks and strokes.
Dietary calcium is released slowly, allowing our regulatory mechanisms time to avoid such unnaturally high levels.
Update 7/30/2010: Research involving over 8000 patients was reported in the British Medical Journal (BMJ) today. They
found that taking calcium supplements raised the likelihood of having a heart attack by about 30% over the placebo group.
Previous studies have found no similar heart attack risk by increasing calcium intake by dietary changes only.
Update 2/2013: A large prospective NIH study from the USA concurred that calcium supplements significantly increase
cardiovascular and cerebrovascular mortality in men. The study showed no similar overall increase risk in women.
Update 2/13/2013: A BMJ-reported Swedish study followed 61,433 women for an average of 19 years. The principle
author concluded, “Women with the highest intake of calcium (>1400 mg/day) and who used supplement tablets had an
all-cause risk for death 2.5 times higher than women who had similar total intakes but were not taking a supplement!”
My advice from these studies is: Men should get 1000 mg of calcium daily from foods only. Women should first strive to
get 1200 mg from dietary sources daily. If they fall short, they should use supplements in such doses that make up the
deficit only. It’s no longer prudent to advise patients to take the high supplement doses that all us docs used to advise!

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Posted by James A. Ferrel MD
07 March 2013 | 21h11

Calcium supplementation

I just read an article-advertisement in Bone Science News (Vol.3-Issue 1) presumably by Craig Mintzer om taking calcium. Front page claim is that if you are taking calcium supplements you increase your risk of heart attack by 86%. The same article quotes that taking calcium supplements reduces fractures by only 10% The article quotes "...supplementing with 500mg 600mg or 1000mg of calcium, this intake of calcium causes serum calcium levels in the blood to spike dangerously high for hours. This spike can cause calcification of your arteries, hardening of the arteries and plaque buildup which all lead to heart attacks." He quotes other studies that claim women who take the least amount of supplementation have fewer fractures. He also states that you get enough calcium already from our regular diet. Your article here excludes the role of Vitamin K in getting calcium into the bones. Mintzer in his promo for his article promotes supplementation with strontium to build strong bones and his article references results of people who do take strontium actually vastly improve bone density. What say you

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Posted by Denis
07 March 2013 | 17h38

But what about the evidence of an increased skin cancer risk with Vit D?

I suffer from osteopenia and skin cancer. I had been given combined calcium and Vitamin D for the osteopenia, but was then told by my oncologist to cease taking the combined calcium and Vitamin D, as too much vitamin D can cause skin cancer, as can too little. It is very difficult to balance competing priorities.

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Posted by Lynne
11 February 2013 | 17h58

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