VII. Meta-Analysis of Calcium Supplementation for the Prevention of Postmenopausal Osteoporosis

Shea, Beverley; Wells, George; Cranney, Ann; Zytaruk, Nicole; Robinson, Vivian; Griffith, Lauren; Ortiz, Zulma; Peterson, Joan; Adachi, Jonathan D.; Tugwell, Peter; Guyatt, Gordon

doi:10.1210/er.2001-7002

Cited by 345 publications

(140 citation statements)

References 29 publications

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“…The size of these associations corresponds to those previously reported for a 100‐mg increase in magnesium (0.020 g/cm 2 ; 2% of mean BMD) or vitamin C (0.017 g/cm 2 ) and supplementation with calcium (1.66% increase in mean BMD for lumbar spine; 1.64% increase in mean BMD for hip) 41, 42, 43. The greatest difference in BMD of 0.024 g/cm 2 was observed between extreme quintiles of leucine intake; this corresponded to a difference in intake of 0.6% energy or 1.4 g. This intake could readily be incorporated in the diet through animal sources, eg, one salmon steak (80 g) contains 1.6 g leucine, or through a variety of vegetable sources, eg, one medium avocado (145 g = 0.2 g leucine), or an average portion of brown rice (180 g = 0.3 g leucine), almonds (40 g = 0.5 g leucine), or high fiber breakfast cereal (40 g = 0.3 g leucine).…”

Section: Discussionsupporting

confidence: 86%

“…In conclusion, these novel data suggest a beneficial role for selected amino acids on BMD and prevalence of low bone mass, with significant associations observed for BMD similar in magnitude to those previously reported for other nutrients including magnesium, calcium, and vitamin C 41, 42, 43. Furthermore, consuming a higher proportion of amino acids from vegetable sources than from animal sources was beneficial in terms of the prevalence of osteoporosis or osteopenia, and intakes of the amino acids associated with the current findings could be incorporated into the diet from readily available vegetable sources.…”

Section: Discussionsupporting

confidence: 80%

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Amino Acid Intakes Are Associated With Bone Mineral Density and Prevalence of Low Bone Mass in Women: Evidence From Discordant Monozygotic Twins

Jennings

Macgregor

Spector

et al. 2015

Journal of Bone and Mineral Research

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Although a higher protein intake, particularly from vegetable sources, has been shown to be associated with higher bone mineral density (BMD) the relative impact of specific amino acids on BMD and risk of osteoporosis remains to be determined. Mechanistic research suggests that a number of specific amino acids, including five nonessential amino acids—alanine, arginine, glutamic acid, glycine, and proline—may play a role in bone health, principally through improved production of insulin and insulin‐like growth factor 1 and the synthesis of collagen and muscle protein. However to date, no previous studies have examined the associations between habitual intake of amino acids and direct measures of BMD and prevalence of osteoporosis or osteopenia, and no studies have examined this relationship in discordant identical twin‐pairs. In these analyses of female monozygotic twin‐pairs discordant for amino acid intake (n = 135), twins with higher intakes of alanine and glycine had significantly higher BMD at the spine than their co‐twins with within‐pair differences in spine‐BMD of 0.012 g/cm2 (SE 0.01; p = 0.039) and 0.014 g/cm2 (SE 0.01; p = 0.026), respectively. Furthermore, in cross‐sectional multivariable analyses of 3160 females aged 18 to 79 years, a higher intake of total protein was significantly associated with higher DXA‐measured BMD at the spine (quartile Q4 to quartile Q1: 0.017 g/cm2, SE 0.01, p = 0.035) and forearm (Q4 to Q1: 0.010 g/cm2, SE 0.003, p = 0.002). Intake of six amino acids (alanine, arginine, glutamic acid, leucine, lysine, and proline) were associated with higher BMD at the spine and forearm with the strongest association observed for leucine (Q4 to Q1: 0.024 g/cm2, SE 0.01, p = 0.007). When intakes were stratified by protein source, vegetable or animal, prevalence of osteoporosis or osteopenia was 13% to 19% lower comparing extreme quartiles of vegetable intake for five amino acids (not glutamic acid or proline). These data provide evidence to suggest that intake of protein and several amino acids, including alanine and glycine, may be beneficial for bone health, independent of genetic background. © 2015 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 80%

Amino Acid Intakes Are Associated With Bone Mineral Density and Prevalence of Low Bone Mass in Women: Evidence From Discordant Monozygotic Twins

Jennings

Macgregor

Spector

et al. 2015

Journal of Bone and Mineral Research

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“…The proportion of women who had ceased taking their calcium supplement 24 months later (17%) is substantially lower than the 30 to 45 percent commonly reported in randomized controlled trials [2,3,[5][6][7]. The women taking supplements in our study were doing so as their own choice and not as part of a study protocol.…”

Section: Discussionmentioning

confidence: 63%

“…The estimated average requirement (EAR) for calcium is highest for this older sector of our population corresponding to a time when total energy needs are reduced and appetite may be compromised by concurrent medications, co-morbidities and poor mobility. The average Australian woman aged at least 70 does not meet the estimated requirement for calcium intake [1] and long-term adherence to calcium supplements is typically poor [2][3][4][5][6][7]. Thus, ensuring adequate intake in older women is a challenge.…”

Section: Introductionmentioning

confidence: 99%

Annual Feedback Is an Effective Tool for a Sustained Increase in Calcium Intake among Older Women

et al. 2010

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Abstract:We aimed to optimize calcium intake among the 2,000+ older women taking part in the Vital D study. Calcium supplementation was not included in the study protocol. Our hypothesis was that annual feedback of calcium intake and informing women of strategies to improve calcium intake can lead to a sustained increase in the proportion of women who consume adequate levels of the mineral. Calcium intake was assessed on an annual basis using a validated short food frequency questionnaire (FFQ). Supplemental calcium intake was added to the dietary estimate. Participants and their nominated doctor were sent a letter that the participant's estimated daily calcium intake was adequate or inadequate based on a cutoff threshold of 800 mg/day. General brief statements outlining the importance of an adequate calcium intake and bone health were included in all letters. At baseline, the median daily consumption of calcium was 980 mg/day and 67 percent of 1,951 participants had calcium intake of at least 800 mg per day. Of the 644 older women advised of an inadequate calcium intake at baseline (<800 mg/day), 386 (60%) had increased their intake by at least 100 mg/day when re-assessed twelve months later. This desirable change was sustained at 24 months after baseline with almost half of these women (303/644) consuming over 800 mg calcium per day. This study devised an efficient method to provide feedback on calcium intake to over 2,000 older women. The improvements were modest but significant and most apparent in those with a low intake at baseline. The decreased proportion of these women with an inadequate intake of calcium 12-and 24-months later, suggests this might be a practical, low cost strategy to maintain an adequate calcium intake among older women.

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“…A moderate level of evidence from several large RCTs suggests calcium does not reduce the risk of vertebral or nonvertebral fracture. 9,10 However, 2 separate pooled analyses found that calcium significantly reduced hip fracture risk. 5 The value of vitamin D in reducing fracture risk is uncertain despite a large body of literature.…”

Section: Literature Search and Study Selectionmentioning

confidence: 99%

Summary of AHRQ’s Comparative Effectiveness Review of Treatment to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis: Update of the 2007 Report

Levis

Theodore

2012

JMCP

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VII. Meta-Analysis of Calcium Supplementation for the Prevention of Postmenopausal Osteoporosis

Abstract: Calcium supplementation alone has a small positive effect on bone density. The data show a trend toward reduction in vertebral fractures, but do not meaningfully address the possible effect of calcium on reducing the incidence of nonvertebral fractures.

Cited by 345 publications

References 29 publications

Amino Acid Intakes Are Associated With Bone Mineral Density and Prevalence of Low Bone Mass in Women: Evidence From Discordant Monozygotic Twins

Amino Acid Intakes Are Associated With Bone Mineral Density and Prevalence of Low Bone Mass in Women: Evidence From Discordant Monozygotic Twins

Annual Feedback Is an Effective Tool for a Sustained Increase in Calcium Intake among Older Women

Summary of AHRQ’s Comparative Effectiveness Review of Treatment to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis: Update of the 2007 Report

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