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Online Clinical Calculator |
1000 mg calcium/400 IU vit D not
very effective for fracture prevention (WHI)
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Clinical Question:
Does supplementation with 1000 mg calcium and 400 IU vitamin D reduce the
risk of fracture in healthy women?
Bottom Line:
Among healthy postmenopausal women, calcium with vitamin D supplementation
resulted in a small but significant improvement in hip bone density, did not
significantly reduce hip fracture, and increased the risk of kidney stones.
Reference:
Jackson RD, LaCroix AZ, Gass M, et al, for the Women's Health Initiative
Investigators. Calcium plus vitamin D supplementation and the risk of
fractures. N Engl J Med 2006; 354: 669-83. |
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Study Design:
Randomized controlled trial (double-blinded)
Synopsis:
The efficacy of calcium with vitamin D supplementation for preventing hip
and other fractures in healthy postmenopausal women remains equivocal. We
recruited 36,282 postmenopausal women, 50 to 79 years of age, who were
already enrolled in a Women's Health Initiative (WHI) clinical trial. We
randomly assigned participants to receive 1000 mg of elemental [corrected]
calcium as calcium carbonate with 400 IU of vitamin D3 daily or placebo.
Fractures were ascertained for an average follow-up period of 7.0 years.
Bone density was measured at three WHI centers. Hip bone density was 1.06
percent higher in the calcium plus vitamin D group than in the placebo group
(P<0.01). Intention-to-treat analysis indicated that participants receiving
calcium plus vitamin D supplementation had a hazard ratio of 0.88 for hip
fracture (95 percent confidence interval, 0.72 to 1.08), 0.90 for clinical
spine fracture (0.74 to 1.10), and 0.96 for total fractures (0.91 to 1.02).
The risk of renal calculi increased with calcium plus vitamin D (hazard
ratio, 1.17; 95 percent confidence interval, 1.02 to 1.34). Censoring data
from women when they ceased to adhere to the study medication reduced the
hazard ratio for hip fracture to 0.71 (95 percent confidence interval, 0.52
to 0.97). Effects did not vary significantly according to prerandomization
serum vitamin D levels. |
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