Skip to main content
Top
Published in: Osteoporosis International 5/2008

01-05-2008 | Original Article

Calcium and vitamin D intake influence bone mass, but not short-term fracture risk, in Caucasian postmenopausal women from the National Osteoporosis Risk Assessment (NORA) study

Authors: J. W. Nieves, E. Barrett-Connor, E. S. Siris, M. Zion, S. Barlas, Y. T. Chen

Published in: Osteoporosis International | Issue 5/2008

Login to get access

Abstract

Summary

The impact of calcium and vitamin D intake on bone density and one-year fracture risk was assessed in 76,507 postmenopausal Caucasian women. Adequate calcium with or without vitamin D significantly reduced the odds of osteoporosis but not the risk of fracture in these Caucasian women.

Introduction

Calcium and vitamin D intake may be important for bone health; however, studies have produced mixed results.

Methods

The impact of calcium and vitamin D intake on bone mineral density (BMD) and one-year fracture incidence was assessed in 76,507 postmenopausal Caucasian women who completed a dietary questionnaire that included childhood, adult, and current consumption of dairy products. Current vitamin D intake was calculated from milk, fish, supplements and sunlight exposure. BMD was measured at the forearm, finger or heel. Approximately 3 years later, 36,209 participants returned a questionnaire about new fractures. The impact of calcium and vitamin D on risk of osteoporosis and fracture was evaluated by logistic regression adjusted for multiple covariates.

Results

Higher lifetime calcium intake was associated with reduced odds of osteoporosis (peripheral BMD T-score ≤−2.5; OR = 0.80; 95% CI 0.72, 0.88), as was a higher current calcium (OR = 0.75; (0.68, 0.82)) or vitamin D intake (OR = 0.73; 95% CI 0.0.66, 0.81). Women reported 2,205 new osteoporosis-related fractures. The 3-year risk of any fracture combined or separately was not associated with intake of calcium or vitamin D.

Conclusions

Thus, higher calcium and vitamin D intakes significantly reduced the odds of osteoporosis but not the 3-year risk of fracture in these Caucasian women.
Literature
1.
go back to reference Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327(23):1637–1642PubMedCrossRef Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327(23):1637–1642PubMedCrossRef
2.
go back to reference Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 337(10):670–676PubMedCrossRef Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 337(10):670–676PubMedCrossRef
3.
go back to reference Komulainen MH, Kroger H, Tuppurainen MT, Heikkinen AM, Alhava E, Honkanen R, Saarikoski S (1998) HRT and Vit D in prevention of non-vertebral fractures in postmenopausal women; a 5 year randomized trial. Maturitas 31(1):45–54PubMedCrossRef Komulainen MH, Kroger H, Tuppurainen MT, Heikkinen AM, Alhava E, Honkanen R, Saarikoski S (1998) HRT and Vit D in prevention of non-vertebral fractures in postmenopausal women; a 5 year randomized trial. Maturitas 31(1):45–54PubMedCrossRef
4.
go back to reference Mackerras D, Lumley T (1997) First- and second-year effects in trials of calcium supplementation on the loss of bone density in postmenopausal women. Bone 21(6):527–533PubMedCrossRef Mackerras D, Lumley T (1997) First- and second-year effects in trials of calcium supplementation on the loss of bone density in postmenopausal women. Bone 21(6):527–533PubMedCrossRef
6.
go back to reference Shea B, Wells G, Cranney A, Zytaruk N, Robinson V, Griffith L, Ortiz Z, Peterson J, Adachi J, Tugwell P, Guyatt G (2002) Meta-analyses of therapies for postmenopausal osteoporosis. VII. Meta-analysis of calcium supplementation for the prevention of postmenopausal osteoporosis. Endocr Rev 23(4):552–559PubMedCrossRef Shea B, Wells G, Cranney A, Zytaruk N, Robinson V, Griffith L, Ortiz Z, Peterson J, Adachi J, Tugwell P, Guyatt G (2002) Meta-analyses of therapies for postmenopausal osteoporosis. VII. Meta-analysis of calcium supplementation for the prevention of postmenopausal osteoporosis. Endocr Rev 23(4):552–559PubMedCrossRef
7.
go back to reference Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B (2005) Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 293(18):2257–2264PubMedCrossRef Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B (2005) Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 293(18):2257–2264PubMedCrossRef
8.
go back to reference Trivedi DP, Doll R, Khaw KT (2003) Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. Bmj 326(7387):469PubMedCrossRef Trivedi DP, Doll R, Khaw KT (2003) Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. Bmj 326(7387):469PubMedCrossRef
9.
go back to reference Assessment of fracture risk and its application to screening for postmenopausal osteoporosis (1994) Report of a WHO Study Group. World Health Organ Tech Rep Ser 843:1–129 Assessment of fracture risk and its application to screening for postmenopausal osteoporosis (1994) Report of a WHO Study Group. World Health Organ Tech Rep Ser 843:1–129
10.
go back to reference Grant AM, Avenell A, Campbell MK, McDonald AM, MacLennan GS, McPherson GC, Anderson FH, Cooper C, Francis RM, Donaldson C, Gillespie WJ, Robinson CM, Torgerson DJ, Wallace WA (2005) Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet 365(9471):1621–1628PubMedCrossRef Grant AM, Avenell A, Campbell MK, McDonald AM, MacLennan GS, McPherson GC, Anderson FH, Cooper C, Francis RM, Donaldson C, Gillespie WJ, Robinson CM, Torgerson DJ, Wallace WA (2005) Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet 365(9471):1621–1628PubMedCrossRef
11.
go back to reference Lips P, Graafmans WC, Ooms ME, Bezemer PD, Bouter LM (1996) Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo-controlled clinical trial. Ann Intern Med 124(4):400–406PubMed Lips P, Graafmans WC, Ooms ME, Bezemer PD, Bouter LM (1996) Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo-controlled clinical trial. Ann Intern Med 124(4):400–406PubMed
12.
go back to reference Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, Bassford T, Beresford SA, Black HR, Blanchette P, Bonds DE, Brunner RL, Brzyski RG, Caan B, Cauley JA, Chlebowski RT, Cummings SR, Granek I, Hays J, Heiss G, Hendrix SL, Howard BV, Hsia J, Hubbell FA, Johnson KC, Judd H, Kotchen JM, Kuller LH, Langer RD, Lasser NL, Limacher MC, Ludlam S, Manson JE, Margolis KL, McGowan J, Ockene JK, O’Sullivan MJ, Phillips L, Prentice RL, Sarto GE, Stefanick ML, Van Horn L, Wactawski-Wende J, Whitlock E, Anderson GL, Assaf AR, Barad D (2006) Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 354(7):669–683PubMedCrossRef Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, Bassford T, Beresford SA, Black HR, Blanchette P, Bonds DE, Brunner RL, Brzyski RG, Caan B, Cauley JA, Chlebowski RT, Cummings SR, Granek I, Hays J, Heiss G, Hendrix SL, Howard BV, Hsia J, Hubbell FA, Johnson KC, Judd H, Kotchen JM, Kuller LH, Langer RD, Lasser NL, Limacher MC, Ludlam S, Manson JE, Margolis KL, McGowan J, Ockene JK, O’Sullivan MJ, Phillips L, Prentice RL, Sarto GE, Stefanick ML, Van Horn L, Wactawski-Wende J, Whitlock E, Anderson GL, Assaf AR, Barad D (2006) Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 354(7):669–683PubMedCrossRef
13.
go back to reference Recker RR, Hinders S, Davies KM, Heaney RP, Stegman MR, Lappe JM, Kimmel DB (1996) Correcting calcium nutritional deficiency prevents spine fractures in elderly women. J Bone Miner Res 11(12):1961–1966PubMed Recker RR, Hinders S, Davies KM, Heaney RP, Stegman MR, Lappe JM, Kimmel DB (1996) Correcting calcium nutritional deficiency prevents spine fractures in elderly women. J Bone Miner Res 11(12):1961–1966PubMed
14.
go back to reference Reid IR, Ames RW, Evans MC, Gamble GD, Sharpe SJ (1995) Long-term effects of calcium supplementation on bone loss and fractures in postmenopausal women: a randomized controlled trial. Am J Med 98(4):331–335PubMedCrossRef Reid IR, Ames RW, Evans MC, Gamble GD, Sharpe SJ (1995) Long-term effects of calcium supplementation on bone loss and fractures in postmenopausal women: a randomized controlled trial. Am J Med 98(4):331–335PubMedCrossRef
15.
go back to reference Chapuy MC, Pamphile R, Paris E, Kempf C, Schlichting M, Arnaud S, Garnero P, Meunier PJ (2002) Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Osteoporos Int 13(3):257–264PubMedCrossRef Chapuy MC, Pamphile R, Paris E, Kempf C, Schlichting M, Arnaud S, Garnero P, Meunier PJ (2002) Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Osteoporos Int 13(3):257–264PubMedCrossRef
16.
go back to reference Chevalley T, Rizzoli R, Nydegger V, Slosman D, Rapin CH, Michel JP, Vasey H, Bonjour JP (1994) Effects of calcium supplements on femoral bone mineral density and vertebral fracture rate in vitamin-D-replete elderly patients. Osteoporos Int 4(5):245–252PubMedCrossRef Chevalley T, Rizzoli R, Nydegger V, Slosman D, Rapin CH, Michel JP, Vasey H, Bonjour JP (1994) Effects of calcium supplements on femoral bone mineral density and vertebral fracture rate in vitamin-D-replete elderly patients. Osteoporos Int 4(5):245–252PubMedCrossRef
17.
go back to reference Larsen ER, Mosekilde L, Foldspang A (2004) Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res 19(3):370–378PubMedCrossRef Larsen ER, Mosekilde L, Foldspang A (2004) Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res 19(3):370–378PubMedCrossRef
18.
go back to reference Meyer HE, Smedshaug GB, Kvaavik E, Falch JA, Tverdal A, Pedersen JI (2002) Can vitamin D supplementation reduce the risk of fracture in the elderly? A randomized controlled trial. J Bone Miner Res 17(4):709–715PubMedCrossRef Meyer HE, Smedshaug GB, Kvaavik E, Falch JA, Tverdal A, Pedersen JI (2002) Can vitamin D supplementation reduce the risk of fracture in the elderly? A randomized controlled trial. J Bone Miner Res 17(4):709–715PubMedCrossRef
19.
go back to reference Cumming RG, Nevitt MC (1997) Calcium for prevention of osteoporotic fractures in postmenopausal women. J Bone Miner Res 1997(12):1321–1329CrossRef Cumming RG, Nevitt MC (1997) Calcium for prevention of osteoporotic fractures in postmenopausal women. J Bone Miner Res 1997(12):1321–1329CrossRef
20.
go back to reference Xu L, McElduff P, D’Este C, Attia J (2004) Does dietary calcium have a protective effect on bone fractures in women? A meta-analysis of observational studies. Br J Nutr 91(4):625–634PubMedCrossRef Xu L, McElduff P, D’Este C, Attia J (2004) Does dietary calcium have a protective effect on bone fractures in women? A meta-analysis of observational studies. Br J Nutr 91(4):625–634PubMedCrossRef
21.
go back to reference Michaelsson K, Melhus H, Bellocco R, Wolk A (2003) Dietary calcium and vitamin D intake in relation to osteoporotic fracture risk. Bone 32(6):694–703PubMedCrossRef Michaelsson K, Melhus H, Bellocco R, Wolk A (2003) Dietary calcium and vitamin D intake in relation to osteoporotic fracture risk. Bone 32(6):694–703PubMedCrossRef
22.
go back to reference Feskanich D, Willett WC, Colditz GA (2003) Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr 77(2):504–511PubMed Feskanich D, Willett WC, Colditz GA (2003) Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr 77(2):504–511PubMed
23.
go back to reference Ho SC, Chen YM, Woo JL, Lam SS (2004) High habitual calcium intake attenuates bone loss in early postmenopausal Chinese women: an 18-month follow-up study. J Clin Endocrinol Metab 89(5):2166–2170PubMedCrossRef Ho SC, Chen YM, Woo JL, Lam SS (2004) High habitual calcium intake attenuates bone loss in early postmenopausal Chinese women: an 18-month follow-up study. J Clin Endocrinol Metab 89(5):2166–2170PubMedCrossRef
24.
go back to reference Suzuki Y, Whiting SJ, Davison KS, Chilibeck PD (2003) Total calcium intake is associated with cortical bone mineral density in a cohort of postmenopausal women not taking estrogen. J Nutr Health Aging 7(5):296–299PubMed Suzuki Y, Whiting SJ, Davison KS, Chilibeck PD (2003) Total calcium intake is associated with cortical bone mineral density in a cohort of postmenopausal women not taking estrogen. J Nutr Health Aging 7(5):296–299PubMed
25.
go back to reference Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA 286(22):2815–2822PubMedCrossRef Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA 286(22):2815–2822PubMedCrossRef
26.
go back to reference Fleming KH, Heimbach JT (1994) Consumption of calcium in the U.S.: food sources and intake levels. J Nutr 124(8 Suppl):1426S–1430SPubMed Fleming KH, Heimbach JT (1994) Consumption of calcium in the U.S.: food sources and intake levels. J Nutr 124(8 Suppl):1426S–1430SPubMed
27.
go back to reference Holick MF (2002) Vitamin D: the underappreciated D-lightful hormone that is important for skeletal and cellular health. Current Opinon in Endocrinology & Diabetes 9:87–98CrossRef Holick MF (2002) Vitamin D: the underappreciated D-lightful hormone that is important for skeletal and cellular health. Current Opinon in Endocrinology & Diabetes 9:87–98CrossRef
28.
go back to reference Institute of Medicine (1997) Dietary reference intakes for calcium, magnesium, phosphorus, vitamin D and fluoride. National Academy Press, Washington, DC Institute of Medicine (1997) Dietary reference intakes for calcium, magnesium, phosphorus, vitamin D and fluoride. National Academy Press, Washington, DC
29.
go back to reference Moore C, Murphy MM, Keast DR, Holick MF (2004) Vitamin D intake in the United States. J Am Diet Assoc 104(6):980–983PubMedCrossRef Moore C, Murphy MM, Keast DR, Holick MF (2004) Vitamin D intake in the United States. J Am Diet Assoc 104(6):980–983PubMedCrossRef
30.
go back to reference Burger H, de Laet CE, van Daele PL, Weel AE, Witteman JC, Hofman A, Pols HA (1998) Risk factors for increased bone loss in an elderly population: the Rotterdam Study. Am J Epidemiol 147(9):871–879PubMed Burger H, de Laet CE, van Daele PL, Weel AE, Witteman JC, Hofman A, Pols HA (1998) Risk factors for increased bone loss in an elderly population: the Rotterdam Study. Am J Epidemiol 147(9):871–879PubMed
31.
go back to reference Kroger H, Tuppurainen M, Honkanen R, Alhava E, Saarikoski S (1994) Bone mineral density and risk factors for osteoporosis-a population-based study of 1600 perimenopausal women. Calcif Tissue Int 55(1):1–7PubMedCrossRef Kroger H, Tuppurainen M, Honkanen R, Alhava E, Saarikoski S (1994) Bone mineral density and risk factors for osteoporosis-a population-based study of 1600 perimenopausal women. Calcif Tissue Int 55(1):1–7PubMedCrossRef
32.
go back to reference Nguyen TV, Kelly PJ, Sambrook PN, Gilbert C, Pocock NA, Eisman JA (1994) Lifestyle factors and bone density in the elderly: implications for osteoporosis prevention. J Bone Miner Res 9(9):1339–1346PubMed Nguyen TV, Kelly PJ, Sambrook PN, Gilbert C, Pocock NA, Eisman JA (1994) Lifestyle factors and bone density in the elderly: implications for osteoporosis prevention. J Bone Miner Res 9(9):1339–1346PubMed
33.
go back to reference Barrett-Connor E (1991) Nutrition epidemiology: how do we know what they ate? Am J Clin Nutr 54(1 Suppl):182S–187SPubMed Barrett-Connor E (1991) Nutrition epidemiology: how do we know what they ate? Am J Clin Nutr 54(1 Suppl):182S–187SPubMed
34.
go back to reference Nieves JW, Golden AL, Siris E, Kelsey JL, Lindsay R (1995) Teenage and current calcium intake are related to bone mineral density of the hip and forearm in women aged 30–39 years. Am J Epidemiol 141(4):342–351PubMedCrossRef Nieves JW, Golden AL, Siris E, Kelsey JL, Lindsay R (1995) Teenage and current calcium intake are related to bone mineral density of the hip and forearm in women aged 30–39 years. Am J Epidemiol 141(4):342–351PubMedCrossRef
35.
go back to reference Wright JD, Wang CY, Kennedy-Stephenson J, Ervin RB (2003) Dietary intake of ten key nutrients for public health, United States: 1999–2000. Adv Data (334):1–4 Wright JD, Wang CY, Kennedy-Stephenson J, Ervin RB (2003) Dietary intake of ten key nutrients for public health, United States: 1999–2000. Adv Data (334):1–4
36.
go back to reference Ervin RB, Wang CY, Wright JD, Kennedy-Stephenson J (2004) Dietary intake of selected minerals for the United States population: 1999–2000. Adv Data (341):1–5 Ervin RB, Wang CY, Wright JD, Kennedy-Stephenson J (2004) Dietary intake of selected minerals for the United States population: 1999–2000. Adv Data (341):1–5
37.
go back to reference Fulgoni 3rd VL, Huth PJ, DiRienzo DB, Miller GD (2004) Determination of the optimal number of dairy servings to ensure a low prevalence of inadequate calcium intake in Americans. J Am Coll Nutr 23(6):651–659PubMed Fulgoni 3rd VL, Huth PJ, DiRienzo DB, Miller GD (2004) Determination of the optimal number of dairy servings to ensure a low prevalence of inadequate calcium intake in Americans. J Am Coll Nutr 23(6):651–659PubMed
38.
go back to reference Miller PD, Siris ES, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Chen YT, Berger ML, Santora AC, Sherwood LM. Prediction of fracture risk in postmenopausal white women with peripheral bone densitometry: evidence from the National Osteoporosis Risk Assessment. J Bone Miner Res 2002:17(12):2222–2230PubMedCrossRef Miller PD, Siris ES, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Chen YT, Berger ML, Santora AC, Sherwood LM. Prediction of fracture risk in postmenopausal white women with peripheral bone densitometry: evidence from the National Osteoporosis Risk Assessment. J Bone Miner Res 2002:17(12):2222–2230PubMedCrossRef
Metadata
Title
Calcium and vitamin D intake influence bone mass, but not short-term fracture risk, in Caucasian postmenopausal women from the National Osteoporosis Risk Assessment (NORA) study
Authors
J. W. Nieves
E. Barrett-Connor
E. S. Siris
M. Zion
S. Barlas
Y. T. Chen
Publication date
01-05-2008
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 5/2008
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-007-0501-2

Other articles of this Issue 5/2008

Osteoporosis International 5/2008 Go to the issue