title: Calcium supplements and bone resorption in pregnancy: a randomized crossover trial.
abstract: BACKGROUND
  Pregnancy is a time of increased need for calcium. The role of calcium supplements in altering maternal responses to fetal demand for calcium is not fully understood. This article describes the results of a randomized, crossover trial of calcium supplementation on bone resorption among pregnant women. DESIGN/SETTING PARTICIPANTS: Thirty-one Mexican women at 25-35 weeks gestation participated in the study for 20 days. Each woman received a 1200 mg calcium supplement on 10 consecutive days and a multivitamin without calcium for 10 days. Urine samples were collected daily. Two pooled specimens from each subject (representing urine from multivitamin days and from calcium days) were preserved, and levels of cross-linked, N-telopeptides of type I collagen (NTX), a biomarker of bone resorption, were measured. Dietary calcium intake was assessed using a food-frequency questionnaire.
  
  
  RESULTS
  Of the 31 participants, 27 (87.1%) showed reductions in urinary NTX levels while ingesting calcium supplements. When not ingesting calcium, NTX levels for the 31 subjects had a mean of 96.8 nM BCE/mM creatinine; this was significantly higher (p<0.001) than the mean urinary NTX levels of 83.2 nM BCE/mM creatinine during ingestion of the calcium supplements. Neither age nor dietary calcium intake was a significant predictor of treatment effect.
  
  
  CONCLUSIONS
  A bedtime, 1200-mg calcium supplement during the third trimester of pregnancy reduces maternal bone resorption by an average of 13.6 nM BCE/mM creatinine (14%), as reflected by urinary NTX levels. These results suggest that calcium supplements reduce maternal skeletal-bone turnover during the third trimester of pregnancy.
authors.affiliation: Brigham and Women's Hospital, Department of Obstetrics and Gynecology, Boston, Massachusetts 02115, USA. vjanakiraman@partners.org
authors.forename: Vanitha
authors.initials: V
authors.lastname: Janakiraman
authors.forename: Adrienne
authors.initials: A
authors.lastname: Ettinger
authors.forename: Adriana
authors.initials: A
authors.lastname: Mercado-Garcia
authors.forename: Howard
authors.initials: H
authors.lastname: Hu
authors.forename: Mauricio
authors.initials: M
authors.lastname: Hernandez-Avila
mesh_terms: D000293:Adolescent; D000328:Adult; D016723:Bone Remodeling / Q000187:drug effects*; D001862:Bone Resorption / Q000517:prevention & control*; D002118:Calcium / Q000494:pharmacology*; D024042:Collagen Type I / Q000652:urine; D018592:Cross-Over Studies; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011263:Pregnancy Trimester, Third
chemical_list: D024042:Collagen Type I; D002118:Calcium