title: Randomized controlled trial of calcium in healthy older women.
abstract: OBJECTIVE
  Calcium has been shown to have positive effects on bone mineral density in postmenopausal women. However, these effects are small, it is unknown whether they are sustained with long-term use, they have not been shown with intention-to-treat analyses, and the evidence for fracture prevention with calcium monotherapy is inconsistent.
  
  
  METHODS
  A randomized controlled trial of calcium (1 g/day as the citrate) in 1471 healthy postmenopausal women (aged 74+/-4 years) was performed to assess the effects on bone density and fracture incidence over 5 years.
  
  
  RESULTS
  Follow-up was complete in 90% of subjects, and average medication compliance was 55% to 58%. Calcium had a significant beneficial effect on bone density (intention-to-treat analysis), with between-groups differences at 5 years of 1.8% (spine), 1.6% (total hip), and 1.2% (total body). Effects were greater in a per-protocol analysis (5-year differences of 2.3%, 2.8%, and 1.8%, respectively). A total of 425 fractures occurred in 281 women. Hazard ratios, based on time to first fracture, were 0.90 (95% confidence interval [CI], 0.71-1.16) for any symptomatic fracture, 0.72 (95% CI, 0.44-1.18) for vertebral, 3.55 (95% CI, 1.31-9.63) for hip, and 0.65 (95% CI, 0.41-1.04) for forearm fracture. Per-protocol analysis found respective hazard ratios of 0.86 (95% CI, 0.64-1.17), 0.62 (95% CI, 0.33-1.16), 3.24 (95% CI, 0.65-16.1), and 0.45 (95% CI, 0.24-0.87). Height loss was reduced by calcium in the per-protocol population (P=.03). Serum alkaline phosphatase and procollagen type-I N-terminal propeptide were lower in the calcium group at 5 years, but constipation was more common.
  
  
  CONCLUSIONS
  Calcium results in a sustained reduction in bone loss and turnover, but its effect on fracture remains uncertain. Poor long-term compliance limits its effectiveness.
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand. i.reid@auckland.ac.nz
authors.forename: Ian R
authors.initials: IR
authors.lastname: Reid
authors.forename: Barbara
authors.initials: B
authors.lastname: Mason
authors.forename: Anne
authors.initials: A
authors.lastname: Horne
authors.forename: Ruth
authors.initials: R
authors.lastname: Ames
authors.forename: Helen E
authors.initials: HE
authors.lastname: Reid
authors.forename: Usha
authors.initials: U
authors.lastname: Bava
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Bolland
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Gamble
mesh_terms: D000368:Aged; D015415:Biomarkers; D015519:Bone Density / Q000187:drug effects*; D019355:Calcium Citrate / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control*; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000517:prevention & control*; D017698:Postmenopause; D013997:Time Factors
chemical_list: D015415:Biomarkers; D019355:Calcium Citrate