title: Urinary tract stone occurrence in the Women's Health Initiative (WHI) randomized clinical trial of calcium and vitamin D supplements.
abstract: BACKGROUND
  The Women's Health Initiative (WHI) randomized clinical trial (RCT) of calcium plus vitamin D (CaD) supplements found a 17% excess in urinary tract stone incidence in the supplemented group. This study evaluated whether this risk is modified by participant characteristics.
  
  
  OBJECTIVE
  We examined the correlates of urinary tract stone occurrence in the CaD arm of the WHI trial.
  
  
  METHODS
  We analyzed an RCT involving 36,282 postmenopausal women aged 50-79 y from 40 WHI centers: 18,176 women received 500 mg calcium carbonate plus 200 IU vitamin D(3) twice daily (1000 mg and 400 IU daily, respectively), and 18,106 women received a matching placebo for an average of 7.0 y. The incidence of urinary tract stones was determined.
  
  
  RESULTS
  The incidence of self-reported clinically diagnosed urinary tract stones was more common in the active CaD medication group than in the placebo group (hazard ratio: 1.17; 95% CI: 1.02, 1.34): 449 women in the CaD group and 381 women in the placebo group reported a stone during the trial. The rates of self-reported stones did not differ between various demographic, anthropomorphic, dietary, and other hypothesized risk factors according to randomization assignment. Neither the total calcium intake nor the use of calcium supplements at baseline was associated with the risk of stones. In sensitivity analyses that censored participants who were below 80% adherence, the findings were similar.
  
  
  CONCLUSIONS
  Daily supplementation with CaD for 7 y was associated with an increase in the number of self-reported urinary tract stones. These findings have implications for CaD supplement use. This trial was registered with the WHI at clinicaltrials.gov as NCT00000611.
authors.affiliation: Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA 52242, USA. robert-wallace@uiowa.edu
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wallace
authors.forename: Jean
authors.initials: J
authors.lastname: Wactawski-Wende
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: O'Sullivan
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Larson
authors.forename: Barbara
authors.initials: B
authors.lastname: Cochrane
authors.forename: Margery
authors.initials: M
authors.lastname: Gass
authors.forename: Kamal
authors.initials: K
authors.lastname: Masaki
mesh_terms: D000368:Aged; D002136:Calcium, Dietary / Q000009:adverse effects*; D019587:Dietary Supplements / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D014545:Urinary Calculi / Q000139:chemically induced*; D014807:Vitamin D / Q000009:adverse effects*; D016387:Women's Health
chemical_list: D002136:Calcium, Dietary; D014807:Vitamin D