[Optimization of calcium intake for the prevention of osteoporosis and osteoporotic fractures: a review of the evidence]. Milk, dietary calcium, and bone fractures in women: a 12-year prospective study. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Hypertension-related dietary patterns of rural older adults. Is dietary counselling effective in increasing dietary calcium, protein and energy intake in patients with osteoporotic fractures? A randomized controlled clinical trial. Calcium supplementation and bone mineral density in adolescent girls. Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Does calcium supplementation prevent bone stress injuries? A clinical trial. Dietary calcium and vitamin D intake in relation to osteoporotic fracture risk. Calcium, diet and fracture risk: a prospective study of 1898 incident fractures among 34 696 British women and men. Calcium supplementation and increases in bone mineral density in children. Effect of calcium or 25OH vitamin D3 dietary supplementation on bone loss at the hip in men and women over the age of 60. Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care Cluster-Randomized Non-Inferiority Trial to Compare Supplement Consumption and Adherence to Different Dosing Regimens for Antenatal Calcium and Iron-Folic Acid Supplementation to Prevent Preeclampsia and Anaemia: Rationale and Design of the Micronutrient Initiative Study Vitamin D and health in adults in Australia and New Zealand: a position statement. Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Proteins, dietary acid load, and calcium and risk of postmenopausal fractures in the E3N French women prospective study. Calcium supplementation for the prevention of pre-eclampsia. Calcium intake in children with positive IgG RAST to cow's milk. [Effects of calcium supplementation on bone mineral accretion in adolescents]. Prediagnostic Calcium Intake and Lung Cancer Survival: A Pooled Analysis of 12 Cohort Studies Prevention of hip fractures by correcting calcium and vitamin D insufficiencies in elderly people.
One of the main focuses of lifestyle modification for the prevention of osteoporosis and osteoporotic fractures  in Japan is improvement in dietary calcium intake . However , virtually no r and omized controlled trial to assess the preventive effects of administration of calcium on the risk of fractures has been conducted in Japan . In this study , we review ed all the scientific papers currently available from medical literature data bases to propose evidence -based recommendations on the preventive procedures for osteoporosis . The result of the present systematic review gives the evidence showing that calcium supplementation or optimal dietary calcium intake increases bone density in childhood and adolescence and reduces the risk of fracture due to osteoporosis in the elderly people regardless of the gender . The evidence also supports the current health policy guiding the elderly to increase their dietary calcium intake in daily life OBJECTIVES This study examined whether higher intakes of milk and other calcium-rich foods during adult years can reduce the risk of  osteoporotic fractures .  METHODS This was a 12-year prospect i ve study among 77761 women , aged 34 through 59 years in 1980 , who had never used calcium supplements .  Dietary intake was assessed with a food-frequency question naire in 1980 , 1984 , and 1986 . Fractures of the proximal femur ( n = 133 ) and distal radius ( n = 1046 ) from low or moderate trauma were self-reported on biennial question naires . RESULTS We found no evidence that higher intakes of milk or calcium from food sources reduce fracture incidence . Women who drank two or more glasses of milk per day had relative risks of 1.45 for hip fracture ( 95 % confidence interval [ CI ] = 0.87 , 2.43 ) and 1.05 for forearm fracture ( 95 % CI = 0.88 , 1.25 ) when compared with women consuming one glass or less per week . Likewise , higher intakes of total  dietary calcium or calcium from dairy foods were not associated with decreased risk of hip or forearm fracture . CONCLUSIONS These data do not support the hypothesis that higher consumption of milk or other food sources of calcium  by adult women protects against hip or forearm fractures BACKGROUND Short trials of calcium supplementation show that it reduces loss of bone density in postmenopausal women ; longer observational studies do not generally find a lower risk of hip fracture with higher-calcium diets . Fewer studies have focused on vitamin D in preventing postmenopausal osteoporosis or fractures . OBJECTIVE We assessed relations between postmenopausal hip fracture risk and calcium , vitamin D , and milk consumption . DESIGN In an 18-y prospect i ve analysis in 72 337 postmenopausal women , dietary intake and nutritional supplement use were assessed at baseline in 1980 and up date d several times during follow-up . We identified 603 incident hip fractures result ing from low or moderate trauma .  Relative risks ( RRs ) from proportional hazards models were controlled for other dietary and nondietary factors . RESULTS Women consuming > or = 12.5 microg vitamin D/d from food plus supplements had a 37 % lower risk of hip fracture ( RR = 0.63 ; 95 % CI : 0.42 , 0.94 ) than did women consuming < 3.5 microg/d . Total calcium intake was not associated with hip fracture risk ( RR = 0.96 ; 95 % CI : 0.68 , 1.34 for > or = 1200 compared with < 600 mg/d ) . Milk consumption was also not associated with a lower risk of hip fracture ( P for trend = 0.21 ) . CONCLUSIONS An adequate vitamin D intake is associated with a lower risk of osteoporotic hip fractures in postmenopausal women . Neither milk nor a high-calcium diet appears to reduce risk . Because women commonly consume less than the recommended intake of vitamin D , supplement use or dark fish consumption may be prudent BACKGROUND Prevalence of hypertension is greater in older adults , and increased intake of fruits , vegetables , and dairy-good sources of potassium , calcium , and magnesium-can reduce blood pressure . This study examined the hypertension-related dietary patterns of older adults . METHODS A cohort of 180 Pennsylvania adults ( aged > /=65 ) , 90 with hypertension , were r and omly selected from the Geisinger Rural Aging Study ( GRAS ) . Data were collected by trained interviewers at a home visit . Dietary assessment used five 24-h recalls . We compared the characteristics and dietary intake of people with hypertension to those without hypertension and compared their intakes to current recommendations . RESULTS Mean intakes of all participants were less than two thirds of the DRI for calcium and magnesium and fell far short of the 3,500 mg of potassium recommended for prevention and treatment of hypertension . Participants with hypertension consumed less sodium than controls . Both groups ate fewer fruits and vegetables than recommended but reached the dairy recommendation . Calcium intake was mainly from high-fat dairy products , beans were the top source of potassium and magnesium . CONCLUSIONS Older adults with hypertension should be guided to choose more low-fat dairy products and other low-fat calcium sources and to increase intakes of beans , dark green leafy vegetables , and other potassium and magnesium sources To determine the feasibility of increasing the calcium , protein and calorie intake of osteoporotic fracture patients by repeated dietary counselling delivered by a dietitian , a r and omized controlled trial was conducted . Among 189 patients presenting with osteoporotic fractures to an Orthopaedics and Traumatology Department of a large regional hospital , 98 patients were r and omized to the intervention group and 91 were r and omized to the control group ( with usual care ) . Intervention group received three sessions of dietary counselling with tailored made recommendations over a period of 4 months , while the control group only received dietary assessment and pamphlets on the prevention of osteoporosis . Almost all subjects in both intervention and control groups had calcium intake below the recommended level of 1000 mg at baseline . Half and 60 % of subjects in both groups had total energy and protein intake below recommended levels respectively . The mean weights of control and intervention groups at baseline were 51.5 and 50.9 kg respectively , while the body mass index ( BMI ) were 22.6 ( kg m(-2 ) ) and 22.6 ( kg m(-2 ) ) respectively . After dietary intervention , significant increase of intake was seen in calcium intake ( P = 0.0095 by t-test ) in the intervention group . No significant increase was seen in protein or calorie intake . No significant change was observed in the body weight or BMI although there was a positive trend in the intervention group for all these parameters . We concluded that there was general malnutrition in Chinese elderly who presented with osteoporotic fractures . Dietary calcium could be increased by repeated professional dietary counselling . Future studies with longer duration and more objective clinical outcomes will be helpful to further demonstrate the long-term effects of dietary intervention on osteoporosis and other chronic diseases OBJECTIVE To evaluate the effect of calcium supplementation on bone acquisition in adolescent white girls . DESIGN A r and omized , double-blind , placebo-controlled trial of the effect of 18 months of calcium supplementation on bone density and bone mass . SUBJECTS Ninety-four girls with a mean age of 11.9 + 0.5 years at study entry . SETTING University hospital in a small town . INTERVENTIONS Calcium supplementation , 500 mg/d calcium as calcium citrate malate ; controls received placebo pills . MAIN OUTCOME MEASURES Bone mineral density and bone mineral content of the lumbar spine and total body were measured by dual-energy x-ray absorptiometry and calcium excretion from 24-hour urine specimens . RESULTS Calcium intake from dietary sources averaged 960 mg/d for the entire study group . The supplemented group received , on average , an additional 354 mg/d of calcium . The supplemented group compared with the placebo group had greater increases of lumbar spine bone density ( 18.7 % vs 15.8 % ; P = .03 ) , lumbar spine bone mineral content ( 39.4 % vs 34.7 % ; P = .06 ) , total body bone mineral density ( 9.6 % vs 8.3 % ; P = .05 ) , and 24-hour urinary calcium excretion ( 90.4 vs 72.9 mg/d ; P = .02 ) , respectively . CONCLUSIONS Increasing daily calcium intake from 80 % of the recommended daily allowance to 110 % via supplementation with calcium citrate malate result ed in significant increases in total body and spinal bone density in adolescent girls . The increase of 24 g of bone gain per year among the supplemented group translates to an additional 1.3 % skeletal mass per year during adolescent growth , which may provide protection against future osteoporotic fracture Dietary data from a prospect i ve study were used to relate factors influencing calcium balance ( estimates of dietary calcium intake , protein intake from nondairy animal sources ( meat , fish , and eggs ) , and coffee consumption ) to the incidence of  hip fracture . During the years 1977 - 1983 , women and men born between 1925 and 1940 and living in one of three Norwegian counties were invited to a  cardiovascular screening that included a dietary survey . The attendance rate at screening was 91.1 % , and 90.7 % of these persons ( 19,752 women and 20,035 men ) filled in and returned a semiquantitative dietary question naire . This cohort was followed for an average of 11.4 years ( range , 0.01 - 13.8 years ) with respect to hip fracture , defined as cervical or trochanteric fracture . During follow-up , 213 hip fractures were identified , excluding fractures associated with high-energy trauma and metastatic bone disease . There was no clear association between  calcium intake or nondairy animal protein intake  and hip fracture in this cohort . However , an elevated risk of fracture was found in women with a high intake of protein from nondairy animal sources in the presence of low calcium intake ( relative risk = 1.96 ( 95 % confidence interval 1.09 - 3.56 ) for the highest quarter of nondairy protein intake and the lowest quarter of calcium intake vs. the three lower quarters of protein intake and the three higher quarters of calcium intake ) . Women who drank nine or more cups of coffee per day also had an increased risk of fracture , while there was no association between coffee consumption and hip fracture in men . Although these findings do not necessarily imply causal relations , they suggest the presence of risk factors for hip fracture that act through a negative calcium balance in this population BACKGROUND There is currently no consensus on the effect of dietary protein intake on the skeleton , but there is some indication that low calcium intakes adversely influence the effect of dietary protein on fracture risk . OBJECTIVE The objective of the present study was to determine whether supplemental calcium citrate malate and vitamin D influence any associations between  protein intake and change in bone mineral density ( BMD ) . DESIGN Associations between protein intake and change in BMD were examined in 342 healthy men and women ( aged > or = 65 y ) who had completed a 3-y , r and omized , placebo-controlled trial of calcium and vitamin D supplementation . Protein intake was assessed at the midpoint of the study with the use of a food-frequency question naire and  BMD  was assessed every 6 mo by dual-energy X-ray absorptiometry . RESULTS The mean ( + /-SD ) protein intake of all subjects was 79.1 + /- 25.6 g/d and the mean total calcium intakes of the supplemented and placebo groups were 1346 + /- 358 and 871 + /- 413 mg/d , respectively . Higher protein intake was significantly associated with a favorable 3-y change in total-body BMD in the supplemented group ( in a model containing terms for age , sex , weight , total energy intake , and dietary calcium intake ) but not in the placebo group . The pattern of change in femoral neck BMD with increasing protein intake in the supplemented group was similar to that for the total body . CONCLUSION Increasing protein intake may have a favorable effect on change in BMD in elderly subjects supplemented with calcium citrate malate and vitamin This study investigated the effect of calcium supplementation in preventing  bone stress injuries . Healthy male military recruits ( N = 1,398 ) served as subjects , of which 247 were r and omly allocated to an experimental group ( E ) while 1,151 served as a control group ( C ) . For 9 weeks both groups wore the same footwear and had the same physical training program . The baseline dietary intake of calcium in 50 r and omly selected subjects of each group was assessed using a 24-hr dietary record . The E group received a daily calcium supplement while the C group did not . Injuries were monitored in all subjects by a panel of doctors who followed specific diagnostic criteria . The mean weekly injury incidence for all overuse injuries , but specifically tibial stress syndrome and stress fractures , was similar in both groups . Mean baseline daily dietary calcium intake was above 800 mg in both subgroups . This study demonstrated that large-scale calcium supplementation ( 500 mg/day ) beyond usual dietary intake did not influence the risk of developing bone stress injuries during a 9-wk physical training program in these young military recruits The etiologic role of dietary calcium and vitamin D intake in primary prevention of  osteoporotic fractures is uncertain , despite considerable research efforts . With the aim to examine these associations with an improved precision , we used data from a large population -based prospect i ve cohort study in central Sweden . We estimated nutrient intake from a self-administered food-frequency question naire filled in by 60,689 women , aged 40 - 74 years at baseline during 1987 - 1990 . During follow-up , we observed 3986 women with a fracture at any site and 1535 with a hip fracture .  Rate ratio of fractures ( RR ) and 95 % CI were estimated using Cox proportional hazards models . We found no dose-response association between dietary calcium intake and fracture risk . The age-adjusted RR of hip fracture was 1.01 ( 95 % CI 0.96 - 1.06 ) per 300 mg calcium/day and the corresponding risk of any osteoporotic fracture was 0.99 ( 95 % CI 0.96 - 1.03 ) . Furthermore , women with an estimated calcium intake below 400 mg/day and those with a calcium intake higher than 1200 mg/day both had a similar age-adjusted hip fracture risk as those with intermediate calcium intakes : RR 1.07 ( 95 % CI 0.92 - 1.24 ) and RR 1.00 ( 95 % CI 0.79 - 1.27 ) , respectively . Vitamin D intake was not associated with fracture risk . Furthermore , women in the highest quintiles compared to the lowest quintiles of both calcium and vitamin D intake had an age-adjusted RR of 1.02 for all fractures ( 95 % CI 0.88 - 1.17 ) . Dietary calcium or vitamin D intakes estimated at middle and older age do not seem to be of major importance for the primary prevention of osteoporotic fractures in women OBJECTIVE The risk factors for fractures are incompletely understood . An outst and ing question concerns the optimal amount of dietary calcium needed to minimise the risk of fracture . DESIGN We examined the associations of dietary calcium and other nutrients with self-reported fracture risk in a prospect i ve cohort study . Nutrient intakes were estimated using a semi-quantitative food-frequency question naire administered at recruitment . SETTING The UK . PARTICIPANTS A total of 26 749 women and 7947 men aged 20 - 89 years . RESULTS Over an average of 5.2 years of follow-up , 1555 women and 343 men reported one or more fractures , 72 % of these result ing from a fall . Among women , fracture risk was higher at lower calcium intakes , with a relative risk of 1.75 ( 95 % confidence interval ( CI ) 1.33 - 2.29 ) among women with a calcium intake of < 525 mg day- 1 compared with women with a calcium intake of at least 1200 mg day- 1 ( test for linear trend , P < 0.001 ) . The association of  dietary calcium with fracture risk was stronger among women aged under 50 years at recruitment than among women aged 50 and above .  Dietary calcium intake was not associated with fracture risk in men . Fracture risk was not related to the dietary intake of any other nutrient examined . CONCLUSION In this population , women with a low dietary calcium intake had an increased risk of bone fracture , and this association was more marked among younger women than among older women BACKGROUND Increased dietary intake of calcium during childhood , usually as calcium in milk , is associated with increased bone mass in adulthood ; the increase in mass is important in modifying the later risk of fracture . Whether the increase is due to the calcium content of milk , however , is not certain . METHODS We conducted a three-year , double-blind , placebo-controlled trial of the effect of calcium supplementation ( 1000 mg of calcium citrate malate per day ) on bone mineral density in 70 pairs of identical twins ( mean [ + /- SD ] age , 10 + /- 2 years ; range , 6 to 14 ) . In each pair , one twin served as a control for the other ; 45 pairs completed the study .  Bone mineral density was measured by photon absorptiometry at two sites in the radius ( at base line , six months , and one , two , and three years ) and at three sites in the hip and in the spine ( at base line and three years ) . RESULTS The mean daily calcium intake of the twins given placebo was 908 mg , and that of the twins given calcium supplements was 1612 mg ( 894 mg from the diet and 718 mg from the supplement ) . Among the 22 twin pairs who were prepubertal throughout the study , the twins given supplements had significantly greater increases in bone mineral density at both radial sites ( mean difference in the increase in bone mineral density : midshaft radius , 5.1 percent [ 95 percent confidence interval , 1.5 to 8.7 percent ] ; distal radius , 3.8 percent [ 95 percent confidence interval , 1.4 to 6.2 percent ] ) and in the lumbar spine ( increase , 2.8 percent [ 95 percent confidence interval , 1.1 to 4.5 percent ] ) after three years ; the differences in the increases at two of three femoral sites approached significance ( Ward 's triangle in the femoral neck , 2.9 percent ; greater trochanter , 3.5 percent ) . Among the 23 pairs who went through puberty or were postpubertal , the twins given supplements received no benefit . CONCLUSIONS In prepubertal children whose average dietary intake of calcium approximated the recommended dietary allowance , calcium supplementation increased the rate of increase in bone mineral density . If the gain persists , peak bone density should be increased and the risk of fracture reduced Dietary supplements that prevent bone loss at the hip and that can be applied safely in the elderly are likely to reduce hip fractures . A daily dietary supplement of 750 mg calcium or 15 microg 25OH vitamin D3 on bone loss at the hip and other sites , bone turnover and calcium-regulating hormones were studied over 4 yr in elderly volunteers using a r and omized , double-blind , placebo-controlled trial . Bone mineral density ( BMD ) was measured by dual x-ray absorptiometry and bone structure by radiographs . Calcium biochemistry and bone turnover markers were measured in blood and urine . The 316 women entering the trial had a mean age of 73.7 yr and the 122 men of 75.9 yr . Baseline median calcium intake was 546 mg/day , and median serum 25OH vitamin D3 was 59 nmol/L. On placebo , loss of BMD at total hip was 2 % and femoral medulla expansion was 3 % over 4 yr . Calcium reduced bone loss , secondary hyperparathyroidism , and bone turnover . 25OH vitamin D3 was intermediate between placebo and calcium . Fracture rates and drop-out rates were similar among groups , and there were no serious adverse events with either supplement . A calcium supplement of 750 mg/day prevents loss of BMD , reduces femoral medullary expansion , secondary hyperparathyroidism , and high bone turnover . A supplement of 15 microg/day 25OH vitamin D3 is less effective , and because its effects are seen only at low calcium intakes , suggests that its beneficial effect is to reverse calcium insufficiency Abstract Objective To assess whether supplementation with calcium and cholecaliferol ( vitamin D3 ) reduces the risk of fracture in women with one or more risk factors for fracture of the hip . Design Pragmatic open r and omised controlled trial . Setting Practice nurse led clinics in primary care . Participants 3314 women aged 70 and over with one or more risk factors for hip fracture : any previous fracture , low body weight ( < 58 kg ) , smoker , family history of hip fracture , or fair or poor self reported health . Intervention Daily oral supplementation using 1000 mg calcium with 800 IU cholecaliferol and information leaflet on dietary calcium intake and prevention of falls , or leaflet only ( control group ) . Main outcome measures Primary outcome measure was all clinical fractures and secondary outcome measures were adherence to treatment , falls , and quality of life ( measured with the SF-12 ) . Results 69 % of the women who completed the follow-up question naire at 24 months were still taking supplements ( 55 % with inclusion of r and omised participants known to be alive ) . After a median follow-up of 25 months ( range 18 to 42 months ) , clinical fracture rates were lower than expected in both groups but did not significantly differ for all clinical fractures ( odds ratio for fracture in supplemented group 1.01 , 95 % confidence interval 0.71 to 1.43 ) . The odds ratio for hip fracture was 0.75 ( 0.31 to 1.78 ) . The odds of a woman having a fall at six and 12 months was 0.99 and 0.98 , respectively . Quality of life did not significantly differ between the groups . Conclusion We found no evidence that calcium and vitamin D supplementation reduces the risk of clinical fractures in women with one or more risk factors for hip fracture . Registration IS RCT N26118436 , controlled trials registry Background : To prevent pre-eclampsia in population s with insufficient dietary calcium ( Ca ) intake , the World Health Organisation ( WHO ) recommends routine Ca supplementation during antenatal care ( ANC ) . WHO guidelines suggest a complex dosing regimen , requiring as many as 5 pill-taking events per day when combined with iron and folic acid ( IFA ) supplements . Poor adherence may undermine public health effectiveness , so simpler regimens may be preferable . This trial will compare the effect of the WHO-recommended ( higher-dose ) regimen vs. a simpler , lower-dose regimen on supplement consumption and pill-taking behaviours in Kenyan ANC clients . Design and methods : This is a parallel , non-inferiority , cluster-r and omized trial ; we examined 16 primary care health facilities in Kenya , 1047 pregnant women between 16 - 30 weeks gestational age . Higher-dose regimen : 1.5 g elemental calcium in 3 separate doses ( 500 mg Ca/pill ) and IFA ( 60 mg Fe + 400 µg folic acid ) taken with evening dose . Lower-dose regimen : 1.0 g calcium in 2 separate doses ( 500 mg Ca/pill ) with IFA taken as above . Measurements : Primary outcome is Ca pills consumed per day , measured by pill counts . Secondary outcomes include IFA pills consumed per day , client knowledge , motivation , social support , and satisfaction , measured at 4 to 10 weeks post-enrolment . Statistical analyses : Unit of r and omization is the healthcare facility ; unit of analysis is individual client . Intent-to-treat analysis will be implemented with multi-level models to account for clustering . Expected public health impact : If pregnant women prescribed lower doses of Ca ingest as many pills as women prescribed the WHO-recommended regimen , developing a lower-dose recommendation for antenatal Ca and IFA supplementation programs could save re sources . Significance for public health Pre-eclampsia is a leading cause of maternal mortality . Based on clinical evidence of significant reduction in risk of pre-eclampsia , the WHO recommends including calcium ( Ca ) supplementation in antenatal care services in setting s with inadequate dietary Ca intakes . A high daily amount of Ca administered in a complex dosing regimen is recommended to maximize efficacy and bioavailability . Factors such as client adherence , motivation , cost and logistical complexities may undermine effectiveness when implemented in public health programs . This cluster-r and omized trial will compare Ca supplement consumption between higher and lower-dose regimens delivered through antenatal care in Kenya , integrated with iron-folic acid supplementation . If a lower-dose regimen improves adherence , women ’s Ca supplement consumption may be comparable to that achieved under a complex , higher-dose regimen . Evidence gained from this trial will guide public health planning for antenatal calcium supplementation programs to maximize benefits through reducing logistical , cost and adherence barriers The prevalence of vitamin D deficiency varies , with the groups at greatest risk including housebound , community-dwelling older and /or disabled people , those in residential care , dark-skinned people ( particularly those modestly dressed ) , and other people who regularly avoid sun exposure or work indoors . Most adults are unlikely to obtain more than 5%-10 % of their vitamin D requirement from dietary sources . The main source of vitamin D for people residing in Australia and New Zeal and is exposure to sunlight . A serum 25-hydroxyvitamin D ( 25-OHD ) level of ≥ 50 nmol/L at the end of winter ( 10 - 20 nmol/L higher at the end of summer , to allow for seasonal decrease ) is required for optimal musculoskeletal health . Although it is likely that higher serum 25-OHD levels play a role in the prevention of some disease states , there is insufficient evidence from r and omised controlled trials to recommend higher targets . For moderately fair-skinned people , a walk with arms exposed for 6 - 7 minutes mid morning or mid afternoon in summer , and with as much bare skin exposed as feasible for 7 - 40 minutes ( depending on latitude ) at noon in winter , on most days , is likely to be helpful in maintaining adequate vitamin D levels in the body . When sun exposure is minimal , vitamin D intake from dietary sources and supplementation of at least 600 IU ( 15 µg ) per day for people aged ≤ 70 years and 800 IU ( 20 µg ) per day for those aged > 70 years is recommended . People in high-risk groups may require higher doses . There is good evidence that vitamin D plus calcium supplementation  effectively reduces fractures and falls in older men and women BACKGROUND Increased dietary calcium intake has been proposed as a population -based public health intervention to prevent osteoporotic fractures . We have examined whether calcium supplementation decreases clinical fracture risk in elderly women and its mechanism of action . METHODS Five-year , double-blind , placebo-controlled study of 1460 women recruited from the population and older than 70 years ( mean age , 75 years ) who were r and omized to receive calcium carbonate , 600 mg twice per day , or identical placebo .  The primary end points included clinical incident osteoporotic fractures , vertebral deformity , and adverse events ascertained in 5 years . Bone structure was also measured using dual x-ray absorptiometry of the hip and whole body , quantitative ultrasonography of the heel , and peripheral quantitative computed tomography of the distal radius . RESULTS Among our patients , 16.1 % sustained 1 or more clinical osteoporotic fractures . In the intention-to-treat analysis , calcium supplementation did not significantly reduce fracture risk ( hazard ratio , 0.87 ; 95 % confidence interval , 0.67 - 1.12 ) . However , 830 patients ( 56.8 % ) who took 80 % or more of their tablets ( calcium or placebo ) per year had reduced fracture incidence in the calcium compared with the placebo groups ( 10.2 % vs 15.4 % ; hazard ratio , 0.66 ; 95 % confidence interval , 0.45 - 0.97 ) . Calcium-treated patients had improved quantitative ultrasonography findings of the heel , femoral neck and whole-body dual x-ray absorptiometry data , and bone strength compared with placebo-treated patients . Of the 92 000 adverse events recorded , constipation was the only event increased by the treatment ( calcium group , 13.4 % ; placebo group , 9.1 % ) . CONCLUSION Supplementation with calcium carbonate tablets supplying 1200 mg/d is ineffective as a public health intervention in preventing clinical fractures in the ambulatory elderly population owing to poor long-term compliance , but it is effective in those patients who are compliant Excess dietary proteins and " acid ash " diets have been suspected to increase the risk of osteoporosis , but experimental and epidemiological evidence is mixed . We aim ed to determine whether the association between protein intake and the overall acid-base equilibrium of the diet ( as renal net acid excretion [ RNAE ] estimate ) and fracture risk vary according to calcium intake . During an average of 8.37 + /- 1.73 yr of follow-up , 2408 women reported a fracture ( excluding high-impact trauma ) among 36,217 postmenopausal women from the E3N prospect i ve study . We used Cox regression models to study the interaction between calcium and , respectively , proteins and RNAE , from the 1993 dietary question naire for fracture risk determination , adjusting for potential confounders . There was no overall association between fracture risk and total protein or RNAE . However , in the lowest quartile of calcium ( < 400 mg/1000 kcal ) , high protein intake was associated with a significant increased fracture risk ( RR = 1.51 for highest versus lowest quartile ; 95 % CI , 1.17 - 1.94 ) . An increasing fracture risk with increasing animal protein intake was also observed ( trend , p < 0.0001 ) . A similar pattern of interaction for fracture risk was observed between RNAE and calcium . In this Western population of postmenopausal women with normal to high protein intake and fairly high calcium intake , there was no overall association between total protein or RNAE and fracture risk . However , there was some evidence that high protein-high acid ash diets were associated with an increased risk of fracture when calcium intake was low ( < 400 mg/1000 kcal ) OBJECTIVE To study the effect of calcium supplementation during pregnancy on blood pressure and maternal and neonatal outcomes . METHOD A total of 524 healthy primigravidas with a blood pressure less than 140/90 mm Hg were r and omly assigned between the 12th and 25th weeks to receive 2 g of elemental calcium or placebo and were followed-up until delivery . RESULTS The incidence of pre-eclampsia was significantly less in the calcium than in the placebo group ( 4.0 % vs 12.0 % ; odds ratio [ OR ] , 0.31 ; 95 % confidence interval [ CI ] , 0.15 - 0.63 ) ; the mean systolic and diastolic blood pressures at study completion were different in the calcium and placebo group ( P=0.007 and P=0.02 ) . The risk for preterm delivery was less in the calcium ( 7.0 % ) than in the placebo ( 12.7 % ) group ( OR , 0.51 ; 95 % CI , 0.28 - 0.93 ) . The mean baseline calcium intake was 313.83+/-203.25 mg/day ( range , 85.71 - 910.71 mg/day ) , which is lower than the recommended dietary intake of 1000 mg , and the 24-hour urinary calcium excretion was 130.82+/-67.44 mg/dL ( range , 40.5 - 387 mg/dL ) . CONCLUSION Calcium supplementation appears to reduce the occurrence of pre-eclampsia and preterm delivery in primigravidas who have a daily dietary calcium intake less than the recommended dietary allowances OBJECTIVE This study was made to : ( i ) identify the prevalence of low calcium intakes in a paediatric population with loosely defined ' milk allergy ' ; and ( ii ) assess long-term ( mean 21 months later ) changes in calcium intake following a single nutrition counselling session with those patients initially found to have a low intake . METHODOLOGY Calcium intake was assessed in a cross-sectional study of 58 patients ages 5 - 16 years ( mean 9.9 years ) with IgG radioallergosorbent test ( RAST ) class II or higher for cow 's milk protein . Those 31 patients found to have a low calcium intake were prospect ively re-evaluated 12 - 30 months later following a single nutrition counselling session . RESULTS  Calcium intake was < recommended dietary allowance ( RDA ) for 31 of 58 ( 53 % ) patients . The patient 's perception of their intake was unreliable ; 44 % of those who rated their calcium intake fair or good did not meet their RDA . Taking a calcium supplement did not ensure adequate intake ; 21 % of those taking supplements still did not meet their RDA . Milk intake predicted calcium intake ; 8 % of those who did not drink milk vs 68 % of those who did drink at least some milk met their RDA without supplementation . The 31 patients with low intakes received counselling and were re-evaluated at an average follow-up of nearly 2 years . Calcium intake was increased a mean of 360 mg/day and use of supplements increased from 10 to 52 % of the group . Despite these positive changes , 48 % still did not meet their RDA . CONCLUSION Limited milk intake is likely to be associated with suboptimal calcium intake . Efforts should be made to educate the family about the importance of calcium and its non-dairy sources . With many families repeated discussion s of this issue may be necessary to influence calcium intake The trial is conducted to evaluate the effects of calcium on bone mineral accretion in adolescents . 161 healthy adolescents aged of 9 to 20 year-old are recruited and are r and omly divided into experimental groups in which 300 mg Ca is supplemented per day for each participant and control group . The  dietary calcium , physical activity , SMR , distal one-third radial bone mineral content ( BMC ) , bone width ( BW ) , height , weight and serum total ALP are measured at both the beginning and the end of the trial . It is found that the average calcium intake from dietary sources is 500 mg/d in both groups . Increasing daily calcium intake via calcium supplementation in adolescents results in a moderate increases of BMC , and there is a significant increase of BMC in the females during the late adolescence . No significant differences in anthropometry are observed between the two groups at the end of the study while the increase of serum ALP level in the females in experiment group is significantly lower than that in the control group during the late adolescence . It is concluded that during the pubertal years when the BMC accretion is evident , there are no significant differences in bone mass accrual between the two groups . While in the females , calcium supplementation may help enhance the bone mineral accrual during late adolescence when the BMC accretion is remarkably reduced Background : Lung cancer is the leading cause of cancer death . Little is known about whether prediagnostic nutritional factors may affect survival . We examined the associations of prediagnostic calcium intake from foods and /or supplements with lung cancer survival . Methods : The present analysis included 23,882 incident , primary lung cancer patients from 12 prospect i ve cohort studies .  Dietary calcium intake was assessed using food-frequency question naires at baseline in each cohort and st and ardized to caloric intake of 2,000 kcal/d for women and 2,500 kcal/d for men . Stratified , multivariable-adjusted Cox regression was applied to compute hazard ratios ( HR ) and 95 % confidence intervals ( CI ) . Results : The 5-year survival rates were 56 % , 21 % , and 5.7 % for localized , regional , and distant stage lung cancer , respectively . Low prediagnostic dietary calcium intake ( < 500–600 mg/d , less than half of the recommendation ) was associated with a small increase in risk of death compared with recommended calcium intakes ( 800–1,200 mg/d ) ; HR ( 95 % CI ) was 1.07 ( 1.01–1.13 ) after adjusting for age , stage , histology , grade , smoking status , pack-years , and other potential prognostic factors . The association between low calcium intake and higher lung cancer mortality was evident primarily among localized/regional stage patients , with HR ( 95 % CI ) of 1.15 ( 1.04–1.27 ) . No association was found for supplemental calcium with survival in the multivariable-adjusted model . Conclusions : This large pooled analysis is the first , to our knowledge , to indicate that low prediagnostic dietary calcium intake may be associated with poorer survival among early-stage lung cancer patients . Impact : This multinational prospect i ve study linked low calcium intake to lung cancer prognosis . Cancer Epidemiol Biomarkers Prev ; 26(7 ) ; 1060–70 . © 2017 AACR For a 50-year old caucasian woman today , the risk of a hip fracture over her remaining lifetime is about 17 % . Tomorrow the situation will clearly be worse because the continual increase in life expectancy will cause a 3-fold rise in worldwide fracture incidence over the next 60 years , particularly in women , but also in men . In addition , a secular increase in the incidence of hip fractures in individuals of the same age has been noted in both sexes by several investigators , and the cost of hip fractures is expected to dramatically increase in the next decades . Consequently , preventive strategies are urgently required . A great deal has been learned in recent years about the risk factors for hip fracture , the pathophysiology of this fracture , and the prediction of fracture risk , particularly through bone mass measurements on the hip and biochemical evaluations of parathyroid and vitamin D status . The two main determinants of hip fractures are falls and bone loss leading to an intrinsic femoral fragility . A substantial femoral bone loss continues throughout the old age , with a continuous and exponential increase in the risk of hip fracture , and any reduction or arrest of this loss will induce an important reduction in the incidence of hip fractures . A preventive effect on the risk of hip fracture may be partly achieved by using long term estrogen replacement therapy after menopause , but also by using vitamin D and calcium supplements for a late prevention in elderly people .  Vitamin D insufficiency and deficit in calcium intake are very common in elderly people living either in institutions or at home , particularly in Europe where dairy products are not fortified with vitamin D. The cumulative response to this deficit in calcium intake and low vitamin D status is a negative calcium balance which stimulates parathyroid hormone secretion . In 300 residents of nursing homes , we recently found a significant negative correlation between serum 25 OHD and log serum PTH after age-adjustment . In addition , in 446 elderly women living at home in 5 French cities and selected from the voting lists , we also found an age-adjusted relationship between serum 25 OHD and PTH concentrations . This senile secondary hyperparathyroidism is one of the determinants of femoral bone loss and can be reversed by calcium and vitamin D supplements . We have shown in a 3-year controlled prospect i ve study that the daily use of these supplements ( 1.2 g of calcium and 800 IU of vitamin D3 ) given in a large population of 3270 elderly ambulatory women living in nursing homes reduced of 23 % ( intention-to-treat analysis ) the number of hip fractures and other non vertebral fractures . In parallel , serum perathyroid hormone concentration was reduced of 28 % and low serum 25-hydroxyvitamin D concentration returned to normal values . After 18 months of treatment the bone density of the total proximal femoral region had increased 2.7 % the vitamin D3-calcium group and decreased 4.6 % in the placebo group ( p < 0.001 ) . This prevention is safe and can be recommended in people living in institutions . It could be also useful in other elderly subjects particularly at risk because of a low calcium intake , an absence of solar exposure and a previous history of falls . From the data of our study we assessed the economic consequences in terms of medical cost of this prevention . In case of treatment of all women living in nursing homes in France , this would saved FF 150000000 per year , the economic balance of prevention becoming positive as soon as the age of the beginning of the prevention reaches 73.5 years . It is now possible to partly stop bone loss in elderly people and it is never too late to prevent hip fractures with calcium and vitamin D supplements
CONCLUSIONS Dietary calcium intake is not associated with risk of fracture , and there is no clinical trial evidence that increasing calcium intake from dietary sources prevents fractures .
OBJECTIVE To examine the evidence underpinning recommendations to increase calcium intake through dietary sources or calcium supplements to prevent fractures .