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 .
Prediction of absolute risk of non-spinal fractures using clinical risk factors and heel quantitative ultrasound
Summary The relationship between osteoporosis risk factors , bone quantitative ultrasound ( QUS ) and non-spinal fracture risk was estimated in a cohort of 5,201 postmenopausal women from Spain who were prospect ively evaluated during three years . Several clinical risk factors and low heel QUS values were independently associated with non-spinal fracture risk . Introduction Low-trauma , non-spinal fractures are a growing source of morbidity and mortality in the elderly . The aim of the present study was to examine the association of heel  quantitative ultrasound ( QUS ) and a series of osteoporosis and fracture risk factors , with incident low energy non-spinal fractures in a population of elderly women , and to incorporate them into fracture prediction models . Methods 5,201 women aged 65 or older were enrolled in a three-year cohort study . Participants completed an osteoporosis and fracture risk factors question naire . QUS was measured at the heel with a gel-coupled device . Cox-proportional hazard analyses were performed to evaluate the association with the first incident low-trauma non-spinal fracture . Results Three hundred and eleven women ( 6.0 % ) sustained a total of 363 low-trauma fractures , including 133 forearm/wrist , 54 hip , 50 humerus , 37 leg and 17 pelvic fractures . For every st and ard deviation decrease in the quantitative ultrasound index , the adjusted hazard ratios ( 95 % CI ) for any non-vertebral , hip , forearm/wrist , and humerus fractures were 1.31 ( 1.15–1.49 ) , 1.40 ( 1.01–1.95 ) , 1.50 ( 1.19–1.89 ) and 1.35 ( 0.97–1.87 ) , respectively . Similar results were observed with other QUS variables . The best predictive models indicated that age , a history of falls , a previous low-trauma fracture , a family history of fracture , a calcium intake from dairy products of less than 250 mg/day , and lower values of QUS parameters were independently associated with the risk of non-spinal fractures . Conclusions Both clinical risk factors and QUS are independent predictors of risk of fragility non-spinal fractures . A prediction algorithm using these variables was developed to estimate the absolute risk of non-spinal fractures in elderly women in Spain
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 .