There was no effect of calcium supplementation  on femoral neck or lumbar spine BMD .
There was no evidence of effect modification by baseline calcium intake , sex , ethnicity , physical activity or pubertal stage .
While there is a small effect of calcium supplementation in the upper limb , the increase in BMD which results is unlikely to result in a clinical ly significant decrease in fracture risk .
The results do not support the use of calcium supplementation  in healthy children as a public health intervention .
These results can not be extrapolated to children with medical conditions affecting bone metabolism
BACKGROUND Clinical trials have shown that  calcium supplementation in children can increase  bone mineral density ( BMD ) although this effect may not be maintained .
There has been no quantitative systematic review of this intervention .
To determine the effectiveness of calcium supplementation for improving BMD  in children .
.
To determine if any effect varies by sex , pubertal stage , ethnicity or level of physical activity , and if any effect persists after supplementation is ceased .
Skeletal effects and functional outcome with olpadronate in children with osteogenesis imperfecta: a 2-year randomised placebo-controlled study
BACKGROUND Non-r and omised studies have suggested beneficial effects of bisphosphonates in osteogenesis imperfecta . We assessed the effects of oral olpadronate in children with this disorder in a r and omised double-blind placebo-controlled trial . METHODS 34 children recruited from the Dutch national centre for osteogenesis imperfecta were r and omly assigned olpadronate ( 10 mg/m2 daily ; n=16 ) or placebo ( n=18 ) for 2 years . All children also received calcium and vitamin D supplements . Primary endpoints were incident fractures of long bones and changes in bone mineral content ( BMC ) , bone mineral density ( BMD ) , and functional outcome . Anthropometry , vertebral height , and urinary markers of bone resorption were also studied . Analyses were by intention to treat . FINDINGS Fracture follow-up was complete for all the children , including two who withdrew from the study ( one from each group ) . Olpadronate treatment was associated with a 31 % reduction in relative risk of fracture of long bones ( hazard ratio 0.69 [ 95 % CI 0.52 - 0.91 ] , p=0.01 ) . The olpadronate group showed significantly greater increases than the placebo group in spinal BMC ( difference between groups 2.24 g/year [ 0.20 - 4.29 ] , p=0.03 ) and spinal BMD ( difference between groups 0.054 g/cm2 per year [ 0.012 - 0.096 ] , p=0.01 ) . There were no detectable effects on functional outcome , anthropometrics , or vertebral height and no differences between the groups in changes in urinary markers of bone resorption . INTERPRETATION Oral treatment with olpadronate at a daily dose of 10 mg/m2 results in a reduction of fracture risk of long bones in children with osteogenesis imperfecta . However , the issue of whether bisphosphonates will alter the natural course of osteogenesis imperfecta remains unresolved , and further studies are needed
There was no effect of calcium supplementation  on femoral neck or lumbar spine BMD .
There was no evidence of effect modification by baseline calcium intake , sex , ethnicity , physical activity or pubertal stage .
While there is a small effect of calcium supplementation in the upper limb , the increase in BMD which results is unlikely to result in a clinical ly significant decrease in fracture risk .
The results do not support the use of calcium supplementation  in healthy children as a public health intervention .
These results can not be extrapolated to children with medical conditions affecting bone metabolism
BACKGROUND Clinical trials have shown that  calcium supplementation in children can increase  bone mineral density ( BMD ) although this effect may not be maintained .
There has been no quantitative systematic review of this intervention .
To determine the effectiveness of calcium supplementation for improving BMD  in children .
.
To determine if any effect varies by sex , pubertal stage , ethnicity or level of physical activity , and if any effect persists after supplementation is ceased .