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 .
Use of Clinical Risk Factors in Elderly Women with Low Bone Mineral Density to Identify Women at Higher Risk of Hip Fracture: The EPIDOS Prospective Study

Abstract : Elderly women with very low bone mineral density ( BMD ) ( T-score ≤−3.5 ) have a risk of hip fracture more than two times higher than the average risk of women of the same age . Using data from the EPIDOS prospect i ve study , we have shown that by measuring BMD on the 50 % of women who have the lowest weight , it is possible to identify the majority of these women at higher risk . In the present analysis , we assessed whether the use of clinical risk factors , in the subset of women selected for osteodensitometry and with moderately low BMD ( T-score between −3.5 and −2.5 ) , allows the identification of another subgroup of women with a risk 2 times higher than average and , thereby , increases the efficiency of selective BMD screening . We then assessed the discriminant value for hip fracture of the overall screening strategy ( i.e. , use of weight to select women for osteodensitometry , then use of clinical risk factors to enhance the predictive value of BMD ) , and compared it with the value of BMD used as a population screening tool . In total , 6933 EPIDOS participants , aged 75 years or above , were included in this analysis . Using Cox regression models , we first determined which baseline factors were most predictive of hip fracture among the 1588 women with weight below median ( selection criteria for osteodensitometry in the proposed strategy ) and T-score between −3.5 and −2.5 . Based on the relative risk ( RR ) estimates from the final risk function , we calculated an individual risk score for hip fracture . We assessed the incidence of hip fracture for each value of the score , and determined the cutoff to identify women with a risk about 2 times higher than the average risk in this elderly cohort . The overall screening strategy ( i.e. , selective BMD measurement based on weight , followed by clinical fracture risk assessment ) identifies two subgroups of higher risk women : a group with very low BMD ( T-score ≤–3.5 ) , and another group with moderately low BMD ( T-score between –3.5 and –2.5 ) but a high fracture risk score . We calculated the total number of women classified as being at high risk , and assessed the overall sensitivity and specificity of this strategy to identify elderly women who will suffer a hip fracture  . Among women with weight below median and T-score between −3.5 and −2.5 , the factors most predictive of the risk of hip fracture were age , history of fall , ability to do the t and em walk ( test of dynamic balance ) , gait speed and visual acuity . A simple additive score based on these factors ( except visual acuity ) allows a high-risk group ( risk about 2 times higher than average ) to be clearly distinguished from a low-risk group ( risk below average ) . Overall , the proposed strategy identifies approximately 15 % of the women in the cohort as being at high risk , i.e. , 543 women with T-score ≤−3.5 and 503 women with −3.5 < T-score ≤−2.5 and a high fracture risk score . The sensitivity for hip fracture is equal to 37 % and the specificity to 85 % , which is equivalent to the discriminant value of BMD as a population screening tool . In elderly women , the use of a simple clinical risk score , in women with previous BMD values , allows the number of high-risk women identified to be increased . Overall , the proposed screening strategy ( use of weight to select women for osteodensitometry , and then use of clinical risk factors to enhance the predictive value of BMD ) has the same discriminant value for hip fracture as BMD used as a population screening tool
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 .