Randomized controlled trial of the effects of calcium with or without vitamin D on bone structure and bone-related chemistry in elderly women with vitamin D insufficiency

Kun Zhu, David Bruce, Nicole Austin, A. Devine, P.R. Ebeling, Richard Prince

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Abstract

There are few data on the relative effects of calcium supplementation with or without extra vitamin D on BMD in patients selected for low vitamin 0 status. The aim of this study is to evaluate the relative importance of vitamin D and calcium treatment on BMD and bone-related chemistry in elderly women with vitamin D insufficiency. Three hundred two elderly women (age, 77.2 +/- 4.6 yr) with serum 25(OH)D concentrations < 60 nM participated in a 1-yr randomized, double-blind, placebo-controlled trial. All subjects received 1000 mg calcium citrate per day with either 1000 IU ergocalciferol (vitamin 132) oridentical placebo (control). The effects of time and time treatment interactions were evaluated by repeated-measures ANOVA. At baseline, calcium intake was 1100 mg/d, and 25(OH)D was 44.3 +/- 12.9 nM; this increased in the vitamin D group by 34% but not the control group after 1 year (59.8 +/- 13.8 versus 45.0 +/- 13.3 nM, p < 0.001). Total hip and total body BMD increased significantly, and procollagen type I intact N-terminal propeptide (PINP) decreased during the study with no difference between the treatment groups (hip BMD change: vitamin D, +0.5%; control, +0.2%; total body BMD change: vitamin D, +0.4%; control, +0.4%; PINP change: vitamin D, -3.9%; placebo, -2.8%). Although the fasting plasma and urine calcium increased in both groups equally, there was no detectable change in serum PTH. The increase in 25(OH)D achieved with vitamin D supplementation had no extra effect on active fractional intestinal calcium absorption, which fell equally in both groups (vitamin D, -17.4%; control, -14.8%). In patients with a baseline calcium intake of 1100 mg/d and vitamin D insufficiency, vitamin D-2 1000 IU for 1 year has no extra beneficial effect on bone structure, bone formation markers, or intestinal calcium absorption over an additional 1000 mg of calcium. Vitamin D supplementation adds no extra short-term skeletal benefit to calcium citrate supplementation even in women with vitamin D insufficiency.
Original languageEnglish
Pages (from-to)1343-1348
JournalJournal of Bone and Mineral Research
Volume23
Issue number8
DOIs
Publication statusPublished - 2008

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Vitamin D
Randomized Controlled Trials
Calcium
Bone and Bones
Calcium Citrate
Ergocalciferols
Intestinal Absorption
Placebos
Collagen Type I
Vitamins
Hip
Serum
Osteogenesis
Fasting
Analysis of Variance
Therapeutics
Urine
Control Groups

Cite this

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title = "Randomized controlled trial of the effects of calcium with or without vitamin D on bone structure and bone-related chemistry in elderly women with vitamin D insufficiency",
abstract = "There are few data on the relative effects of calcium supplementation with or without extra vitamin D on BMD in patients selected for low vitamin 0 status. The aim of this study is to evaluate the relative importance of vitamin D and calcium treatment on BMD and bone-related chemistry in elderly women with vitamin D insufficiency. Three hundred two elderly women (age, 77.2 +/- 4.6 yr) with serum 25(OH)D concentrations < 60 nM participated in a 1-yr randomized, double-blind, placebo-controlled trial. All subjects received 1000 mg calcium citrate per day with either 1000 IU ergocalciferol (vitamin 132) oridentical placebo (control). The effects of time and time treatment interactions were evaluated by repeated-measures ANOVA. At baseline, calcium intake was 1100 mg/d, and 25(OH)D was 44.3 +/- 12.9 nM; this increased in the vitamin D group by 34{\%} but not the control group after 1 year (59.8 +/- 13.8 versus 45.0 +/- 13.3 nM, p < 0.001). Total hip and total body BMD increased significantly, and procollagen type I intact N-terminal propeptide (PINP) decreased during the study with no difference between the treatment groups (hip BMD change: vitamin D, +0.5{\%}; control, +0.2{\%}; total body BMD change: vitamin D, +0.4{\%}; control, +0.4{\%}; PINP change: vitamin D, -3.9{\%}; placebo, -2.8{\%}). Although the fasting plasma and urine calcium increased in both groups equally, there was no detectable change in serum PTH. The increase in 25(OH)D achieved with vitamin D supplementation had no extra effect on active fractional intestinal calcium absorption, which fell equally in both groups (vitamin D, -17.4{\%}; control, -14.8{\%}). In patients with a baseline calcium intake of 1100 mg/d and vitamin D insufficiency, vitamin D-2 1000 IU for 1 year has no extra beneficial effect on bone structure, bone formation markers, or intestinal calcium absorption over an additional 1000 mg of calcium. Vitamin D supplementation adds no extra short-term skeletal benefit to calcium citrate supplementation even in women with vitamin D insufficiency.",
author = "Kun Zhu and David Bruce and Nicole Austin and A. Devine and P.R. Ebeling and Richard Prince",
year = "2008",
doi = "10.1359/JBMR.080327",
language = "English",
volume = "23",
pages = "1343--1348",
journal = "Journal of Bone & Mineral Research",
issn = "0884-0431",
publisher = "John Wiley & Sons",
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TY - JOUR

T1 - Randomized controlled trial of the effects of calcium with or without vitamin D on bone structure and bone-related chemistry in elderly women with vitamin D insufficiency

AU - Zhu, Kun

AU - Bruce, David

AU - Austin, Nicole

AU - Devine, A.

AU - Ebeling, P.R.

AU - Prince, Richard

PY - 2008

Y1 - 2008

N2 - There are few data on the relative effects of calcium supplementation with or without extra vitamin D on BMD in patients selected for low vitamin 0 status. The aim of this study is to evaluate the relative importance of vitamin D and calcium treatment on BMD and bone-related chemistry in elderly women with vitamin D insufficiency. Three hundred two elderly women (age, 77.2 +/- 4.6 yr) with serum 25(OH)D concentrations < 60 nM participated in a 1-yr randomized, double-blind, placebo-controlled trial. All subjects received 1000 mg calcium citrate per day with either 1000 IU ergocalciferol (vitamin 132) oridentical placebo (control). The effects of time and time treatment interactions were evaluated by repeated-measures ANOVA. At baseline, calcium intake was 1100 mg/d, and 25(OH)D was 44.3 +/- 12.9 nM; this increased in the vitamin D group by 34% but not the control group after 1 year (59.8 +/- 13.8 versus 45.0 +/- 13.3 nM, p < 0.001). Total hip and total body BMD increased significantly, and procollagen type I intact N-terminal propeptide (PINP) decreased during the study with no difference between the treatment groups (hip BMD change: vitamin D, +0.5%; control, +0.2%; total body BMD change: vitamin D, +0.4%; control, +0.4%; PINP change: vitamin D, -3.9%; placebo, -2.8%). Although the fasting plasma and urine calcium increased in both groups equally, there was no detectable change in serum PTH. The increase in 25(OH)D achieved with vitamin D supplementation had no extra effect on active fractional intestinal calcium absorption, which fell equally in both groups (vitamin D, -17.4%; control, -14.8%). In patients with a baseline calcium intake of 1100 mg/d and vitamin D insufficiency, vitamin D-2 1000 IU for 1 year has no extra beneficial effect on bone structure, bone formation markers, or intestinal calcium absorption over an additional 1000 mg of calcium. Vitamin D supplementation adds no extra short-term skeletal benefit to calcium citrate supplementation even in women with vitamin D insufficiency.

AB - There are few data on the relative effects of calcium supplementation with or without extra vitamin D on BMD in patients selected for low vitamin 0 status. The aim of this study is to evaluate the relative importance of vitamin D and calcium treatment on BMD and bone-related chemistry in elderly women with vitamin D insufficiency. Three hundred two elderly women (age, 77.2 +/- 4.6 yr) with serum 25(OH)D concentrations < 60 nM participated in a 1-yr randomized, double-blind, placebo-controlled trial. All subjects received 1000 mg calcium citrate per day with either 1000 IU ergocalciferol (vitamin 132) oridentical placebo (control). The effects of time and time treatment interactions were evaluated by repeated-measures ANOVA. At baseline, calcium intake was 1100 mg/d, and 25(OH)D was 44.3 +/- 12.9 nM; this increased in the vitamin D group by 34% but not the control group after 1 year (59.8 +/- 13.8 versus 45.0 +/- 13.3 nM, p < 0.001). Total hip and total body BMD increased significantly, and procollagen type I intact N-terminal propeptide (PINP) decreased during the study with no difference between the treatment groups (hip BMD change: vitamin D, +0.5%; control, +0.2%; total body BMD change: vitamin D, +0.4%; control, +0.4%; PINP change: vitamin D, -3.9%; placebo, -2.8%). Although the fasting plasma and urine calcium increased in both groups equally, there was no detectable change in serum PTH. The increase in 25(OH)D achieved with vitamin D supplementation had no extra effect on active fractional intestinal calcium absorption, which fell equally in both groups (vitamin D, -17.4%; control, -14.8%). In patients with a baseline calcium intake of 1100 mg/d and vitamin D insufficiency, vitamin D-2 1000 IU for 1 year has no extra beneficial effect on bone structure, bone formation markers, or intestinal calcium absorption over an additional 1000 mg of calcium. Vitamin D supplementation adds no extra short-term skeletal benefit to calcium citrate supplementation even in women with vitamin D insufficiency.

U2 - 10.1359/JBMR.080327

DO - 10.1359/JBMR.080327

M3 - Article

VL - 23

SP - 1343

EP - 1348

JO - Journal of Bone & Mineral Research

JF - Journal of Bone & Mineral Research

SN - 0884-0431

IS - 8

ER -