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Calcium and Vitamin D May Not Prevent Fractures

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Updated May 19, 2014

Two studies from the UK suggest that calcium and vitamin D are not effective for preventing fractures. These studies were published in the British Medical Journal and The Lancet.

Both studies involved thousands of elderly people over the age of 70 who were at high risk for bone fractures. In each study, the treatment group was given calcium and vitamin D, along with advice on reducing their risks of falling. The control groups were only given the advice to reduce their risks of falling.

The results showed that overall, the incidence rate of fractures was less than what was expected for all participants, but there was no difference in the rates of fractures between the control and the treatment groups.

Does this mean that calcium and vitamin D don't work? Not really. The compliance by subjects declined to 63 percent and even lower after two years. This means several people didn't take the supplements properly.

Another interesting point is that all the participants were given advice on how to limit their risk of falling. This advice was apparently successful, since the fracture rates were lower than expected for all the participants of the studies. These confounding factors may skew the results a bit.

Despite the flaws, these studies show that calcium and vitamin D alone may not be sufficient to reduce the risk of fractures in high-risk elderly people. So prescription medications may be necessary to stop bone loss.

This does not mean that calcium and vitamin D are not important for treatment or prevention of osteoporosis. In fact, all nutritional treatments for osteoporosis include calcium and vitamin D (either in the form of vitamin D2 or vitamin D3).

Although a few individual randomized studies showed no reduction of the risk for bone fractures with daily doses of calcium and vitamin D, recent systematic analysis of all published randomized trials suggest that these supplements may reduce the number of fractures and the loss of bone in people who take them every day.

Other important nutrients for the treatment or prevention of osteoporosis include vitamin B12, magnesium and vitamin K.

Lifestyle changes are also needed for successful treatment or prevention of osteoporosis. Those changes include cessation of smoking, reduction of caffeine and alcohol, eating a healthy diet and lifting weights.

Getting Enough Calcium

Rather than waiting until your bones begin to lose too much density, you may wish to take some steps to prevent weak bones and osteoporosis. Here are some tips:
  • Take calcium. You should get at least 1,200 milligrams of calcium per day. Studies show that the calcium from dairy products is the most absorbable form of dietary calcium. However you can also get calcium from anchovies, salmon (with bones), and calcium-fortified foods. If you don't get enough calcium from your diet, take a calcium supplement.
  • Eat fruits and vegetables. They supply your body with nutrients and prevent calcium loss in bones.
  • Choose fish more often. Fish is a great source of protein, omega-3 fatty acids and eating fish has been associated with having healthy bones.
  • Watch the caffeine. Caffeine may be linked to calcium loss from bones, so limit your intake of caffeinated beverages.
  • Get enough vitamin D. Your body needs vitamin D to be able to absorb calcium. Your body makes normally makes vitamin D after exposure to the sun. You don't need to be a sun worshipper; just spending a few minutes outside every day is enough. You may also take 800 IU vitamin D as a supplement.
  • Don't smoke. There are so many reasons not to smoke, and this is just another one. Smoking leads to an increase in the risk of bone fractures. If you smoke, you need to quit. If you don't smoke, don't start.
  • Get some exercise. Resistive exercise, like weight lifting, is essential for strong bones. Weight lifting puts stress on your bones, but this type of stress is good because it keeps your bones strong.
Notice how most of these tips are important for good health in general and not just for keeping your bones strong? Exercise and a balanced diet will keep your cardiovascular system (and the rest of your body) healthy too.

Sources:

Grant AM, Avenell A, Campbell MK, McDonald AM, MacLennan GS, McPherson GC, Anderson FH, Cooper C, Francis RM, Donaldson C, Gillespie WJ, Robinson CM, Torgerson DJ, Wallace WA; RECORD Trial Group. "Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial." Lancet. 2005 May 7-13;365(9471):1621-8.

Kamel HK. "Postmenopausal osteoporosis: etiology, current diagnostic strategies, and nonprescription interventions." J Manag Care Pharm. 2006 Jul;12.

Kitchin B, Morgan SL. "Not just calcium and vitamin D: other nutritional considerations in osteoporosis." Curr Rheumatol Rep. 2007 Apr;9(1):85-92.

Porthouse J, Cockayne S, King C, Saxon L, Steele E, Aspray T, Baverstock M, Birks Y, Dumville J, Francis R, Iglesias C, Puffer S, Sutcliffe A, Watt I, Torgerson DJ. "Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care." BMJ. 2005 Apr 30;330(7498):1003.

Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. "Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis." Lancet. 2007 Aug 25;370(9588):657-66.

Wong PK, Christie JJ, Wark JD. "The effects of smoking on bone health." Clin Sci (Lond). 2007 Sep;113(5):233-41.

Weaver CM. "Calcium bioavailability and its relation to osteoporosis." Proc Soc Exp Biol Med. 1992 Jun;200(2):157-60.

Zalloua PA, Hsu YH, Terwedow H, Zang T, Wu D, Tang G, Li Z, Hong X, Azar ST, Wang B, Bouxsein ML, Brain J, Cummings SR, Rosen CJ, Xu X. "Impact of seafood and fruit consumption on bone mineral density." Maturitas. 2007 Jan 20;56(1):1-11. Epub 2006 Jun 27.

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