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2015 ; 351
(ä): h4580
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Calcium intake and risk of fracture: systematic review
#MMPMID26420387
Bolland MJ
; Leung W
; Tai V
; Bastin S
; Gamble GD
; Grey A
; Reid IR
BMJ
2015[Sep]; 351
(ä): h4580
PMID26420387
show ga
OBJECTIVE: To examine the evidence underpinning recommendations to increase
calcium intake through dietary sources or calcium supplements to prevent
fractures. DESIGN: Systematic review of randomised controlled trials and
observational studies of calcium intake with fracture as an endpoint. Results
from trials were pooled with random effects meta-analyses. DATA SOURCES: Ovid
Medline, Embase, PubMed, and references from relevant systematic reviews. Initial
searches undertaken in July 2013 and updated in September 2014. ELIGIBILITY
CRITERIA FOR SELECTING STUDIES: Randomised controlled trials or cohort studies of
dietary calcium, milk or dairy intake, or calcium supplements (with or without
vitamin D) with fracture as an outcome and participants aged >50. RESULTS: There
were only two eligible randomised controlled trials of dietary sources of calcium
(n=262), but 50 reports from 44 cohort studies of relations between dietary
calcium (n=37), milk (n=14), or dairy intake (n=8) and fracture outcomes. For
dietary calcium, most studies reported no association between calcium intake and
fracture (14/22 for total, 17/21 for hip, 7/8 for vertebral, and 5/7 for forearm
fracture). For milk (25/28) and dairy intake (11/13), most studies also reported
no associations. In 26 randomised controlled trials, calcium supplements reduced
the risk of total fracture (20 studies, n=58,573; relative risk 0.89, 95%
confidence interval 0.81 to 0.96) and vertebral fracture (12 studies, n=48,967.
0.86, 0.74 to 1.00) but not hip (13 studies, n=56,648; 0.95, 0.76 to 1.18) or
forearm fracture (eight studies, n=51,775; 0.96, 0.85 to 1.09). Funnel plot
inspection and Egger's regression suggested bias toward calcium supplements in
the published data. In randomised controlled trials at lowest risk of bias (four
studies, n=44,505), there was no effect on risk of fracture at any site. Results
were similar for trials of calcium monotherapy and co-administered calcium and
vitamin D. Only one trial in frail elderly women in residential care with low
dietary calcium intake and vitamin D concentrations showed significant reductions
in risk of fracture. 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. Evidence that calcium supplements
prevent fractures is weak and inconsistent.
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