title: Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Combined Calcium and Vitamin D3 Supplementation in Elderly Women: Confirmation of Reversal of Secondary Hyperparathyroidism and Hip Fracture Risk: The Decalyos II Study Prediction of absolute risk of non-spinal fractures using clinical risk factors and heel quantitative ultrasound Risk factors for proximal humerus, forearm, and wrist fractures in elderly men and women: the Dubbo Osteoporosis Epidemiology Study. Effect of calcium supplementation on fracture risk: a double-blind randomized controlled trial. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study DIETARY CALCIUM AND RISK OF HIP FRACTURE: 14-YEAR PROSPECTIVE POPULATION STUDY Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: the OFELY study. The effect of calcium citrate on bone density in the early and mid-postmenopausal period: a randomized placebo-controlled study. Calcium supplements for the prevention of colorectal adenomas. Calcium Polyp Prevention Study Group. Risk factors for fracture in nonosteoporotic men and women. Dietary calcium and hip fracture risk: The NHANES I Epidemiologic Follow-Up Study Health risks and benefits from calcium and vitamin D supplementation: Women's Health Initiative clinical trial and cohort study Calcium, vitamin D and anabolic steroid in treatment of aged bones: double-blind placebo-controlled long-term clinical trial. Incidence and risk factors for osteoporotic vertebral fracture in low-income community-dwelling elderly: a population-based prospective cohort study in Brazil. The São Paulo Ageing & Health (SPAH) Study Diet and hip fractures among elderly Europeans in the EPIC cohort Gender-specific associations between soy and risk of hip fracture in the Singapore Chinese Health Study. Dietary calcium, physical activity, and risk of hip fracture: a prospective study. Dietary and supplemental calcium intake and cardiovascular disease mortality: the National Institutes of Health-AARP diet and health study. Proteins, dietary acid load, and calcium and risk of postmenopausal fractures in the E3N French women prospective study. Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care Protective association of milk intake on the risk of hip fracture: results from the Framingham Original Cohort. Does increased sunlight exposure work as a strategy to improve vitamin D status in the elderly: a cluster randomised controlled trial Two-year randomized controlled trial of vitamin K1 (phylloquinone) and vitamin D3 plus calcium on the bone health of older women. Diet, smoking and anthropometric indices and postmenopausal bone fractures: a prospective study. Effect of calcium or 25OH vitamin D3 dietary supplementation on bone loss at the hip in men and women over the age of 60. Calcium, diet and fracture risk: a prospective study of 1898 incident fractures among 34 696 British women and men. 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
   Risk Factors for Perimenopausal Distal Forearm Fracture Correcting calcium nutritional deficiency prevents spine fractures in elderly women. Independent predictors of all osteoporosis-related fractures among healthy Saudi postmenopausal women: the CEOR Study. Exercise and Other Factors in the Prevention of Hip Fracture: The Leisure World Study Calcium plus vitamin D supplementation and the risk of fractures. Risk factors for hip fracture in white men: the NHANES I Epidemiologic Follow-up Study. False alarms and pseudo-epidemics: the limitations of observational epidemiology. Predictors of non-spine fracture in elderly men: the MrOS study. Endogenous sex hormones and incident fracture risk in older men: the Dubbo Osteoporosis Epidemiology Study. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial Use of Calcium Supplements, Vitamin D Supplements and Specific Osteoporosis Drugs Among French Women Aged 75–85 Years: Patterns of Use and Associated Factors Ten-year risk of osteoporotic fractures in postmenopausal Chinese women according to clinical risk factors and BMD T-scores: a prospective study. Effects of calcium supplements on femoral bone mineral density and vertebral fracture rate in vitamin-D-replete elderly patients Risk Factors for Perimenopausal Fractures: A Prospective Study Effect of calcium supplementation on bone loss in postmenopausal women. Vitamin D3 and calcium to prevent hip fractures in elderly women. Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Clinical risk factors for fractures in multi-ethnic women: the Women's Health Initiative. Effect of vitamin D(3) and calcium on fracture risk in 65- to 71-year-old women: a population-based 3-year randomized, controlled trial--the OSTPRE-FPS. Women’s Health Initiative clinical trials: interaction of calcium and vitamin D with hormone therapy Effect of the fluoride/calcium regimen on vertebral fracture occurrence in postmenopausal osteoporosis. Comparison with conventional therapy. The effect of fluoride and calcium on spinal bone mineral content: A controlled, prospective (3 years) study Long-term effects of calcium supplementation on serum parathyroid hormone level, bone turnover, and bone loss in elderly women. Milk supplementation of the diet of postmenopausal Chinese women on a low calcium intake retards bone loss. Reappraisal of Katsuragi Calcium study, a prospective, double-blind, placebo-controlled study of the effect of active absorbable algal calcium (AAACa) on vertebral deformity and fracture Risk factors for incident vertebral fractures in men and women: the Rotterdam Study. Nutrition and subsequent hip fracture risk among a national cohort of white women. A randomised, controlled comparison of different calcium and vitamin D supplementation regimens in elderly women after hip fracture: The Nottingham Neck of Femur (NONOF) Study. The effects of an open design on trial participant recruitment, compliance and retention – a randomized controlled trial comparison with a blinded, placebo-controlled design Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. Treatment with alendronate plus calcium, alendronate alone, or calcium alone for postmenopausal low bone mineral density Dietary calcium and vitamin D intake in relation to osteoporotic fracture risk. Long-term effects of calcium supplementation on bone loss and fractures in postmenopausal women: a randomized controlled trial. Randomized controlled trial of calcium in healthy older women. Randomized controlled trial of calcium supplementation in healthy, nonosteoporotic, older men.
abstract: Dietary data from a prospect i ve study were used to relate factors influencing calcium balance ( estimates of dietary calcium intake , protein intake from nondairy animal sources ( meat , fish , and eggs ) , and coffee consumption ) to the incidence of  hip fracture . During the years 1977 - 1983 , women and men born between 1925 and 1940 and living in one of three Norwegian counties were invited to a  cardiovascular screening that included a dietary survey . The attendance rate at screening was 91.1 % , and 90.7 % of these persons ( 19,752 women and 20,035 men ) filled in and returned a semiquantitative dietary question naire . This cohort was followed for an average of 11.4 years ( range , 0.01 - 13.8 years ) with respect to hip fracture , defined as cervical or trochanteric fracture . During follow-up , 213 hip fractures were identified , excluding fractures associated with high-energy trauma and metastatic bone disease . There was no clear association between  calcium intake or nondairy animal protein intake  and hip fracture in this cohort . However , an elevated risk of fracture was found in women with a high intake of protein from nondairy animal sources in the presence of low calcium intake ( relative risk = 1.96 ( 95 % confidence interval 1.09 - 3.56 ) for the highest quarter of nondairy protein intake and the lowest quarter of calcium intake vs. the three lower quarters of protein intake and the three higher quarters of calcium intake ) . Women who drank nine or more cups of coffee per day also had an increased risk of fracture , while there was no association between coffee consumption and hip fracture in men . Although these findings do not necessarily imply causal relations , they suggest the presence of risk factors for hip fracture that act through a negative calcium balance in this population Vitamin D insufficiency and low calcium intake contribute to increase parathyroid function and bone fragility in elderly people .  Calcium and vitamin D supplements can reverse secondary hyperparathyroidism thus preventing hip fractures , as proved by Decalyos I. Decalyos II is a 2-year , multicenter , r and omized , double-masked , placebo-controlled confirmatory study . The intention-to-treat population consisted of 583 ambulatory institutionalized women ( mean age 85.2 years , SD = 7.1 ) r and omized to the  calcium – vitamin D3  fixed combination group ( n= 199 ) ; the calcium plus vitamin D3 separate combination group ( n= 190 ) and the placebo group ( n= 194 ) . Fixed and separate combination groups received the same daily amount of calcium ( 1200 mg ) and vitamin D3 ( 800 IU ) , which had similar pharmacodynamic effects . Both types of calcium-vitamin D3 regimens increased serum 25-hydroxyvitamin D and decreased serum intact parathyroid hormone to a similar extent , with levels returning within the normal range after 6 months . In a subgroup of 114 patients  , femoral neck bone mineral density ( BMD ) decreased in the placebo group ( mean = –2.36 % per year , SD = 4.92 ) , while remaining unchanged in women treated with calcium-vitamin D3 ( mean = 0.29 % per year , SD = 8.63 ) . The difference between the two groups was 2.65 % ( 95 % CI = –0.44 , 5.75 % ) with a trend in favor of the active treatment group . No significant difference between groups was found for changes in distal radius BMD and quantitative ultrasonic parameters at the os calcis . The relative risk ( RR ) of HF in the placebo group compared with the active treatment group was 1.69 ( 95 % CI = 0.96 , 3.0 ) , which is similar to that found in Decalyos I ( RR = 1.7 ; 95 % CI = 1.0 , 2.8 ) . Thus , these data are in agreement with those of Decalyos I and indicate that calcium and vitamin D3 in combination reverse senile secondary hyperparathyroidism and reduce both hip bone loss and the risk of hip fracture  in elderly institutionalized women Summary The relationship between osteoporosis risk factors , bone quantitative ultrasound ( QUS ) and non-spinal fracture risk was estimated in a cohort of 5,201 postmenopausal women from Spain who were prospect ively evaluated during three years . Several clinical risk factors and low heel QUS values were independently associated with non-spinal fracture risk . Introduction Low-trauma , non-spinal fractures are a growing source of morbidity and mortality in the elderly . The aim of the present study was to examine the association of heel  quantitative ultrasound ( QUS ) and a series of osteoporosis and fracture risk factors , with incident low energy non-spinal fractures in a population of elderly women , and to incorporate them into fracture prediction models . Methods 5,201 women aged 65 or older were enrolled in a three-year cohort study . Participants completed an osteoporosis and fracture risk factors question naire . QUS was measured at the heel with a gel-coupled device . Cox-proportional hazard analyses were performed to evaluate the association with the first incident low-trauma non-spinal fracture . Results Three hundred and eleven women ( 6.0 % ) sustained a total of 363 low-trauma fractures , including 133 forearm/wrist , 54 hip , 50 humerus , 37 leg and 17 pelvic fractures . For every st and ard deviation decrease in the quantitative ultrasound index , the adjusted hazard ratios ( 95 % CI ) for any non-vertebral , hip , forearm/wrist , and humerus fractures were 1.31 ( 1.15–1.49 ) , 1.40 ( 1.01–1.95 ) , 1.50 ( 1.19–1.89 ) and 1.35 ( 0.97–1.87 ) , respectively . Similar results were observed with other QUS variables . The best predictive models indicated that age , a history of falls , a previous low-trauma fracture , a family history of fracture , a calcium intake from dairy products of less than 250 mg/day , and lower values of QUS parameters were independently associated with the risk of non-spinal fractures . Conclusions Both clinical risk factors and QUS are independent predictors of risk of fragility non-spinal fractures . A prediction algorithm using these variables was developed to estimate the absolute risk of non-spinal fractures in elderly women in Spain Fractures of the proximal humerus , forearm , and wrist account for approximately one third of total osteoporotic fractures in the elderly . Several risk factors for these fractures were evaluated in this prospect i ve study of 739 men and 1,105 women aged > or = 60 years in Dubbo , Australia . During follow-up ( 1989 - 1996 ) , the respective incidences of humerus and of forearm and wrist fractures , per 10,000 person-years , were 22.6 and 33.8 for men and 54.8 and 124.6 for women . Independent predictors of humerus fracture were femoral neck bone mineral density ( FNBMD ) ( relative risk ( RR ) = 2.3 , 95 % confidence interval ( CI ) : 1.2 , 4.5 ) in men and FNBMD ( RR = 2.4 , 95 % CI : 1.7 , 3.5 ) and height loss ( RR = 1.1 , 95 % CI : 1.0 , 1.2 ) in women . For forearm and wrist fractures , risk factors were FNBMD ( men : RR = 1.5 , 95 % CI : 1.0 , 2.3 ; women : RR = 1.5 , 95 % CI : 1.2 , 1.9 ) and height loss ( men : RR = 1.2 , 95 % CI : 1.0 , 1.3 ; women : RR = 1.1 , 95 % CI : 1.0 , 1.2 ) . In addition , dietary calcium ( men : RR = 2.0 , 95 % CI : 1.0 , 3.6 ) and a history of falls ( women : RR = 1.9 , 95 % CI : 1.4 , 2.6 ) were also significant . These data suggest that elderly men and women largely share common risk factors for upper limb fractures and that FNBMD is the primary risk factor BACKGROUND The effect of supplementation with calcium alone on risk fractures in a healthy population is not clear . OBJECTIVE The objective was to determine whether 4 y of calcium supplementation would reduce the fracture risk during treatment and subsequent follow-up in a r and omized placebo-controlled trial . DESIGN The participants were aged < 80 y at study entry ( mean age : 61 y ) , were generally healthy , and had a recent diagnosis of colorectal adenoma . A total of 930 participants ( 72 % men ; mean age : 61 y ) were r and omly assigned to receive 4 y of treatment with 3 g CaCO(3 ) ( 1200 mg elemental Ca ) daily or placebo and were followed for a mean of 10.8 y. The primary outcomes of this analysis were all fractures and minimal trauma fractures ( caused by a fall from st and ing height or lower while sitting , st and ing , or walking ) . RESULTS There were 46  fractures  ( 15 from minimal trauma ) in 464 participants in the calcium group and 54 ( 29 from minimal trauma ) in 466 participants in the placebo group . The overall risk of fracture differed significantly between groups during the treatment phase [ hazard ratio ( HR ) : 0.28 ; 95 % CI : 0.09 , 0.85 ] , but not during the subsequent posttreatment follow-up ( HR : 1.10 ; 95 % CI : 0.71 , 1.69 ) . Minimal trauma fractures were also less frequent in the calcium group during treatment ( HR : 0 ; 95 % CI : 0 , 0.50 ) . CONCLUSION Calcium supplementation reduced the risk of all fractures and of minimal trauma fractures among healthy individuals . The benefit appeared to dissipate after treatment was stopped . This trial was registered at clinical trials.gov as NCT00153816 BACKGROUND Short trials of calcium supplementation show that it reduces loss of bone density in postmenopausal women ; longer observational studies do not generally find a lower risk of hip fracture with higher-calcium diets . Fewer studies have focused on vitamin D in preventing postmenopausal osteoporosis or fractures . OBJECTIVE We assessed relations between postmenopausal hip fracture risk and calcium , vitamin D , and milk consumption . DESIGN In an 18-y prospect i ve analysis in 72 337 postmenopausal women , dietary intake and nutritional supplement use were assessed at baseline in 1980 and up date d several times during follow-up . We identified 603 incident hip fractures result ing from low or moderate trauma .  Relative risks ( RRs ) from proportional hazards models were controlled for other dietary and nondietary factors . RESULTS Women consuming > or = 12.5 microg vitamin D/d from food plus supplements had a 37 % lower risk of hip fracture ( RR = 0.63 ; 95 % CI : 0.42 , 0.94 ) than did women consuming < 3.5 microg/d . Total calcium intake was not associated with hip fracture risk ( RR = 0.96 ; 95 % CI : 0.68 , 1.34 for > or = 1200 compared with < 600 mg/d ) . Milk consumption was also not associated with a lower risk of hip fracture ( P for trend = 0.21 ) . CONCLUSIONS An adequate vitamin D intake is associated with a lower risk of osteoporotic hip fractures in postmenopausal women . Neither milk nor a high-calcium diet appears to reduce risk . Because women commonly consume less than the recommended intake of vitamin D , supplement use or dark fish consumption may be prudent UNLABELLED This study of 9605 community-dwelling residents supports that vitamin D and calcium supplementation may prevent  osteoporotic fractures in elderly in a northern European region known to be deficient in vitamin D , especially during winter periods . INTRODUCTION We evaluated the effect of two programs for the prevention of osteoporotic fractures leading to acute hospital admission in a population of elderly community-dwelling residents . MATERIAL S AND METHODS This was a factorial , cluster-r and omized , pragmatic , intervention study . We included 9605 community-dwelling residents aged 66 + years . We offered a prevention program of a daily supplement of 1000 mg of elemental calcium as calcium carbonate and 400 IU ( 10 microg ) of vitamin D3 to a total of 4957 participants . Another program with evaluation and suggestions for the improvement of the domestic environment was offered to a total of 5063 participants . Both programs included revision of the resident 's current pharmaceutical treatment . We achieved information on osteoporotic fractures in the study population from the Danish Hospital Registration Data base . We defined osteoporotic fractures as low energy fractures of the proximal humerus , distal forearm , vertebral column , pelvis , cervical femur , and intertrochanteric femur . RESULTS Active participation was 50.3 % in the Calcium and Vitamin D Program and 46.4 % in the Environmental and Health Program . We observed a 16 % reduction in fracture incidence rate ( relative risk [ RR ] , 0.84 ; CI , 0.72 - 0.98 ; p < 0.025 ) among male and female residents offered the Calcium and Vitamin D Program ( intention-to-prevent analysis ) . CONCLUSIONS This study supports that vitamin D and calcium supplementation may prevent osteoporotic fractures in community-dwelling elderly people in a northern European region known to be deficient in vitamin D , especially during winter periods Objective To investigate associations between long term dietary intake of calcium and risk of fracture of any type , hip fractures , and osteoporosis . Design A longitudinal and prospect i ve cohort study , based on the Swedish Mammography Cohort , including a subcohort , the Swedish Mammography Cohort Clinical . Setting A population based cohort in Sweden established in 1987 . Participants 61 433 women ( born between 1914 and 1948 ) were followed up for 19 years . 5022 of these women participated in the subcohort . Main outcome measures Primary outcome measures were incident fractures of any type and hip fractures , which were identified from registry data . Secondary outcome was osteoporosis diagnosed by dual energy x ray absorptiometry in the subcohort . Diet was assessed by repeated food frequency question naires . Results During follow-up , 14 738 women ( 24 % ) experienced a first fracture of any type and among them 3871 ( 6 % ) a first hip fracture . Of the 5022 women in the subcohort , 1012 ( 20 % ) were measured as osteoporotic . The risk patterns with dietary calcium were non-linear . The crude rate of a first fracture of any type was 17.2/1000 person years at risk in the lowest quintile of calcium intake , and 14.0/1000 person years at risk in the third quintile , corresponding to a multivariable adjusted hazard ratio of 1.18 ( 95 % confidence interval 1.12 to 1.25 ) . The hazard ratio for a first hip fracture was 1.29 ( 1.17 to 1.43 ) and the odds ratio for osteoporosis was 1.47 ( 1.09 to 2.00 ) . With a low vitamin D intake , the rate of fracture in the first calcium quintile was more pronounced . The highest quintile of calcium intake did not further reduce the risk of fractures of any type , or of osteoporosis , but was associated with a higher rate of hip fracture , hazard ratio 1.19 ( 1.06 to 1.32 ) . Conclusion Gradual increases in dietary calcium intake above the first quintile in our female population were not associated with further reductions in fracture risk or osteoporosis To assess the effect of dietary calcium intake on risk of hip fracture  , a geographically defined caucasian population in southern California was studied prospect ively . Between 1973 and 1975 , a quantified 24 hour diet recall was obtained by a dietician from 957 men and women aged 50 to 79 years at baseline . Follow-up to 1987 with mortality records and interviews showed 15 men and 18 women with hip fractures . The age-adjusted risk of hip fracture was inversely associated with dietary calcium whether considered as mg per day or as nutrient density ( mg per 1000 kcal ) . No other nutrient was consistently associated with hip fracture in any Cox proportional hazards model that included calcium . The association between  calcium  and fracture persisted after adjustment for cigarette smoking , alcohol intake , exercise , and obesity . The significant independent inverse association of  dietary calcium  with subsequent risk of hip fracture ( relative risk = 0.6 per 198 mg/1000 kcal ) strongly supports the hypothesis that increased dietary calcium intake protects against hip fracture Several epidemiological studies have identified clinical factors that predict the risk of hip fractures in elderly women independently of the level of bone mineral density ( BMD ) , such as low body weight , history of fractures , and clinical risk factors for falls . Their relevance in predicting all fragility fractures in all postmenopausal women , including younger ones , is unknown . The objective of this study was to identify independent predictors of all osteoporosis-related fractures in healthy postmenopausal women . We prospect ively followed for 5.3 + /- 1.1 years a cohort of 672 healthy postmenopausal women ( mean age 59.1 + /- 9.8 years ) . Information on social and professional conditions , demographic data , current and past medical history , fracture history , medication use , alcohol consumption , caffeine consumption , daily calcium intake , cigarette smoking , family history of fracture , and past and recent physical activity  was obtained .  Anthropometric and total hip bone mineral density measurements were made . Incident falls and fractures were ascertained every year . We observed 81 osteoporotic fractures ( annual incidence , 21 per 1000 women/year ) . The final model consisted of seven independent predictors of incident osteoporotic fractures : age > or = 65 years , odds ratio estimate ( OR ) , 1.90 [ 95 % confidence interval ( CI ) 1.04 - 3.46 ] , past falls , OR , 1.76 ( CI 1.00 - 3.09 ) , total hip bone mineral density ( BMD ) < or = 0.736 g/cm(2 ) , OR , 3.15 ( CI 1.75 - 5.66 ) , left grip strength < or = 0.60 bar , OR , 2.05 ( CI 1.15 - 3.64 ) , maternal history of fracture , OR , 1.77 ( CI 1.01 - 3.09 ) , low physical activity , OR , 2.08 ( CI 1.17 - 3.69 ) , and personal history of fragility fracture , OR , 3.33 ( CI 1.75 - 5.66 ) . In contrast , body weight , weight loss , height loss , smoking , neuromuscular coordination assessed by three tests , and hormone replacement therapy were not independent predictors of all fragility fractures after adjustment for all variables . We found that some -- but not all -- previously reported clinical risk factors for skeletal fragility predicted all fragility fractures independently of BMD in healthy postmenopausal women , although they differed somewhat from those predicting specifically hip fractures in elderly women . These risk factors appear to reflect quality of bone structure ( previous fragility fracture ) , lifestyle habits ( physical activity ) , muscle function and health status ( grip strength ) , heredity ( maternal history of fracture ) , falls , and aging . Measurements of these variables should be included in the clinical assessment of the risk of osteoporotic fractures in postmenopausal women This placebo-controlled r and omized trial was conducted to ascertain the value of calcium citrate supplementation in averting bone loss in 63 postmenopausal women , 57 of whom were early postmenopausal ( five years after menopause ) and six of whom were mid-postmenopausal ( five to ten years after menopause ) .  Bone density data were available for 25 women who took 800 mg of calcium citrate daily and 31 women who received placebo for one to two years . The two groups were similar in baseline age , years postmenopause ( 3.3 in the calcium citrate group vs 2.7 in the placebo group ) , height , weight , calcium intake , and L2-L4 bone density . L2-L4 bone density did not change during calcium citrate treatment ( + 1.03 % after two years ) , whereas it declined significantly by -2.38 % after two years on placebo ( P < .001 ) . Femoral neck bone density did not change in either group . Radial shaft bone density did not change in the calcium citrate group ( -0.02 % after two years ) , but it declined significantly in the placebo group ( -1.79 % after one year and -3.03 % after two years , P < .01 ) . The difference in bone density of the L2-L4 vertebrae and radial shaft after two years of treatment was significant between the two groups . An analysis of covariance disclosed no significant effect of calcium citrate on L2-L4 bone density during the first three years after menopause , but a protective effect after three years . Although serum PTH did not change , serum and urinary calcium increased and serum calcitriol and urinary phosphorus decreased in the calcium citrate group , indicative of parathyroid suppression . Serum bone-specific alkaline phosphatase and osteocalcin , and urinary hydroxyproline and N-telopeptide decreased during some calcium citrate treatment periods , indicative of a reduction in bone turnover . Thus , calcium citrate supplementation ( 400 mg of calcium twice daily ) averted bone loss and stabilized bone density in the spine , femoral neck , and radial shaft in women relatively soon after menopause . This bone-sparing action was probably due to the inhibition of bone resorption from parathyroid suppression BACKGROUND AND METHODS Laboratory , clinical , and epidemiologic evidence suggests that calcium may help prevent colorectal adenomas . We conducted a r and omized , double-blind trial of the effect of supplementation with calcium carbonate on the recurrence of colorectal adenomas . We r and omly assigned 930 subjects ( mean age , 61 years ; 72 percent men ) with a recent history of colorectal adenomas to receive either calcium carbonate ( 3 g [ 1200 mg of elemental calcium ] daily ) or placebo , with follow-up colonoscopies one and four years after the qualifying examination . The primary end point was the proportion of subjects in whom at least one adenoma was detected after the first follow-up endoscopy but up to ( and including ) the second follow-up examination . Risk ratios for the recurrence of adenomas were adjusted for age , sex , lifetime number of adenomas before the study , clinical center , and length of the surveillance period . RESULTS The subjects in the calcium group had a lower risk of recurrent adenomas . Among the 913 subjects who underwent at least one study colonoscopy , the adjusted risk ratio for any recurrence of adenoma with calcium as compared with placebo was 0.85 ( 95 percent confidence interval , 0.74 to 0.98 ; P=0.03 ) . The main analysis was based on the 832 subjects ( 409 in the calcium group and 423 in the placebo group ) who completed both follow-up examinations . At least one adenoma was diagnosed between the first and second follow-up endoscopies in 127 subjects in the calcium group ( 31 percent ) and 159 subjects in the placebo group ( 38 percent ) ; the adjusted risk ratio was 0.81 ( 95 percent confidence interval , 0.67 to 0.99 ; P=0.04 ) . The adjusted ratio of the average number of adenomas in the calcium group to that in the placebo group was 0.76 ( 95 percent confidence interval , 0.60 to 0.96 ; P=0.02 ) . The effect of calcium was independent of initial dietary fat and calcium intake . CONCLUSIONS Calcium supplementation is associated with a significant - though moderate - reduction in the risk of recurrent colorectal adenomas CONTEXT AND OBJECTIVE It is not known which factors are associated with fracture in nonosteoporotic elderly . The aim of this study was to assess the association between fall-related risk factors and  fracture risk in men and women without osteoporosis . DESIGN This study was part of the ongoing Dubbo Osteoporosis Epidemiology Study , which was design ed as a prospect i ve population -based cohort investigation . PARTICIPANTS At baseline , 924 women and 723 men aged 60 + yr did not have osteoporosis [ bone mineral density ( BMD ) T-scores > -2.5 ] . The individuals have been followed for up to 15 yr . MAIN OUTCOME MEASURES Atraumatic fractures were prospect ively identified through radiologists ' reports . RISK FACTORS At baseline , femoral neck BMD ( FNBMD ) was measured by dual energy x-ray absorptiometry ( DXA ) ; history of fall , postural stability , and quadriceps strength  was obtained . RESULTS During the follow-up period , among the nonosteoporotic group , 221 women and 105 men had sustained a fracture , accounting for 55 and 74 % of total fractures in the entire Dubbo Osteoporosis Epidemiology Study sample , respectively . The following factors were independent risk factors for any fracture : in women , age per sd ( hazard ratio , 1.2 ; 95 % CI , 1.0 - 1.3 ) , postural sway per sd ( 1.1 , 1.0 - 1.2 ) , FNBMD per sd ( 1.6 , 1.3 - 1.9 ) , fall in the previous 12 months ( 2.1 , 1.6 - 2.7 ) , and prior fracture ( 1.8 , 1.2 - 2.7 ) ; in men , age ( 1.4 , 1.1 - 1.6 ) , postural sway ( 1.2 , 1.0 - 1.3 ) , FNBMD ( 1.2 , 1.0 - 1.5 ) , and fall in the previous 12 months ( 1.9 , 1.2 - 3.0 ) . Exposure to at least one of the risk factors could account for 49 % ( women ) and 39 % ( men ) of any fractures in this population . CONCLUSION In nonosteoporotic elderly , the combination of low BMD , advancing age , fall during the last 12 months , and prior fracture could identify a subgroup of individuals with high risk of fracture The effect of dietary calcium on  hip fracture risk was examined prospect ively using the NHANES I Epidemiologic Follow-Up Study cohort , which is derived from a nationally representative sample of the United States population . A cohort of 4342 white men and postmenopausal women ages 50–74 years at baseline ( 1971–1975 ) were observed through 1987 for up to 16 years of follow-up . Quantitative estimates of calcium intake were obtained at baseline from a 24-h recall , while weekly frequency of dairy food consumption was obtained from a qualitative food frequency . By 1987 , 44 men and 122 women had experienced a hip fracture according to hospital records or death certificates . In the total sample of women the risk of hip fracture was only slightly lower for the highest quartile compared with the lowest . However , although not statistically significant , the age-adjusted risk of hip fracture was approximately 50 % lower in the highest quartile of calcium intake compared with the lowest quartile in the subgroup of women who were at least 6 years postmenopausal and not taking postmenopausal hormone . The low relative risk observed among men , although interesting , must be interpreted cautiously due to small sample size . Adjusting for other risk factors did not appreciably change the results for either sex . The pattern of relative risks for calcium quartiles and by selected cutpoints was not consistent with a dose-response effect of calcium . Our results suggest that calcium may lower hip fracture risk in late menopausal women Summary The Women 's Health Initiative ( WHI ) double-blind , placebo-controlled clinical trial r and omly assigned 36,282 postmenopausal women in the U.S. to 1,000 mg elemental calcium carbonate plus 400 IU of vitamin D3 daily or placebo , with average intervention period of 7.0 years . The trial was design ed to test whether calcium plus vitamin D supplementation in a population in which the use of these supplements was widespread would reduce hip fracture , and secondarily , total fracture and colorectal cancer . Introduction This study further examines the health benefits and risks of calcium and vitamin D supplementation using WHI data , with emphasis on fractures , cardiovascular disease , cancer , and total mortality . Methods WHI calcium and vitamin D r and omized clinical trial ( CT ) data through the end of the intervention period were further analyzed with emphasis on treatment effects in relation to duration of supplementation , and these data were contrasted and combined with corresponding data from the WHI prospect i ve observational study ( OS ) . Results Among women not taking personal calcium or vitamin D supplements at baseline , the hazard ratio [ HR ] for hip fracture occurrence in the CT following 5 or more years of calcium and vitamin D supplementation versus placebo was 0.62 ( 95 % confidence interval ( CI ) , 0.38–1.00 ) . In combined analyses of CT and OS data , the corresponding HR was 0.65 ( 95 % CI , 0.44–0.98 ) . Supplementation effects were not apparent on the risks of myocardial infa rct ion , coronary heart disease , total heart disease , stroke , overall cardiovascular disease , colorectal cancer , or total mortality , while evidence for a reduction in breast cancer risk and total invasive cancer risk among calcium plus vitamin D users was only suggestive . Conclusion Though based primarily on a subset analysis , long-term use of calcium and vitamin D appears to confer a reduction that may be substantial in the risk of hip fracture among postmenopausal women . Other health benefits and risks of supplementation at doses considered , including an elevation in urinary tract stone formation , appear to be modest and approximately balanced In a double-blind trial , 327 patients ( 57 men ) over 65 ( mean age 79.5 ) years received all possible combinations of calcium carbonate 3 g , vitamin D3 1000 iu , meth and ienone 2.5 mg and /or placebos daily for 9 months . The higher incidence of bone fractures in the placebo group was not significant . Serum calcium , phosphorus , creatinine , aspartate aminotransferase and alkaline phosphatase were followed : the greatest changes occurred with meth and ienone , which thus reduced osteoporotic activity and increased the muscular mass most effectively ; calcium carbonate had the poorest effect . Surprisingly , coronary mortality was higher among those taking all three active substances . With two treatments the increase was not significant , but when both the groups receiving a combination of any two of the treatments were compared with those taking only one or neither of these two treatments , a significant increase in coronary deaths was seen , most significant ( P less than 0.001 ) in those receiving vitamin D3 and meth and ienone Summary We ascertained the incidence and predictors of radiographic vertebral fracture  in a Brazilian elderly cohort , since no data in this field have been reported in low-income countries . This is the first population -based study to demonstrate the high frequency of vertebral fracture in elderly Latin Americans . Age , prior fracture , BMD , and bone turnover were predictors of fracture . Introduction Vertebral fractures are associated with increased future fracture risk and mortality . No data on incidence of osteoporotic vertebral fracture have been reported in low-income countries where the population ’s aging has been faster . Thus , we sought to describe the incidence and risk factors for radiographic vertebral fracture in a longitudinal prospect i ve Brazilian population -based elderly cohort . Methods 707 older adults ( 449 women and 258 men ) were evaluated  with spinal radiographs obtained at baseline and after a mean follow-up of 4.3 ± 0.8 years . New vertebral fracture was defined as distinct alteration in the morphology of vertebrae result ing in higher grade of deformity on the second radiograph when compared to the baseline radiograph . Clinical question naire , bone mineral density ( BMD ) , and laboratory tests were performed at baseline . Multivariate Poisson regression models were used to identify independent predictors of fracture . Results The age-st and ardized incidence of vertebral fracture was 40.3/1,000 person-years in women and 30.6/1,000 in men . In women , three models of risk factors for fracture were fitted : ( 1 ) age ( relative risks ( RR ) 2.46 , 95 % confidence interval ( CI ) 1.66–3.65 ) , previous osteoporotic fracture ( RR 1.65 , 95 % CI 1.00–2.71 ) , and lumbar spine BMD ( RR 1.21 , 95 % CI 1.03–1.41 ) ; ( 2 ) age ( RR 2.25 , 95 % CI 1.52–3.34 ) and femoral neck BMD ( RR 1.42 , 95 % CI 1.11–1.81 ) ; ( 3 ) age ( RR 2.11 , 95 % CI 1.41–3.15 ) and total hip BMD ( RR 1.56 , 95 % CI 1.21–2.0 ) . In men , the highest quartile of cross-linked C-telopeptide ( CTx ) ( RR 1.96 , 95 % CI 0.98–3.91 ) and prior fracture ( RR 2.10 , 95 % CI 1.00–4.39 ) were predictors of new vertebral fracture . Conclusions This is the first population -based study to ascertain the incidence of vertebral fracture in elderly Latin Americans , confirming the high frequency of the disorder . Age , prior fracture , BMD , and bone turnover were predictors of the short-term incidence of vertebral fracture Background / Objectives : Evidence on the role of diet during adulthood and beyond on fracture occurrence is limited . We investigated diet and hip fracture incidence in a population of elderly Europeans , participants in the European Prospect i ve Investigation into Cancer and nutrition study .Subjects/ Methods : 29 122 volunteers ( 10 538 men , 18 584 women ) aged 60 years and above ( mean age : 64.3 ) from five countries were followed up for a median of 8 years and 275 incident hip fractures ( 222 women and 53 men ) were recorded .  Diet  was assessed at baseline through vali date d dietary question naires . Data were analyzed through Cox proportional-hazards regression with adjustment for potential confounders . Results : No food group or nutrient was significantly associated with hip fracture occurrence . There were suggestive inverse associations , however , with vegetable consumption ( hazard ratio ( HR ) per increasing sex-specific quintile : 0.93 , 95 % confidence interval ( CI ) : 0.85–1.01 ) , fish consumption ( HR per increasing sex-specific quintile : 0.93 , 95 % CI : 0.85–1.02 ) and polyunsaturated lipid intake ( HR per increasing sex-specific quintile : 0.92 , 95 % CI : 0.82–1.02 ) , whereas saturated lipid intake was positively associated with hip fracture risk ( HR per increasing sex-specific quintile : 1.13 , 95 % CI : 0.99–1.29 ) . Consumption of dairy products did not appear to influence the risk ( HR per increasing sex-specific quintile : 1.02 , 95 % CI : 0.93–1.12 ) . Conclusions : In a prospect i ve study of the elderly , diet , including consumption of dairy products , alcohol and vitamin D , did not appear to play a major role in hip fracture incidence . There is however , weak and statistically non-significant evidence that vegetable and fish consumption and intake of polyunsaturated lipids may have a beneficial , whereas saturated lipid intake a detrimental effect Although there is some epidemiologic evidence that soy may reduce risk of osteoporotic fracture in women , it is not known whether this risk reduction also occurs for men . The authors examined gender-specific associations between soy intake and hip fracture risk in the Singapore Chinese Health Study , a prospect i ve cohort of 63,257 Chinese living in Singapore . At recruitment between 1993 and 1998 , each subject was administered a food frequency question naire and questions on medical history and lifestyle factors . As of December 31 , 2006 , 276 incident cases of hip fracture in men and 692 cases in women were identified via linkage with hospital discharge data bases . For both genders , hip fracture risk was positively associated with cigarette smoking and was inversely associated with body mass index . There was a statistically significant association of tofu equivalents , soy protein , and isoflavones with hip fracture risk among women but not among men . Compared with women in the lowest quartile of intakes for tofu equivalents ( < 49.4 g/day ) , soy protein ( < 2.7 g/day ) , and isoflavones ( < 5.8 mg/1,000 kcal/day ) , those in the second-fourth quartiles exhibited 21%-36 % reductions in risk ( all P < 0.036 ) . Risk levels were comparable across the second , third , and fourth quartiles of soy intake categories OBJECTIVE --To determine whether low dietary calcium intake and physical inactivity are risk factors for hip fracture among subjects aged 65 and over . DESIGN --Fifteen year follow up study of a large cohort of r and omly selected elderly people living in the community , who had taken part in the 1973 - 4 survey of the Department of Health and Social Security , and for whom dietary and other data were recorded at initial interview and medical assessment . SETTING --Eight areas in Britain ( Engl and ( five ) , Wales ( one ) , and Scotl and ( two ] . SUBJECTS--1688 Subjects living in the community , of whom 1419 subjects ( 720 men and 699 women ) agreed to participate . 1356 Subjects completed a seven day dietary record and 983 ( 542 men and 441 women ) agreed to be assessed by a geriatrician . RESULTS --Incidence of hip fracture increased with age and was higher in women than men . Comparison with matched controls showed no evidence that the risk of hip fracture was related to calcium intake : the odds ratio for the lowest third of dietary calcium  compared with the highest was 0.7 ( 95 % confidence interval 0.1 to 3.9 ) after adjustment for smoking and body mass index . The adjusted odds ratio for the lowest third of outdoor activity compared with the highest was 4.3 ( 0.7 to 26.8 ) , and that for grip strength was 3.9 ( 0.7 to 23.0 ) . CONCLUSIONS --Reduced intake of dietary calcium does not seem to be a risk factor for hip fracture . Further evidence is provided that physical activity in the elderly protects against hip fracture IMPORTANCE Calcium intake has been promoted because of its proposed benefit on bone health , particularly among the older population . However , concerns have been raised about the potential adverse effect of high calcium intake on cardiovascular health . OBJECTIVE To investigate whether intake of dietary and supplemental calcium is associated with mortality from total cardiovascular disease ( CVD ) , heart disease , and cerebrovascular diseases . DESIGN AND SETTING Prospect i ve study from 1995 through 1996 in California , Florida , Louisiana , New Jersey , North Carolina , and Pennsylvania and the 2 metropolitan areas of Atlanta , Georgia , and Detroit , Michigan . PARTICIPANTS A total of 388 229 men and women aged 50 to 71 years from the National Institutes of Health-AARP Diet and Health Study . MAIN OUTCOME MEASURES  Dietary and supplemental calcium intake  was assessed at baseline ( 1995 - 1996 ) . Supplemental calcium intake included calcium from multivitamins and individual calcium supplements .  Cardiovascular disease deaths were ascertained using the National Death Index . Multivariate Cox proportional hazards regression models adjusted for demographic , lifestyle , and dietary variables were used to estimate relative risks ( RRs ) and 95 % CIs . RESULTS During a mean of 12 years of follow-up , 7904 and 3874 CVD deaths in men and women , respectively , were identified . Supplements containing calcium were used by 51 % of men and 70 % of women . In men , supplemental calcium intake was associated with an elevated risk of CVD death ( RR>1000 vs 0 mg/d , 1.20 ; 95 % CI , 1.05 - 1.36 ) , more specifically with heart disease death ( RR , 1.19 ; 95 % CI , 1.03 - 1.37 ) but not significantly with cerebrovascular disease death ( RR , 1.14 ; 95 % CI , 0.81 - 1.61 ) . In women , supplemental calcium intake was not associated with CVD death ( RR , 1.06 ; 95 % CI , 0.96 - 1.18 ) , heart disease death ( 1.05 ; 0.93 - 1.18 ) , or cerebrovascular disease death ( 1.08 ; 0.87 - 1.33 ) . Dietary calcium intake was unrelated to CVD death in either men or women . CONCLUSIONS AND RELEVANCE Our findings suggest that high intake of supplemental calcium is associated with an excess risk of CVD death in men but not in women . Additional studies are needed to investigate the effect of supplemental calcium use beyond bone health Excess dietary proteins and " acid ash " diets have been suspected to increase the risk of osteoporosis , but experimental and epidemiological evidence is mixed . We aim ed to determine whether the association between protein intake and the overall acid-base equilibrium of the diet ( as renal net acid excretion [ RNAE ] estimate ) and fracture risk vary according to calcium intake . During an average of 8.37 + /- 1.73 yr of follow-up , 2408 women reported a fracture ( excluding high-impact trauma ) among 36,217 postmenopausal women from the E3N prospect i ve study . We used Cox regression models to study the interaction between calcium and , respectively , proteins and RNAE , from the 1993 dietary question naire for fracture risk determination , adjusting for potential confounders . There was no overall association between fracture risk and total protein or RNAE . However , in the lowest quartile of calcium ( < 400 mg/1000 kcal ) , high protein intake was associated with a significant increased fracture risk ( RR = 1.51 for highest versus lowest quartile ; 95 % CI , 1.17 - 1.94 ) . An increasing fracture risk with increasing animal protein intake was also observed ( trend , p < 0.0001 ) . A similar pattern of interaction for fracture risk was observed between RNAE and calcium . In this Western population of postmenopausal women with normal to high protein intake and fairly high calcium intake , there was no overall association between total protein or RNAE and fracture risk . However , there was some evidence that high protein-high acid ash diets were associated with an increased risk of fracture when calcium intake was low ( < 400 mg/1000 kcal ) Abstract Objective To assess whether supplementation with calcium and cholecaliferol ( vitamin D3 ) reduces the risk of fracture in women with one or more risk factors for fracture of the hip . Design Pragmatic open r and omised controlled trial . Setting Practice nurse led clinics in primary care . Participants 3314 women aged 70 and over with one or more risk factors for hip fracture : any previous fracture , low body weight ( < 58 kg ) , smoker , family history of hip fracture , or fair or poor self reported health . Intervention Daily oral supplementation using 1000 mg calcium with 800 IU cholecaliferol and information leaflet on dietary calcium intake and prevention of falls , or leaflet only ( control group ) . Main outcome measures Primary outcome measure was all clinical fractures and secondary outcome measures were adherence to treatment , falls , and quality of life ( measured with the SF-12 ) . Results 69 % of the women who completed the follow-up question naire at 24 months were still taking supplements ( 55 % with inclusion of r and omised participants known to be alive ) . After a median follow-up of 25 months ( range 18 to 42 months ) , clinical fracture rates were lower than expected in both groups but did not significantly differ for all clinical fractures ( odds ratio for fracture in supplemented group 1.01 , 95 % confidence interval 0.71 to 1.43 ) . The odds ratio for hip fracture was 0.75 ( 0.31 to 1.78 ) . The odds of a woman having a fall at six and 12 months was 0.99 and 0.98 , respectively . Quality of life did not significantly differ between the groups . Conclusion We found no evidence that calcium and vitamin D supplementation reduces the risk of clinical fractures in women with one or more risk factors for hip fracture . Registration IS RCT N26118436 , controlled trials registry Dairy foods are rich in bone-beneficial nutrients , yet the role of dairy foods in hip fracture prevention remains controversial . Our objective was to evaluate the association of milk , yogurt , cheese , cream , and milk + yogurt intakes with  incident hip fracture in the Framingham Original Cohort . A total of 830 men and women from the Framingham Original Cohort , a prospect i ve cohort study , completed a food-frequency question naire ( 1988 to 1989 ) and were followed for hip fracture until 2008 . In this population -based study , Cox-proportional hazards regression was used to estimate hazard ratios ( HR ) by categories of energy-adjusted dairy intake ( servings/wk ) , adjusting for st and ard confounders and covariates . The exposure was energy-adjusted intakes of milk , yogurt , cheese , cream , and milk + yogurt ( servings/wk ) . Risk of hip fracture over the follow-up was the primary outcome ; the hypothesis being tested was formulated after data collection . The mean age at baseline was 77 years ( SD 4.9 , range 68 to 96 ) . Ninety-seven hip fractures occurred over the mean follow-up time of 11.6 years ( range 0.04 to 21.9 years ) . The mean ± SD ( servings/wk ) of dairy intakes at baseline were : milk = 6.0 ± 6.4 ; yogurt = 0.4 ± 1.3 ; cheese = 2.6 ± 3.1 ; and cream = 3.4 ± 5.5 . Participants with medium ( > 1 and < 7 servings/wk ) or higher ( ≥7 servings/wk ) milk intake tended to have lower hip fracture risk than those with low ( ≤1 serving/wk ) intake ( high versus low intake HR 0.58 , 95 % confidence interval [ CI ] 0.31 - 1.06 , p = 0.078 ; medium versus low intake HR 0.61 , 95 % CI 0.36 - 1.08 , p = 0.071 ; p trend = 0.178 ] . There appeared to be a threshold for milk , with 40 % lower risk of hip fracture among those with medium/high milk intake compared with those with low intake ( p = 0.061 ) . A similar threshold was observed for  milk  + yogurt intake ( p = 0.104 ) . These associations were further attenuated after adjustment for femoral neck bone mineral density . No significant associations were seen for other dairy foods ( p range = 0.117 to 0.746 ) . These results suggest that greater intakes of milk and milk + yogurt may lower risk for hip fracture in older adults through mechanisms that are partially , but not entirely , attributable to effects on bone mineral density Summary Sunlight exposure by improving vitamin D status could be a simple public health strategy in reducing falls  among frail elder people . In a r and omised controlled trial , adherence to sunlight exposure was low ( median adherence , 26 % ) and no effect of increased UV exposure on falls risk was observed ( incidence rate ratio ( IRR ) 1.06 , P = 0.73 ) . Introduction This study aim ed to determine whether increased sunlight exposure was effective to improve vitamin D status and reduce falls in the elderly . Methods In a cluster r and omised controlled trial ( NCT00322166 at Clinical Trials.gov ) , 602 residents aged 70 or more ( mean age , 86.4 years ; 71 % female ) were recruited from 51 aged care facilities in Northern Sydney , Australia . Participants were r and omised by facility to receive either increased sunlight exposure ( additional 30–40 min/day in the early morning ) with ( UV+ ) or without ( UV ) calcium supplementation ( 600 mg/day ) or neither ( control ) for a year . The co- primary endpoints were change in serum 25 hydroxy vitamin D ( 25OHD ) and falls incidence after 12 months . Results  Adherence to sunlight exposure  was low ( median adherence , 26 % ; IQR , 7%–45 % ) . Serum 25OHD levels were low at baseline ( median , 32.9 nmol/L ) and increased only slightly depending on the number of sunlight sessions attended over 12 months ( P = 0.04 ) . During the study , 327 falls occurred in 111 ( 54 % ) subjects in the control group , 326 falls in 111 ( 58 % ) subjects in the UV only group and 335 falls in 108 ( 52 % ) subjects in the UV+ group . By intention-to-treat analysis , there was no significant effect of  increased UV exposure on falls risk ( IRR , 1.06 ; 95 % CI , 0.76–1.48 ; P = 0.73 ) . However , in 66 participants who attended ≥130 sessions per year ( adherence , ≥50 % of 260 sessions – five per week ) , falls were significantly reduced ( IRR , 0.52 ; 95 % CI , 0.31–0.88 ; P = 0.01 ) compared with the control group . Conclusions Increased sunlight exposure did not reduce vitamin D deficiency or falls risk in frail older people . This public health strategy was not effective most likely due to poor adherence to the intervention UNLABELLED Dietary supplementation with vitamin K(1 ) , with vitamin D(3 ) and calcium or their combination , was examined in healthy older women during a 2-year , double-blind , placebo-controlled trial . Combined vitamin K with vitamin D plus calcium was associated with a modest but significant increase in BMC at the ultradistal radius but not at other sites in the hip or radius . INTRODUCTION The putative beneficial role of high dietary vitamin K(1 ) ( phylloquinone ) on BMD and the possibility of interactive benefits with vitamin D were studied in a 2-year double-blind , placebo-controlled trial in healthy Scottish women > or = 60 years of age . MATERIAL S AND METHODS Healthy , nonosteoporotic women ( n = 244 ) were r and omized to receive either ( 1 ) placebo , ( 2 ) 200 microg/day vitamin K(1 ) , ( 3 ) 10 microg ( 400 IU ) vitamin D(3 ) plus 1000 mg calcium/day , or ( 4 ) combined vitamins K(1 ) and D(3 ) plus calcium . Baseline and 6-month measurements included DXA bone mineral scans of the hip and wrist , markers of bone turnover , and vitamin status . Supplementation effects were tested using multivariate general linear modeling , with full adjustment for baseline and potential confounding variables . RESULTS Significant bone mineral loss was seen only at the mid-distal radius but with no significant difference between groups . However , women who took combined vitamin K and vitamin D plus calcium showed a significant and sustained increase in both BMD and BMC at the site of the ultradistal radius . Serum status indicators responded significantly to respective supplementation with vitamins K and D. Over 2 years , serum vitamin K(1 ) increased by 157 % ( p < 0.001 ) , the percentage of undercarboxylated osteocalcin ( % GluOC ) decreased by 51 % ( p < 0.001 ) , serum 25-hydroxyvitamin D [ 25(OH)D ] increased by 17 % ( p < 0.001 ) , and PTH decreased by 11 % ( p = 0.049 ) . CONCLUSIONS These results provide evidence of a modest synergy in healthy older women from nutritionally relevant intakes of vitamin K(1 ) together with supplements of calcium plus moderate vitamin D(3 ) to enhance BMC at the ultradistal radius , a site consisting of principally trabecular bone . The substantial increase in gamma-carboxylation of osteocalcin by vitamin K may have long-term benefits and is potentially achievable by increased dietary intakes of vitamin K rather than by supplementation OBJECTIVE Bone fractures are an important cause of morbidity and mortality among the elderly in the US . The present study assesses the possible role of a number of risk factors for postmenopausal bone fractures .  METHODS We analysed the relationships of anthropometric , demographic and lifestyle factors  with the risk of bone fracture among 6250 postmenopausal women in a prospect i ve cohort study , the New York University Women 's Health Study . RESULTS After an average of 7.6 years of follow-up , 1025 new incident  bone fractures were reported , including 34 hip and 159 wrist fractures ( incidence rates ; 71.6 and 334.7 per 105 woman-years , respectively ) . The risk of fracture increased with increasing age , body height and total fat intake , while it was significantly lower among obese and African American women . The relative risk among African Americans was 0.45 ( 95 % CI : 0.32 - 0.63 ) compared with non-African Americans . Women taller than 170 cm had a 64 % increase in risk of fractures , as compared with those under 155 cm . These associations were generally more pronounced when fractures were limited to those at the hip and wrist . CONCLUSIONS The present study provides an indication for a potential role of dietary fat in the development of postmenopausal fractures and further evidence to support protective effects of obesity , short stature and African American ethnicity Dietary supplements that prevent bone loss at the hip and that can be applied safely in the elderly are likely to reduce hip fractures . A daily dietary supplement of 750 mg calcium or 15 microg 25OH vitamin D3 on bone loss at the hip and other sites , bone turnover and calcium-regulating hormones were studied over 4 yr in elderly volunteers using a r and omized , double-blind , placebo-controlled trial . Bone mineral density ( BMD ) was measured by dual x-ray absorptiometry and bone structure by radiographs . Calcium biochemistry and bone turnover markers were measured in blood and urine . The 316 women entering the trial had a mean age of 73.7 yr and the 122 men of 75.9 yr . Baseline median calcium intake was 546 mg/day , and median serum 25OH vitamin D3 was 59 nmol/L. On placebo , loss of BMD at total hip was 2 % and femoral medulla expansion was 3 % over 4 yr . Calcium reduced bone loss , secondary hyperparathyroidism , and bone turnover . 25OH vitamin D3 was intermediate between placebo and calcium . Fracture rates and drop-out rates were similar among groups , and there were no serious adverse events with either supplement . A calcium supplement of 750 mg/day prevents loss of BMD , reduces femoral medullary expansion , secondary hyperparathyroidism , and high bone turnover . A supplement of 15 microg/day 25OH vitamin D3 is less effective , and because its effects are seen only at low calcium intakes , suggests that its beneficial effect is to reverse calcium insufficiency OBJECTIVE The risk factors for fractures are incompletely understood . An outst and ing question concerns the optimal amount of dietary calcium needed to minimise the risk of fracture . DESIGN We examined the associations of dietary calcium and other nutrients with self-reported fracture risk in a prospect i ve cohort study . Nutrient intakes were estimated using a semi-quantitative food-frequency question naire administered at recruitment . SETTING The UK . PARTICIPANTS A total of 26 749 women and 7947 men aged 20 - 89 years . RESULTS Over an average of 5.2 years of follow-up , 1555 women and 343 men reported one or more fractures , 72 % of these result ing from a fall . Among women , fracture risk was higher at lower calcium intakes , with a relative risk of 1.75 ( 95 % confidence interval ( CI ) 1.33 - 2.29 ) among women with a calcium intake of < 525 mg day- 1 compared with women with a calcium intake of at least 1200 mg day- 1 ( test for linear trend , P < 0.001 ) . The association of  dietary calcium with fracture risk was stronger among women aged under 50 years at recruitment than among women aged 50 and above .  Dietary calcium intake was not associated with fracture risk in men . Fracture risk was not related to the dietary intake of any other nutrient examined . CONCLUSION In this population , women with a low dietary calcium intake had an increased risk of bone fracture , and this association was more marked among younger women than among older women 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 Abstract : This prospect i ve population -based cohort study investigated factors predicting  distal forearm fracture ( DFF ) in perimenopausal women . The study population consisted of 11 798 women from the Kuopio Osteoporosis Risk Factor and Prevention ( OSTPRE ) Study in Finl and . Mean baseline age of these women was 52.3 ( SD 2.9 ) years ( range 47–56 years ) and 68 % were postmenopausal . Three hundred and sixty-eight women ( 3.1 % ) had a vali date d DFF during the 5-year follow-up . Previous wrist fracture , postmenopausal state , age and nulliparity were independent predictors of DFF , while hormone replacement therapy ( HRT ) , dairy calcium and overweight protected against it in multivariate Cox regression analysis : previous wrist fracture increased the DFF risk by 158 % ( p<0.0001 ) , menopause by 69 % ( p= 0.002 ) and age by 6 % per year ( p= 0.010 ) , whereas the continuous use of HRT decreased the risk by 63 % ( p= 0.0001 ) , the use of dairy calcium at 1000–1499 mg/day ( vs < 500 mg/day ) by 39 % ( p= 0.004 ) , overweight ( BMI > 25 kg/m2 ) by 36 % ( p= 0.0002 ) and parity by 29 % ( p= 0.031 ) . Combining dichotomous low weight , low use of calcium , non-use of HRT and previous wrist fracture into a risk score gave a dose – response effect by score level : the presence ( vs absence ) of all four risk factors result ed in a 12-fold DFF risk . Nevertheless , the sensitivity and specificity of the score for detecting DFF remained low . It was concluded that HRT , high nutritional calcium intake and overweight protect against but a history of wrist fracture predisposes to perimenopausal distal forearm fracture . A simple risk factor inquiry would help to identify perimenopausal women at high risk of distal forearm fracture We tested the spine antifracture and bone sparing efficacy of 1.2 g/day of oral calcium as carbonate in two groups of elderly women , one with prevalent fractures ( PF , n = 94 ) on entry and the other without ( NPF , n = 103 ) . It was a prospect i ve r and omized , double-blind , placebo-controlled trial in mostly rural communities in women over age 60 who were living independently and were consuming < 1 g/day of calcium .  We obtained annual lateral spine radiographs  and semiannual forearm bone density  over 4.3 + /- 1.1 years and determined vertebral fractures by radiographic morphometry augmented by physician assessment . In the PF group , 15 of 53 subjects on calcium had incident fractures , compared with 21 of 41 on placebo ( p = 0.023 , chi2 ) . Calcium did not reduce the rate of incident fractures in the NPF group . Those with a prevalent fracture on entry and not treated with calcium were 2.8 times more likely to experience an incident fracture than all others . Change in the forearm bone mass on placebo in the PF group was -1.24 + /- 2.41%/year compared with + 0.31 + /- 1.80%/year on calcium ( p < 0.001 ) . In the NPF group , the difference was less : -0.39 + /- 2.08%/year versus 0.00 + /- 1.64%/year ( p = 0.2 ) . We conclude that in elderly postmenopausal women with spine fractures and selfselected calcium intakes of < 1 g/day , a calcium supplement of 1.2 g/day reduces the incidence of spine fractures and halts measurable bone loss This study was design ed to identify independent predictors of all osteoporosis-related fractures ( ORFs ) among healthy Saudi postmenopausal women . We prospect ively followed a cohort of 707 healthy postmenopausal women ( mean age , 61.3±7.2 years ) for 5.2±1.3 years . Data were collected on demographic characteristics , medical history , personal and family history of fractures , lifestyle factors , daily calcium intake , vitamin D supplementation , and physical activity score . Anthropometric parameters , total fractures ( 30.01 per 1000 women/year ) , special physical performance tests , bone turnover markers , hormone levels , and bone mineral density ( BMD ) measurements were performed . The final model consisted of seven independent predictors of ORFs : [ lowest quartile ( Q(1 ) ) vs highest quartile ( Q(4 ) ) ] physical activity score ( Q(1 ) vs Q(4 ) : ≤12.61 vs ≥15.38 ) ; relative risk estimate [ RR ] , 2.87 ; ( 95 % confidence interval [ CI ] : 1.88 - 4.38 ) ; age≥60 years vs age<60 years ( RR=2.43 ; 95 % CI : 1.49 - 3.95 ) ; h and grip strength ( Q(1 ) vs Q(4 ) : ≤13.88 vs ≥17.28 kg ) ( RR=1.88 ; 95 % CI : 1.15 - 3.05 ) ; BMD total hip ( Q(1 ) vs Q(4 ) : ≤0.784 vs 0.973 g/cm(2 ) ) ( RR=1.86 ; 95 % CI : 1.26 - 2.75 ) ; dietary calcium intake ( Q(1 ) vs Q(4 ) : ≤391 vs ≥648 mg/day ) ( RR=1.66 ; 95 % CI : 1.08 - 2.53 ) ; serum 25(OH)D ( Q(1 ) vs Q(4 ) : ≤17.9 vs ≥45.1 nmol/L ) ( RR=1.63 ; 95 % CI : 1.06 - 2.51 ) ; and past year history of falls ( RR=1.61 ; 95 % CI : 1.06 - 2.48 ) . Compared with having none ( 41.9 % of women ) , having three or more clinical risk factors ( 4.8 % of women ) increased fracture risk by more than 4-fold , independent of BMD . Having three or more risk factors and being in the lowest tertile of T-score of [ total hip/lumbar spine ( L1-L4 ) ] was associated with a 14.2-fold greater risk than having no risk factors and being in the highest T-score tertile . Several clinical risk factors were independently associated with all ORFs in healthy Saudi postmenopausal women . The combination of multiple clinical risk factors and low BMD is a very powerful indicator of fracture risk As part of a prospect i ve study begun in 1981 , we evaluated 8,600 postmenopausal women and 5,049 men residing in a southern California retirement community for risk factors for hip fracture . Incidence rates were twice as high in women as in men , but in both sexes the rates nearly doubled every 5 years between 70 and 90 years . Active exercise was strongly and negatively associated with hip fracture risk in both sexes ; the age-adjusted relative risk was 0.6 and 0.5 for females and males , respectively , for 1 or more hours of exercise per day compared with less than 1/2 hour of exercise . A high body mass index ( upper tertile of weight divided by height squared ) was associated with a strong reduction in hip fracture risk for females ( RR = 0.5 ) . Current cigarette smokers had a significantly increased risk ( RR = 1.8 and RR = 2.2 for females and males , respectively ) compared with never-smokers , but the risk for past smokers was not different from that of lifetime nonsmokers . Other factors related to reduced hip fracture risk in women were high parity , late age at menarche , and long menstrual cycle length . These age-adjusted relative risk estimates did not change material ly in multivariate analysis when adjusted simultaneously for age , active exercise , body mass , smoking , and , for women , age at menarche and number of children . Among estrogen users , the lowest risk of hip fracture was observed for recent users ( RR = 0.8 ) , while users who had stopped estrogen use 15 or more years ago had a relative risk of 1.1 , suggesting that the protective effect of estrogen dissipates after many years since cessation of estrogen BACKGROUND The efficacy of calcium with vitamin D supplementation for preventing hip and other fractures in healthy postmenopausal women remains equivocal . METHODS We recruited 36,282 postmenopausal women , 50 to 79 years of age , who were already enrolled in a Women 's Health Initiative ( WHI ) clinical trial . We r and omly assigned participants to receive 1000 mg of elemental [ corrected ] calcium as calcium carbonate with 400 IU of vitamin D3 daily or placebo .  Fractures were ascertained for an average follow-up period of 7.0 years . Bone density was measured at three WHI centers . RESULTS Hip bone density was 1.06 percent higher in the calcium plus vitamin D group than in the placebo group ( P<0.01 ) . Intention-to-treat analysis indicated that participants receiving calcium plus vitamin D supplementation had a hazard ratio of 0.88 for hip fracture ( 95 percent confidence interval , 0.72 to 1.08 ) , 0.90 for clinical spine fracture ( 0.74 to 1.10 ) , and 0.96 for total fractures ( 0.91 to 1.02 ) . The risk of renal calculi increased with calcium plus vitamin D ( hazard ratio , 1.17 ; 95 percent confidence interval , 1.02 to 1.34 ) . Censoring data from women when they ceased to adhere to the study medication reduced the hazard ratio for hip fracture to 0.71 ( 95 percent confidence interval , 0.52 to 0.97 ) . Effects did not vary significantly according to prer and omization serum vitamin D levels . CONCLUSIONS Among healthy postmenopausal women , calcium with vitamin D supplementation result ed in a small but significant improvement in hip bone density , did not significantly reduce hip fracture , and increased the risk of kidney stones . ( Clinical Trials.gov number , NCT00000611 . ) This prospect i ve population -based study assessed predictors of hip fracture risk in white men . Participants were members of the Epidemiologic Follow-up Study cohort of the First National Health and Nutrition Examination Survey , a nationally representative sample of noninstitutionalized civilians who were followed for a maximum of 22 years . A cohort of 2879 white men ( 2249 in the nutrition and weight-loss sub sample , 1437 in the bone density sub sample ) aged 45 - 74 years at baseline ( 1971 - 1975 ) were observed through 1992 . Ninety-four percent of the original cohort were successfully traced . Hospital records and death certificates were used to identify a total of 71 hip fracture cases ( 61 in the nutrition and weight-loss sub sample , 26 in the bone-density sub sample ) . Among the factors evaluated were age at baseline , previous fractures other than hip , body mass index , smoking status , alcohol consumption , nonrecreational physical activity , weight loss from maximum , calcium intake , number of calories , protein consumption , chronic disease prevalence , and phalangeal bone density . The risk adjusted relative risk ( RR ) of hip fracture was significantly associated with presence of one or more chronic conditions ( RR = 1.91 , 95 % confidence interval [ CI ] = 1.19 - 3.06 ) , weight loss from maximum > or = 10 % ( RR = 2.27 , 95 % CI 1.13 - 4.59 ) , and 1 SD change in phalangeal bone density ( RR = 1.73 , 95 % CI 1.11 - 2.68 ) . No other variables were significantly related to hip fracture risk . Although based on a small number of cases , this is one of the first prospect i ve studies to relate weight loss and bone density to hip fracture risk in men Most reported associations in observational clinical research are false , and the minority of associations that are true are often exaggerated . This credibility problem has many causes , including the failure of authors , review ers , and editors to recognize the inherent limitations of these studies . This issue is especially problematic for weak associations , variably defined as relative risks ( RRs ) or odds ratios ( ORs ) less than 4 . Such associations , commonly reported in the medical literature , are more likely to be attributable to bias than to causal association . All observational research has bias ( which can include selection , information , and confounding bias ) . Hence , detection of small associations falls below the discriminatory ability of observational studies . In general , unless RRs in cohort studies exceed 2 to 3 or ORs in case-control studies exceed 3 or 4 , associations in observational research findings should not be considered credible . However , these guidelines are not foolproof : strong ( yet spurious ) associations can result when large amounts of bias are present . Only in a properly performed r and omized controlled trial , free of bias , should small associations merit attention . Better training and more circumspection on the part of investigators , tougher editorial st and ards on the part of journals , and hefty skepticism on the part of referees and readers are necessary to avoid the dangers of false alarms , pseudo-epidemics , and their unfortunate consequences UNLABELLED We examined determinants of  nonvertebral fracture in elderly men from six U.S. communities followed an average of 4.1 years . Six clinical risk factors predicted fracture risk independent of hip BMD : tricyclic antidepressant use , previous fracture , inability to complete a narrow walk trial , falls in previous year , age > or = 80 years , and depressed mood . INTRODUCTION There are few prospect i ve studies of fracture determinants in men . We examined the associations between a comprehensive set of clinical risk factors and risk of nonspine fracture in older men and whether determinants of fracture risk were independent of total hip BMD . MATERIAL S AND METHODS A total of 5995 men > or = 65 years of age were recruited from six communities in the Unites States and followed prospect ively for an average of 4.1 years . Baseline assessment s of demographic , lifestyle , medical history , functional status , anthropometry , and cognitive , visual , and neuromuscular function were assessed by question naire or examination . Triannual mailed question naires ascertained incident fracture ; reported fractures were adjudicated by physicians using medical records and X-ray reports . Proportional hazards models were used to develop multivariable models , selecting variables and controlling for BMD . RESULTS Of 5876 men , 4.7 % ( N = 275 ) reported an incident nonspine fracture during follow-up ( 11.46/1000 person-years ) .  Tricyclic antidepressant use ( hazard ratio [ HR ] , 2.36 ; 95 % CI , 1.25 - 4.46 ) , history of fracture at or after age 50 ( HR , 2.07 ; 95 % CI , 1.62 - 2.65 ) , inability to complete a narrow walk trial ( HR , 1.70 ; 95 % CI , 1.23 - 2.34 ) , falls in previous year ( HR , 1.59 ; 95 % CI , 1.23 - 2.05 ) , age > or = 80 years ( HR , 1.33 ; 95 % CI , 1.01 - 1.76 ) , depressed mood ( HR , 1.72 ; 95 % CI , 1.00 - 2.95 ) , and decreased total hip BMD ( HR , 1.53 ; 95 % CI , 1.34 - 1.74 ) were independently related to increased risk . Compared with having none ( 48.0 % of men ) , having three or more of the clinical risk factors ( 4.9 % of men ) increased fracture risk 5-fold , independent of BMD . Having three or more risk factors and being in the lowest tertile of BMD was associated with a 15-fold greater risk than having no risk factors and being in the highest BMD tertile . CONCLUSIONS Several clinical risk factors were independently associated with nonspine fractures in elderly men . The combination of multiple risk factors and low BMD was a very powerful indicator of fracture risk BACKGROUND Data on the influence of gonadal hormones on incident fracture risk in elderly men are limited . We prospect ively examined the relationship between serum levels of testosterone and estradiol and future fracture risk in community-dwelling men . METHODS A total of 609 men older than 60 years had been observed between January 1989 and December 2005 , with the median duration being 5.8 years ( up to 13 years ) . Clinical risk factors , including bone mineral density and lifestyle factors , were assessed at baseline .  Serum testosterone and estradiol levels were measured by t and em mass spectrometry . The incidence of a low-trauma fracture was ascertained during follow-up . RESULTS During follow-up , 113 men had at least 1 low-trauma fracture . The risk of fracture was significantly increased in men with reduced testosterone levels ( hazard ratio [ HR ] , 1.33 ; 95 % confidence interval [ CI ] , 1.09 - 1.62 ) . After adjustment for sex hormone-binding globulin , serum testosterone ( HR , 1.48 ; 95 % CI , 1.22 - 1.78 ) and serum estradiol ( HR , 1.21 ; 95 % CI , 1.00 - 1.47 ) levels were associated with overall fracture risk . After further adjustment for major risk factors of fractures ( age , weight or bone mineral density , fracture history , smoking status , calcium intake , and sex hormone-binding globulin ) , lower testosterone was still associated with increased risk of fracture , particularly with hip ( HR , 1.88 ; 95 % CI , 1.24 - 2.82 ) and nonvertebral ( HR , 1.32 ; 95 % CI , 1.03 - 1.68 ) fractures . CONCLUSION In community-dwelling men older than 60 years , serum testosterone is independently associated with the risk of osteoporotic fracture and its measurement may provide additional clinical information for the assessment of fracture risk in elderly men Objective To determine the effect of calcium supplementation on myocardial infa rct ion , stroke , and sudden death in healthy postmenopausal women . Design R and omised , placebo controlled trial . Setting Academic medical centre in an urban setting in New Zeal and . Participants 1471 postmenopausal women ( mean age 74 ) : 732 were r and omised to calcium supplementation and 739 to placebo .  Main outcome measures Adverse cardiovascular events over five years : death , sudden death , myocardial infa rct ion , angina , other chest pain , stroke , transient ischaemic attack , and a composite end point of myocardial infa rct ion , stroke , or sudden death . Results Myocardial infa rct ion was more commonly reported in the calcium group than in the placebo group ( 45 events in 31 women v 19 events in 14 women , P=0.01 ) . The composite end point of myocardial infa rct ion , stroke , or sudden death was also more common in the calcium group ( 101 events in 69 women v 54 events in 42 women , P=0.008 ) . After adjudication myocardial infa rct ion remained more common in the calcium group ( 24 events in 21 women v 10 events in 10 women , relative risk 2.12 , 95 % confidence interval 1.01 to 4.47 ) . For the composite end point 61 events were verified in 51 women in the calcium group and 36 events in 35 women in the placebo group ( relative risk 1.47 , 0.97 to 2.23 ) . When unreported events were added from the national data base of hospital admissions in New Zeal and the relative risk of myocardial infa rct ion was 1.49 ( 0.86 to 2.57 ) and that of the composite end point was 1.21 ( 0.84 to 1.74 ) . The respective rate ratios were 1.67 ( 95 % confidence intervals 0.98 to 2.87 ) and 1.43 ( 1.01 to 2.04 ) ; event rates : placebo 16.3/1000 person years , calcium 23.3/1000 person years . For stroke ( including unreported events ) the relative risk was 1.37 ( 0.83 to 2.28 ) and the rate ratio was 1.45 ( 0.88 to 2.49 ) . Conclusion Calcium  supplementation in healthy postmenopausal women is associated with upward trends in cardiovascular event rates . This potentially detrimental effect should be balanced against the likely benefits of calcium on bone . Trial registration Australian Clinical Trials Registry ACTRN 012605000242628 Background Despite the availability of effective preventive and curative medications for osteoporosis , and guidelines for its diagnosis and management , few individuals are treated for osteoporosis , even among those who have already had a fracture . Objectives Our objective was to describe the patterns of use of medication for osteoporosis , i.e. , calcium supplements , vitamin D supplements , and specific anti-osteoporotic drugs , such as bisphosphonates , in a large sample of French older women living at home , and to identify individual factors associated with use of these medications overall and in two specific clinical situations . Methods Cross-sectional analysis of data from 4,221 women aged 75–85 years who participated in a balance and mobility examination as part of the screening procedure for the Ossébo study , a r and omized controlled trial testing the effectiveness of exercise for the prevention of fall-related injuries .  Electoral rolls  were used to invite women in 16 towns to participate ( participation rate 10.3 % ) . Information collected through question naires included current medication use and , in particular , use of osteoporosis medications ( specific osteoporosis drugs , calcium and vitamin D supplementation ) in the past 6 months , and history of fracture since the age of 50 , including fracture locations . Fractures were categorized in three groups : no fracture , major osteoporotic fracture ( hip , humerus , wrist , pelvis , and vertebra ) , and other fracture . Results Nearly 48 % of the participants reported they did not take calcium or vitamin D supplements or any specific  osteoporosis drugs  . Of the 2,133 women who reported using osteoporosis medication , 85 % used  vitamin D supplements ( 25 % as the sole medication against this disease ) , 59 % calcium supplements , and 42 % a specific anti-osteoporotic drug ( 75 % of them combining it with vitamin D supplementation ) . The use of any osteoporosis medication was significantly associated ( p < 0.001 ) with a history of a major osteoporotic fracture , lower weight , dual-energy X-ray absorptiometry ( DXA ) bone-density measurement in the past 5 years , a cancer-screening examination in the past 5 years , and a positive attitude toward medication use in general . Living alone was associated with a lower likelihood of using a specific anti-osteoporotic drug  , and a higher education level was associated with a higher likelihood of vitamin D supplementation . Of the 1,553 women who had already had a major osteoporotic fracture , one-third ( 34.8 % ) were not taking any osteoporosis medication . In this subgroup , use of this medication was associated with the same factors as in the overall study population . In particular , neither older age nor a history of falls in the previous 12 months was associated with a higher likelihood of using osteoporosis medication . Among the 909 women who reported using a specific osteoporosis drug , vitamin D use was associated with a higher educational level and a more frequent preventive attitude . Conclusion In France , as in other western countries , women aged 75 years and over are not managed according to guidelines . Further studies should address the barriers encountered in improving quality of care in osteoporosis management UNLABELLED Independent risk factors for osteoporotic fracture were identified for a Southern Chinese postmenopausal population .  Clinical risk factor assessment with or without BMD measurement was shown to be an effective predictor of 10-yr risk of osteoporotic fracture and provides a more accessible tool for patient evaluation . INTRODUCTION Asian-specific data on risk factors for osteoporosis remain sparse . However , risk factor assessment , in addition to BMD measurement , is increasingly recognized as a reliable predictor of absolute osteoporotic fracture risk . The purpose of this prospect i ve study was to determine the specific independent risk factors for osteoporotic fracture and to predict the 10-yr risk of osteoporotic fracture in the postmenopausal Southern Chinese population . MATERIAL S AND METHODS A total of 1435 community-dwelling , postmenopausal , treatment-naive women were recruited . Baseline demographic characteristics and clinical risk factors were obtained , and  BMD at the spine and  hip  was measured . Subjects were followed for outcomes of incident low trauma fracture . Ten-year risk of osteoporotic fracture was predicted from the risk factor assessment and BMD measurement by Cox proportional hazards models . RESULTS The mean age of subjects was 63.4 + /- 8.3 yr . After 5.0 + /- 2.3 yr ( range , 1.0 - 11.0 yr ) of follow-up , 80 nontraumatic new fractures were reported during follow-up . Eight independent clinical risk factors identified at baseline were found to be significant predictors of osteoporotic fracture , with the most important being use of walking aids ( RR , 4.2 ; 95 % CI , 2.7 - 6.7 ; p < 0.001 ) and a history of fall ( RR , 4.0 ; 95 % CI , 2.5 - 6.2 ; p < 0.001 ) . Other predictive factors included being homebound , calcium intake < 400 mg/d , age > 65 yr , history of fracture , and BMI < 19 kg/cm(2 ) . Subjects with three to eight clinical risk factors had a predicted 10-year risk of osteoporotic fracture of 25 % , which increased to 30 % if they also had total hip BMD T-score < or= -2.5 . CONCLUSIONS Clinical risk factor assessment , with or without BMD measurement  , is a reliable predictor of 10-year risk of osteoporotic fracture and may be particularly useful in regions or primary care clinics without access to bone densitometry equipment The efficacy of calcium ( Ca ) in reducing bone loss is debated . In a r and omized placebo-controlled double-masked study , we investigated the effects of oral Ca supplements on femoral shaft ( FS ) , femoral neck ( FN ) and lumbar spine ( LS ) bone mineral density ( BMD ) , and on the incidence of vertebral fracture in vitamin-D-replete elderly . Ninety-three healthy subjects ( 72.1±0.6 years ) were r and omly allocated to three groups receiving 800 mg/day Ca in two different forms or a placebo for 18 months . Sixty-three patients ( 78.4±1.0 years ) with a recent hip fracture were allocated to two groups receiving the two forms of Ca without placebo . FS BMD changes in Ca-supplemented non-fractured women were significantly different from those in the placebo group ( + 0.6±0.5 % v −1.2±0.7%,p<0.05 ) . There was no difference in effect between the two forms of Ca . The changes of + 0.7±0.8 % v −1.7±1.6 % in FN BMD of Ca-supplemented women and the placebo group did not reach statistical significance . In fractured patients , FS , FN and LS BMD changes were −1.3±0.8 , + 0.3±1.6 and + 3.1±1.2 % ( p<0.05 for the last ) . The rate of new vertebral fractures was 74.3 and 106.2 fractures per 1000 patient-years in Ca-supplemented non-fractured subjects and in the placebo group , respectively , and 144.0 in Ca-supplemented fractured patients . Thus , oral Ca supplements prevented a femoral BMD decrease and lowered vertebral fracture rate in the elderly Abstract : This prospect i ve study was aim ed at determining the risk factors for the development of fractures in perimenopausal women . The study group ( n= 3068 ) was comprised of a stratified population sample of women aged between 47 and 56 years . During the follow-up period of 3.6 years , 257 ( 8.4 % ) of the women sustained a total of 295 fractures . After adjustment for covariates , the relative risk ( RR ) of sustaining a fracture was found to be 1.4 [ 95 % confidence interval ( CI ) 1.2–1.6 ] for a 1 st and ard deviation ( SD ) decrease in the spinal and femoral neck bone mineral density ( BMD ) . Women with a previous fracture history were found to have an increased risk of fracture [ RR 1.7 ( 95 % CI 1.3–2.2 ) ] and those reporting three or more chronic illnesses exhibited a RR of 1.4 ( 95 % CI 1.0–1.9 ) . Women not using hormone replacement therapy ( HRT ) had a RR of 1.5 ( 95 % CI 1.1–2.2 ) for all fracture types . When osteoporotic fractures ( vertebral , hip , proximal humerus and wrist fractures ; n= 98 ) were used as an endpoint , the independent risk factors were found to be a low BMD ( RR for a 1 SD decrease in both spinal and femoral neck BMD was 1.6 , 95 % CI 1.3–2.0 ) , a previous fracture history ( RR 1.9 , 95 % CI 1.3–2.9 ) and nonuse of HRT ( RR 2.2 , 95 % CI 1.3–4.0 ) . The independent risk factors for all other fractures ( n = 158 ) were a low BMD ( RR for a 1 SD decrease in the spinal BMD was 1.4 , 95 % CI 1.2–1.6 and in the femoral neck BMD was 1.3 , 95 % CI 1.1–1.5 ) , a previous fracture history ( RR 1.6 , 95 % CI 1.1–2.2 ) , smoking ( RR 1.8 , 95 % CI 1.1–2.7 ) and having had three or more chronic illnesses ( RR 1.6 , 95 % CI 1.1–2.2 ) . Weight , height , age , menopausal status , maternal hip fracture , use of alcohol , coffee consumption or dietary calcium intake were not independently associated with the development of any particular type of fracture . We conclude that the independent risk factors for perimenopausal fractures are a low bone density , previous fracture history , nonuse of HRT , having had three or more chronic illnesses and smoking , the gradient of risk being similar for spinal and femoral neck BMD measurements in the perimenopausal population . The risk factors are slightly different for perimenopausal osteoporotic than for other types of fractures BACKGROUND The use of calcium supplements slows bone loss in the forearm and has a beneficial effect on the axial bone density of women in late menopause whose calcium intake is less than 400 mg per day . However , the effect of a calcium supplement of 1000 mg per day on the axial bone density of postmenopausal women with higher calcium intakes is not known . METHODS We studied 122 normal women at least three years after they had reached menopause who had a mean dietary calcium intake of 750 mg per day . The women were r and omly assigned to treatment with either calcium ( 1000 mg per day ) or placebo for two years . The bone mineral density of the total body , lumbar spine , and proximal femur was measured every six months by dual-energy x-ray absorptiometry .  Serum and urine indexes of calcium metabolism were measured at base line and after 3 , 12 , and 24 months . RESULTS The mean ( + /- SE ) rate of loss of total-body bone mineral density was reduced by 43 percent in the calcium group ( -0.0055 + /- 0.0010 g per square centimeter per year ) as compared with the placebo group ( -0.0097 + /- 0.0010 g per square centimeter per year , P = 0.005 ) . The rate of loss of bone mineral density was reduced by 35 percent in the legs ( P = 0.02 ) , and loss was eliminated in the trunk ( P = 0.04 ) . Calcium use was of significant benefit in the lumbar spine ( P = 0.04 ) , and in Ward 's triangle the rate of loss was reduced by 67 percent ( P = 0.04 ) . Calcium supplementation had a similar effect whether dietary calcium intake was above or below the mean value for the group . Serum parathyroid hormone concentrations tended to be lower in the calcium group , as were urinary hydroxyproline excretion and serum alkaline phosphatase concentrations . CONCLUSIONS Calcium supplementation significantly slowed axial and appendicular bone loss in normal post-menopausal women BACKGROUND Hypovitaminosis D and a low calcium intake contribute to increased parathyroid function in elderly persons .  Calcium and vitamin D supplements reduce this secondary hyperparathyroidism , but whether such supplements reduce the risk of hip fractures among elderly people is not known . METHODS We studied the effects of supplementation with vitamin D3 ( cholecalciferol ) and calcium on the frequency of hip fractures and other nonvertebral fractures , identified radiologically , in 3270 healthy ambulatory women ( mean [ + /- SD ] age , 84 + /- 6 years ) . Each day for 18 months , 1634 women received tricalcium phosphate ( containing 1.2 g of elemental calcium ) and 20 micrograms ( 800 IU ) of vitamin D3 , and 1636 women received a double placebo . We measured serial serum parathyroid hormone and 25-hydroxyvitamin D ( 25(OH)D ) concentrations in 142 women and determined the femoral bone mineral density at base line and after 18 months in 56 women . RESULTS Among the women who completed the 18-month study , the number of hip fractures was 43 percent lower ( P = 0.043 ) and the total number of nonvertebral fractures was 32 percent lower ( P = 0.015 ) among the women treated with vitamin D3 and calcium than among those who received placebo . The results of analyses according to active treatment and according to intention to treat were similar . In the vitamin D3-calcium group , the mean serum parathyroid hormone concentration had decreased by 44 percent from the base-line value at 18 months ( P < 0.001 ) and the serum 25(OH)D concentration had increased by 162 percent over the base-line value ( P < 0.001 ) . The bone density of the proximal femur increased 2.7 percent in the vitamin D3-calcium group and decreased 4.6 percent in the placebo group ( P < 0.001 ) . CONCLUSIONS Supplementation with vitamin D3 and calcium reduces the risk of hip fractures and other nonvertebral fractures among elderly women BACKGROUND Increased dietary calcium intake has been proposed as a population -based public health intervention to prevent osteoporotic fractures . We have examined whether calcium supplementation decreases clinical fracture risk in elderly women and its mechanism of action . METHODS Five-year , double-blind , placebo-controlled study of 1460 women recruited from the population and older than 70 years ( mean age , 75 years ) who were r and omized to receive calcium carbonate , 600 mg twice per day , or identical placebo .  The primary end points included clinical incident osteoporotic fractures , vertebral deformity , and adverse events ascertained in 5 years . Bone structure was also measured using dual x-ray absorptiometry of the hip and whole body , quantitative ultrasonography of the heel , and peripheral quantitative computed tomography of the distal radius . RESULTS Among our patients , 16.1 % sustained 1 or more clinical osteoporotic fractures . In the intention-to-treat analysis , calcium supplementation did not significantly reduce fracture risk ( hazard ratio , 0.87 ; 95 % confidence interval , 0.67 - 1.12 ) . However , 830 patients ( 56.8 % ) who took 80 % or more of their tablets ( calcium or placebo ) per year had reduced fracture incidence in the calcium compared with the placebo groups ( 10.2 % vs 15.4 % ; hazard ratio , 0.66 ; 95 % confidence interval , 0.45 - 0.97 ) . Calcium-treated patients had improved quantitative ultrasonography findings of the heel , femoral neck and whole-body dual x-ray absorptiometry data , and bone strength compared with placebo-treated patients . Of the 92 000 adverse events recorded , constipation was the only event increased by the treatment ( calcium group , 13.4 % ; placebo group , 9.1 % ) . CONCLUSION Supplementation with calcium carbonate tablets supplying 1200 mg/d is ineffective as a public health intervention in preventing clinical fractures in the ambulatory elderly population owing to poor long-term compliance , but it is effective in those patients who are compliant UNLABELLED To identify risk factors for fractures in multi-ethnic women , we studied 159,579 women enrolled in the Women 's Health Initiative . In general , risk factors for fractures were similar across ethnic groups . However , irrespective of their ethnicity , women with multiple risk factors have a high risk of fracture . Targeting these high-risk women for screening and intervention could reduce fractures . INTRODUCTION Fracture rates tend to be lower in minority women , but consequences may be greater . In addition , the number of fractures is expected to increase in minority women because of current demographic trends . There are limited prospect i ve data on risk factors for fractures in minority women . MATERIAL S AND METHODS We studied 159,579 women 50 - 79 yr of age enrolled in the Women 's Health Initiative . Information on risk factors was obtained by question naire or examination . Nonspine fractures that occurred after study entry were identified over an average follow-up of 8 + /- 2.6 ( SD ) yr . RESULTS Annualized rates ( % ) of fracture in whites , blacks , Hispanics , Asians , and American Indians were 2.0 , 0.9 , 1.3 , 1.2 , and 2.0 , respectively . Significant predictors [ HR ( 95 % CI ) ] of fractures by ethnic group were as follows : blacks : at least a high school education , 1.22 ( 1.0 , 1.5 ) ; ( + ) fracture history , 1.7 ( 1.4 , 2.2 ) ; and more than two falls , 1.7 ( 1.9 , 2.0 ) ; Hispanics : height ( > 162 cm ) , 1.6 ( 1.1 , 2.2 ) ; ( + ) fracture history , 1.9 ( 1.4 , 2.5 ) ; more than two falls , 1.8 ( 1.4 , 2.3 ) ; arthritis , 1.3 ( 1.1 , 1.6 ) ; corticosteroid use , 3.9 ( 1.9 , 8.0 ) ; and parental history of fracture , 1.3 ( 1.0 , 1.6 ) ; Asians : age ( per 5 yr ) , 1.2 ( 1.0 , 1.3 ) ; ( + ) fracture history , 1.5 ( 1.1 , 2.0 ) ; current hormone therapy ( HT ) , 0.7 ( 0.5 , 0.8 ) ; parity ( at least five ) , 1.8 ( 1.1 , 3.0 ) ; more than two falls , 1.4 ( 1.1 , 1.9 ) ; American Indian : ( + ) fracture history , 2 . 9 ( 1.5 , 5.7 ) ; current HT , 0.5 ( 0.3 , 0.9 ) . Women with eight or more risk factors had more than a 2-fold higher rate of fracture compared with women with four or fewer risk factors . Two ethnicity x risk factor interactions were identified : age and fall history . CONCLUSIONS Irrespective of their ethnicity , women with multiple risk factors have a high risk of fracture . Targeting these high-risk women for screening and intervention could reduce fractures Antifracture efficacy of high-dose vitamin D ( 800 IU ) and calcium ( 1000 mg ) remains controversial . To determine whether daily 800 IU of vitamin D and 1000 mg of calcium supplementation prevents fractures , we r and omized 3432 women of the population -based Osteoporosis Risk Factor and Prevention ( OSTPRE ) Study cohort ( ages 65 to 71 years ) living in the region of northern Savonia , Finl and ( latitude 62 degrees to 64 degrees N ) for 3 years to receive 800 IU of cholecalciferol and 1000 mg of calcium as calcium carbonate or to a control group that did not receive placebo . The main outcome measure was incident fractures . Fracture data were collected in telephone interviews and vali date d. Data on 3195 women , 1586 in the intervention group and 1609 in the control group , were available for analysis . In adjusted Cox proportional hazards models , the risk of any fracture decreased in the vitamin D and calcium group by 17 % [ adjusted hazard ratio ( aHR ) = 0.83 ; 95 % confidence interval ( CI ) 0.61 - 1.12 ] , and the risk of any nonvertebral fracture decreased by 13 % ( aHR = 0.87 ; 95 % CI 0.63 - 1.19 ) . The risk of distal forearm fractures decreased by 30 % ( aHR = 0.70 ; 95 % CI 0.41 - 1.20 ) , and the risk of any upper extremity fractures decreased by 25 % ( aHR = 0.75 ; 95 % CI 0.49 - 1.16 ) , whereas the risk of lower extremity fractures remained essentially equal ( aHR = 1.02 ; 95 % CI 0.58 - 1.80 ) . None of these effects reached statistical significance . In conclusion , this study did not produce statistically significant evidence that vitamin D and calcium supplementation prevents fractures in a 65- to 71-year-old general population of postmenopausal women Objective This study aims to test the added value of calcium and vitamin D ( CaD ) in fracture prevention among women taking postmenopausal hormone therapy ( HT ) . Methods This is a prospect i ve , partial-factorial , r and omized , controlled , double-blind trial among Women ’s Health Initiative postmenopausal participants aged 50 to 79 years at 40 centers in the United States with a mean follow-up of 7.2 years . A total of 27,347 women were r and omized to HT ( 0.625 mg of conjugated estrogens alone , or 0.625 mg of conjugated equine estrogens plus 2.5 mg of medroxyprogesterone acetate daily ) , and 36,282 women were r and omized to 1,000 mg of elemental calcium ( carbonate ) plus 400 IU of vitamin D3 daily , each compared with placebo .  A total of 16,089 women participated in both arms . The predefined outcomes were adjudicated hip fractures and measured bone mineral density . Results Interaction between HT and CaD on hip fracture ( P interaction = 0.01 ) was shown . The effect of CaD  was stronger among women assigned to HT ( hazard ratio [ HR ] , 0.59 ; 95 % CI , 0.38 - 0.93 ) than among women assigned to placebo ( HR , 1.20 ; 95 % CI , 0.85 - 1.69 ) . The effect of HT on hip fracture was stronger among women assigned to active CaD ( HR , 0.43 ; 95 % CI , 0.28 - 0.66 ) than among women assigned to placebo ( HR , 0.87 ; 95 % CI , 0.60 - 1.26 ) . CaD supplementation enhanced the antifracture effect of HT at all levels of personal calcium intake . There was no interaction between HT and  CaD  on change in hip or spine bone mineral density .  Conclusions Postmenopausal women at normal risk for hip fracture who are on CaD supplementation  experience significantly reduced incident hip fractures beyond HT alone at all levels of personal baseline total calcium intake We assessed the rates of vertebral fracture in patients with postmenopausal osteoporosis . Forty-five patients were not treated ( 91 person-years of observation ) ; 59 were treated conventionally , with calcium ( alone or combined with estrogen ) or vitamin D or both ( 218 years ) ; and 61 were treated with sodium fluoride combined with conventional therapy ( 251 years ) . The fracture rate ( per thous and person-years ) was 834 in untreated patients , 419 in those given calcium with or without vitamin D , 304 in those given fluoride and calcium with or without vitamin D , 181 in those given estrogen and calcium with or without vitamin D , and 53 in those given fluoride , estrogen , and calcium with or without vitamin D. It was reduced in all treatment groups ( P less than 0.001 for calcium and P less than 1 x 10(-6 ) for other combinations ) ; fluoride ( one years of treatment ) and estrogen ( but not vitamin D ) independently reduced the rate from that observed with calcium alone ( P less than 0.001 ) . The combination of calcium fluoride , and estrogen was more effective than any other combination ( P less than 0.001 ) . These results provide grounds for optimism about the efficacy of combinations of available agents with  sodium fluoride  for fracture in postmenopausal osteoporosis Summary Daily treatment with 30 mg of sodium fluoride ( NaF ) and 1 g of calcium over a 3-year period increased the bone mineral content ( BMC ) in the spines of women ( n=25 ) with osteoporosis . Determination of the BMC was followed with dual photon absorptiometry ( 137Cs-241Am ) in the third lumbar vertebra . No increase in BMC was found with only 10 mg sodium fluoride in combination with calcium ( n=25 ) , with calcium alone ( n=25 ) , or with placebo ( n=25 ) . No serious side effects were registered . There was , however , minor gastrointestinal distress in one-fifth of the patients taking 30 mg NaF daily We report a 4-year r and omized , double-blind , placebo-controlled clinical trial in 236 normal postmenopausal women ( mean age + /- SE , 66.3+/-0.2 years ) who were r and omized to a calcium ( 1600 mg/day as the citrate ) or placebo group .  The women were seen every 6 months ; 177 completed the trial . Net percentage changes in each group are given relative to baseline . The differences in net percentage changes ( calcium group minus placebo group ) in medians were : for lumbar spine bone density , 2.0 % ( p < 0.001 ) at year 1 and 0.3 % ( not significant ) at year 4 ; for proximal femur bone density , 1.3 % ( p = 0.003 ) at year 1 and 1.3 % ( p = 0.015 ) at year 4 ; and for total body bone mineral , 0.4 % ( p = 0.002 ) at year 1 and 0.9 % ( p = 0.017 ) at year 4 . Similar differences at year 4 were : -18.9 % ( p = 0.002 ) for parathyroid hormone ( PTH ) , -11.9 % ( p = 0.026 ) for serum osteocalcin , and -32.2 % ( p = 0.003 ) for urine free pyridinoline . We conclude that long-term administration of calcium supplements  to elderly women partially reverses age-related increases in serum PTH level and bone resorption and decreases bone loss . However , the effects on bone loss were weaker than those reported for estrogen , bisphosphonates , or calcitonin therapy , indicating that calcium supplements alone can not substitute for these in treating established osteoporosis . Nonetheless , because of their safety , high tolerance , and low expense , calcium supplements may be a useful preventive measure for elderly postmenopausal women whose bone mineral density values are normal for their age The Chinese diet is low in calcium ( less than 500 mg/day on average ) , and previous observational studies have suggested an association between a low calcium intake and risk of hip and vertebral fracture . In this study , we r and omly assigned 200 postmenopausal Chinese women ( age range , 55 - 59 years ) to receive 50 g of milk powder containing 800 mg of calcium per day or to a control group . The following are the mean percentage changes ( and SEs ) in height and bone mineral density ( BMD ) over 24 months : for height , -0.1 + /- 0.2 cm in the milk supplementation group and -0.2 + /- 0.1 cm in the control group ; for BMD at the total hip , -0.06 + /- 0.22 % in the milk supplementation group and -0.88 + /- 0.26 % in the control group ; for BMD at the spine ( L1-L4 ) , -0.56 + /- 0.29 % in the milk supplementation group and -1.5 + /- 0.29 % in the control group ; for total body BMD , -0.32 + /- 0.16 % in the milk supplementation group and -1.2 + /- 0.19 % in the control group ( p < 0.05 by analysis of covariance [ ANCOVA ] for repeated measures for height and BMD at all sites ) . The milk supplementation group had less loss in terms of both height and BMD than the control group ( p < 0.05 by ANCOVA for repeated measures ) . Serum parathyroid hormone ( PTH ) concentration was lower and serum 25-hyroxyvitamin D [ 25(OH)D ] level was higher in the milk supplementation group than the control group at 12 months ( p < 0.05 by paired t-test ) . We conclude that supplementing the diet of postmenopausal Chinese women with high calcium milk powder retards bone loss A prospect i ve , double-blind , placebo-controlled study of the effect of supplementation with 900 mg/day of calcium , as active absorbable algal calcium ( AAA Ca ) or calcium carbonate ( CaCO3 ) , on lumbar bone mineral density ( BMD ) carried out in elderly in patients with osteoporosis at Katsuragi Hospital was re-evaluated in terms of the effects on  vertebral fracture and spondylotic deformity .  In addition to the already reported increase in lumbar BMD , AAA Ca was found to inhibit new occurrence of vertebral fracture . Intra-individual variations in L1–L4 BMD ( expressed by the coefficient of variation , indicating the degree of spondylotic deformity , were also inhibited significantly in the group supplemented with AAA Ca ( group A ) , but not in group B ( supplemented with CaCO3 ) , from the level in the placebo-supplement group ( group C ) after 18 months of supple-mentation . According to whole-body dual-energy X-ray absorptiometry ( DXA ) results in the first and second year of the study , whole body mass , lean content , and mineral content , expressed as a percentage of whole body mass , stayed unchanged , while increase of fat content was significantly inhibited in group A , but not in group B , from the level in group C. As to the regional distribution of bone mineral content , the second year/first year value for head bone mineral content was significantly decreased with AAA supplementation compared with placebo , but no significant difference was found between CaCO3 and placebo supplementation . Changes in mineral distribution in the arms , trunk , and legs showed no significant differences among the three groups . In addition to increasing BMD and preventing fracture , AAA Ca , but not CaCO3 , appears to inhibit the occurrence of spondylotic deformity and to decrease body fat content UNLABELLED Low BMD and prevalent vertebral fractures are known risk factors for incident vertebral fractures . In 3001 men and women from the Rotterdam Study , prevalent nonvertebral fractures , early menopause , current smoking , and walking aid use were also strong risk factors for incident vertebral fractures . INTRODUCTION Thus far , age , low BMD , and prevalent vertebral fractures are the only well-known risk factors for incident vertebral fractures . Therefore , our aim was to investigate other potential risk factors for incident vertebral fractures in the elderly . MATERIAL S AND METHODS This study was based on the Rotterdam Study , a large prospect i ve population -based cohort study among men and women > or = 55 years of age . For 3001 subjects , spinal radiographs were obtained at baseline and again approximately 6.3 years later . These follow-up radiographs were scored for vertebral fractures using the McCloskey-Kanis method . Whenever a vertebral fracture was detected , the radiograph was compared with the baseline radiograph . If this fracture was not already present at baseline , it was considered incident . At baseline , information on potential risk factors was obtained . RESULTS Low BMD and prevalent vertebral fractures were strong risk factors for incident vertebral fractures in both men and women ( RR 2.3 [ 1.6 - 3.3 ] and 2.2 [ 0.9 - 5.0 ] for men and RR 2.1 [ 1.6 - 2.6 ] and 4.1 [ 2.5 - 6.7 ] for women , respectively ) . For women , age , early menopause ( < or = 45 years of age ; RR 1.0 [ 1.1 - 3.5 ] ) , current smoking ( 2.1 [ 1.2 - 3.5 ] ) , and walking aid use ( 2.5 [ 1.1 - 5.5 ] ) were additional independent risk factors . For men , only a history of nonvertebral fractures was a significant independent risk factor ( OR 2.4 [ 1.2 - 4.8 ] ) . CONCLUSION Apart from low BMD and prevalent vertebral fractures , prevalent nonvertebral fractures are associated with an increased incident vertebral fracture risk in men . In women , early menopause , current smoking , and walking aid use are additional independent risk factors for incident vertebral fractures This study investigated three aspects of general nutritional status ( dietary intake , biochemical markers , and anthropometric measurements )  in relation to subsequent hip fracture risk by using prospect i ve data from the First National Health and Nutrition Examination Survey ( NHANES I ) epidemiologic follow-up studies . A cohort of 2,513 white women 45 years and over who participated in the NHANES I survey in 1971 - 1975 were subsequently followed in the three follow-up studies in 1982 - 1984 , 1986 , and 1987 , respectively . Multiple nutritional variables were measured at baseline , and 130 incident hip fractures were identified by hospital records or by death certificates during the follow-up period . Cox regression analyses showed that baseline dietary energy intake ; serum albumin ; and weight , body mass index , skinfold , and arm muscle area were significantly and inversely related to subsequent hip fracture risk ( relative risks for a 1-st and ard deviation increment in these variables ranged from 0.68 to 0.83 ) . The authors suggest that poor nutritional status , evident in inadequate dietary intake , reduced serum albumin , and decreased body mass and soft tissues , increases the risk for subsequent hip fracture . The study also showed that age and previous fracture history were significant risk factors ; however , self-reported physical activity , parity , and alcohol use were not significantly related to subsequent hip fracture BACKGROUND survivors of hip fracture are at 5- to 10-fold risk of a second hip fracture . There is little consensus about secondary prevention . Many are given calcium and vitamin D , but the evidence supporting this is circumstantial . OBJECTIVE to compare the effects of different calcium and vitamin D supplementation regimens on bone biochemical markers , bone mineral density and rate of falls in elderly women post-hip fracture . DESIGN r and omised controlled trial . SETTING orthogeriatric rehabilitation ward . METHODS 150 previously independent elderly women , recruited following surgery for hip fracture , were assigned to receive a single injection of 300,000 units of vitamin D(2 ) , injected vitamin D(2 ) plus 1 g/day oral calcium , 800 units/day oral vitamin D(3 ) plus 1 g/day calcium , or no treatment . Follow-up was one year , with measurement of 25-hydroxyvitamin D , parathyroid hormone , bone mineral density , and falls . RESULTS mean 25-hydroxyvitamin D increased and mean parathyroid hormone was suppressed in all the actively treated groups , more so in the group receiving combined oral vitamin D and calcium . Twenty per cent of participants injected with vitamin D were deficient in 25-hydroxyvitamin D a year later . Bone mineral density showed small but statistically significant differences of up to 4.6 % between actively treated groups and placebo . Relative risk of falling in the groups supplemented with vitamin D was 0.48 ( 95 % CI 0.26 - 0.90 ) compared with controls . CONCLUSION Vitamin D supplementation , either orally or with injected vitamin D , suppresses parathyroid hormone , increases bone mineral density and reduces falls . Effects may be more marked with calcium co-supplementation . The 300,000 units of injected vitamin D may not last a whole year Background In r and omized trials there may be no overriding reason whether or not to have a placebo control . Purpose We assessed the effects of an open trial design ( no placebo and people know what tablets they are given ) compared with a blinded , placebo-controlled design on recruitment , compliance and retention within a r and omized trial of secondary osteoporotic fracture prevention . Methods We undertook a r and omized controlled comparison nested within a placebo-controlled trial of nutritional supplementation amongst people aged 70 years or over who had previously sustained a fracture , recruited in a UK teaching hospital . R and omization was 2 : 1 in favour of the blinded , placebo-controlled trial design . Results From 180 eligible participants r and omized to receive information based on the open trial design , 134 ( 74.4 % ) consented to take part , compared with 233 ( 65.1 % ) of 358 people r and omized to the blinded , placebo-controlled design ( difference 9.4 % , 95 % confidence interval 1.3–17.4 % ) . Reluctance to take a placebo  and the desire to know tablet allocation were reasons given for not taking part in the blinded , placebo-controlled design . There was no significant difference in tablet compliance . Open trial participants were more likely to remain in the trial for one year ( difference 13.9 % , 95 % confidence interval 3.1–24.6 % ) , mainly reflecting the high retention of the open trial no tablet group compared to the open trial tablet group ( difference 23.6 % , 95 % confidence interval 11.9–35.2 % ) . The odds ratio for reporting an adverse event in the open trial compared to the blinded , placebo-controlled design was 0.64 ( 95 % confidence interval 0.28–1.49 ) , and for reporting a fracture was 0.81 ( 0.36–1.85 ) . Conclusions We conclude that using an open trial design may enhance participant recruitment and retention and thus improve generalizability and statistical power , but withdrawal rates may differ between the study allocations and may threaten the internal validity of the trial BACKGROUND Inadequate dietary intake of calcium and vitamin D may contribute to the high prevalence of osteoporosis among older persons . METHODS We studied the effects of three years of dietary supplementation with calcium and vitamin D on bone mineral density , biochemical measures of bone metabolism , and the incidence of nonvertebral fractures in 176 men and 213 women 65 years of age or older who were living at home . They received either 500 mg of calcium plus 700 IU of vitamin D3 ( cholecalciferol ) per day or placebo .  Bone mineral density was measured by dual-energy x-ray absorptiometry , blood and urine were analyzed every six months , and cases of nonvertebral fracture were ascertained by means of interviews and verified with use of hospital records . RESULTS The mean ( + /-SD ) changes in bone mineral density in the calcium-vitamin D and placebo groups were as follows : femoral neck , + 0.50+/-4.80 and -0.70+/-5.03 percent , respectively ( P=0.02 ) ; spine,+2.12+/-4.06 and + 1.22+/-4.25 percent ( P=0.04 ) ; and total body , + 0.06+/-1.83 and -1.09+/-1.71 percent ( P<0.001 ) . The difference between the calcium-vitamin D and placebo groups was significant at all skeletal sites after one year , but it was significant only for total-body bone mineral density in the second and third years . Of 37 subjects who had nonvertebral fractures , 26 were in the placebo group and 11 were in the calcium-vitamin D group ( P=0.02 ) . CONCLUSIONS In men and women 65 years of age or older who are living in the community , dietary supplementation with calcium and vitamin D moderately reduced bone loss measured in the femoral neck , spine , and total body over the three-year study period and reduced the incidence of nonvertebral fractures ABSTRACT Objective : Bisphosphonates such as alendronate are widely used for postmenopausal osteoporosis . Supplemental calcium is also generally recommended . This trial directly compares alendronate to supplemental calcium and examines the effect of calcium supplementation on alendronate treatment . Methods : This 2-year , r and omized , double-blind , multicenter trial enrolled healthy , postmenopausal women with low bone mineral density ( BMD ) . Patients with a dietary calcium intake ≥ 800 mg/day received daily vitamin D 400 IU and alendronate 10 mg/calcium-placebo , alendronate 10 mg/elemental calcium 1000 mg , or alendronate-placebo/calcium 1000 mg ( 2:2:1 ) . Endpoints included BMD , bone turnover markers ( BTMs ) , and adverse events . Results : R and omized patients ( N = 701 ) were an average of 20.4 years postmenopausal . After 24 months , increases in lumbar spine BMD differed significantly between patients receiving calcium alone ( 0.8 % ) and either alendronate alone ( 5.6 % ) or alendronate + calcium ( 6.0 % ) ( p < 0.001 ) . Significant differences were also seen at the trochanter and femoral neck ( p < 0.001 ) . BTMs were significantly lower with alendronate-containing treatments than calcium alone ( p < 0.001 ) . Addition of calcium supplementation to alendronate did not significantly increase BMD  compared to alendronate alone ( p = 0.29 to 0.97 ) , but did result in a statistically significant , though small , additional reduction in urinary NTx . Adverse events were similar among treatment groups . Limitations include no assessment of vitamin D levels and a discontinuation rate of approximately 30 % , although discontinuation rates were similar among treatment groups . Conclusions : In postmenopausal women with a daily intake of ≥ 800 mg calcium and 400 IU vitamin D , 24-month treatment with alendronate 10 mg daily with or without calcium 1000 mg result ed in significantly greater increases in BMD and reduction of bone turnover than supplemental calcium alone . Addition of supplemental calcium to alendronate treatment had no effect on BMD and result ed in a small , though statistically significant , additional reduction in NTx The etiologic role of dietary calcium and vitamin D intake in primary prevention of  osteoporotic fractures is uncertain , despite considerable research efforts . With the aim to examine these associations with an improved precision , we used data from a large population -based prospect i ve cohort study in central Sweden . We estimated nutrient intake from a self-administered food-frequency question naire filled in by 60,689 women , aged 40 - 74 years at baseline during 1987 - 1990 . During follow-up , we observed 3986 women with a fracture at any site and 1535 with a hip fracture .  Rate ratio of fractures ( RR ) and 95 % CI were estimated using Cox proportional hazards models . We found no dose-response association between dietary calcium intake and fracture risk . The age-adjusted RR of hip fracture was 1.01 ( 95 % CI 0.96 - 1.06 ) per 300 mg calcium/day and the corresponding risk of any osteoporotic fracture was 0.99 ( 95 % CI 0.96 - 1.03 ) . Furthermore , women with an estimated calcium intake below 400 mg/day and those with a calcium intake higher than 1200 mg/day both had a similar age-adjusted hip fracture risk as those with intermediate calcium intakes : RR 1.07 ( 95 % CI 0.92 - 1.24 ) and RR 1.00 ( 95 % CI 0.79 - 1.27 ) , respectively . Vitamin D intake was not associated with fracture risk . Furthermore , women in the highest quintiles compared to the lowest quintiles of both calcium and vitamin D intake had an age-adjusted RR of 1.02 for all fractures ( 95 % CI 0.88 - 1.17 ) . Dietary calcium or vitamin D intakes estimated at middle and older age do not seem to be of major importance for the primary prevention of osteoporotic fractures in women PURPOSE To determine the long-term effects of calcium supplements or placebo on bone density in healthy women at least 3 years postmenopause . PATIENTS AND METHODS Eighty-six women from our previously reported 2-year study agreed to continue on their double-blind treatment allocation ( 1 g elemental calcium or placebo ) for a further 2 years , with 78 women ( 40 on placebo ) reaching the 4-year end point .  Median ( interquartile range ) dietary calcium intakes for the whole group were 700 mg ( range 540 to 910 ) per day at baseline , 670 mg ( range 480 to 890 ) per day at 2 years , and 640 mg ( range 460 to 880 ) per day at 4 years . The bone mineral density ( BMD ) of the total body , lumbar spine , and proximal femur was measured every 6 months by dual-energy , x-ray absorptiometry . RESULTS There was a sustained reduction in the rate of loss of total body BMD in the calcium group throughout the 4-year study period ( P = 0.002 ) , and bone loss was significantly less in the calcium-treated subjects in years 2 through 4 also ( difference between groups 0.25 % + /- 0.11 % per year , P = 0.02 ) . In the lumbar spine , bone loss was reduced in the calcium group in year 1 ( P = 0.004 ) , but not subsequently . There was , however , a significant treatment effect at this site over the whole 4-year period ( P = 0.03 ) . In the proximal femur , the benefit from calcium treatment also tended to be greater in the first year and was significant over the 4-year study period in the femoral neck ( P = 0.03 ) and the trochanter ( P = 0.01 ) . Nine symptomatic fractures occurred in 7 subjects in the placebo group and 2 fractures in 2 subjects receiving calcium ( P = 0.037 ) . CONCLUSIONS Calcium supplementation produces a sustained reduction in the rate of loss of total body BMD in healthy postmenopausal women PURPOSE Calcium has been shown to have positive effects on bone mineral density in postmenopausal women . However , these effects are small , it is unknown whether they are sustained with long-term use , they have not been shown with intention-to-treat analyses , and the evidence for fracture prevention with calcium monotherapy is inconsistent . METHODS A r and omized controlled trial of calcium ( 1 g/day as the citrate ) in 1471 healthy postmenopausal women ( aged 74+/-4 years ) was performed to assess the effects on  bone density and fracture incidence over 5 years . RESULTS Follow-up was complete in 90 % of subjects , and average medication compliance was 55 % to 58 % . Calcium had a significant beneficial effect on bone density ( intention-to-treat analysis ) , with between-groups differences at 5 years of 1.8 % ( spine ) , 1.6 % ( total hip ) , and 1.2 % ( total body ) . Effects were greater in a per- protocol analysis ( 5-year differences of 2.3 % , 2.8 % , and 1.8 % , respectively ) . A total of 425 fractures occurred in 281 women .  Hazard ratios , based on time to first fracture , were 0.90 ( 95 % confidence interval [ CI ] , 0.71 - 1.16 ) for any symptomatic fracture , 0.72 ( 95 % CI , 0.44 - 1.18 ) for vertebral , 3.55 ( 95 % CI , 1.31 - 9.63 ) for hip , and 0.65 ( 95 % CI , 0.41 - 1.04 ) for forearm fracture . Per- protocol analysis found respective hazard ratios of 0.86 ( 95 % CI , 0.64 - 1.17 ) , 0.62 ( 95 % CI , 0.33 - 1.16 ) , 3.24 ( 95 % CI , 0.65 - 16.1 ) , and 0.45 ( 95 % CI , 0.24 - 0.87 ) . Height loss was reduced by calcium in the per- protocol population ( P=.03 ) . Serum alkaline phosphatase and procollagen type-I N-terminal propeptide were lower in the calcium group at 5 years , but constipation was more common . CONCLUSIONS Calcium results in a sustained reduction in bone loss and turnover , but its effect on fracture remains uncertain . Poor long-term compliance limits its effectiveness BACKGROUND There is no consistent evidence , to our knowledge , that calcium supplementation affects  bone mineral density ( BMD ) in men , despite male osteoporosis being a common clinical problem . METHODS To determine the effects of calcium supplementation ( 600 mg/d , 1200 mg/d , or placebo ) on BMD in men , we conducted a double-blind , r and omized controlled trial for a 2-year period at an academic clinical research center . A total of 323 healthy men at least 40 years old ( mean age , 57 years ) were recruited by newspaper advertisement . Complete follow-up was achieved in 96 % of subjects . RESULTS The BMD increased at all sites in the group receiving calcium , 1200 mg/d , by 1 % to 1.5 % more than those receiving placebo . The results for the group receiving calcium , 600 mg/d , were not different from the placebo group at any BMD site . There was no interaction between the BMD treatment effect and either age or dietary calcium intake . There were dosage-related , sustained decreases in serum parathyroid hormone ( P < .001 ) , total alkaline phosphatase activity ( P = .01 ) , and procollagen type 1 N-terminal propeptide ( P < .001 ) amounting to 25 % , 8 % , and 20 % , respectively , in the group receiving calcium , 1200 mg/d , at 2 years . Tooth loss , constipation , and cramps were unaffected by calcium supplementation , falls tended to be less frequent in the group receiving calcium , 1200 mg/d , but vascular events tended to be more common in the groups receiving calcium vs the group receiving placebo . CONCLUSION Calcium , 1200 mg/d , has effects on BMD in men comparable with those found in postmenopausal women but a dosage of 600 mg/d is ineffective for treating BMD . TRIAL REGISTRATION actr.org.au Identifier : 012605000274673
target: 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 .
background: OBJECTIVE To examine the evidence underpinning recommendations to increase calcium intake through dietary sources or calcium supplements to prevent fractures .