Effect of calcium supplementation on bone mineral accretion in gambian children accustomed to a low-calcium diet. Cumulative effects of calcium supplementation and physical activity on bone accretion in premenarchal children: a double-blind randomised placebo-controlled trial. Calcium supplementation and bone mineral density in females from childhood to young adulthood: a randomized controlled trial. Bone mass and density response to a 12-month trial of calcium and vitamin D supplement in preadolescent girls. The effects of a high calcium dairy food on bone health in pre-pubertal children in New Zealand. Effects of dairy food supplements on bone mineral density in teenage girls A randomized controlled trial of vitamin D3 supplementation in African American women. The effects of calcium supplementation and exercise on bone density in elderly Chinese women The effect on behavior and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women: a randomized controlled trial [NCT00273260] Vitamin D supplementation and bone mineral density in early postmenopausal women. Effect of withdrawal of calcium and vitamin D supplements on bone mass in elderly men and women. Factors affecting bone density in young adults. Reduced rates of skeletal remodeling are associated with increased bone mineral density during the development of peak skeletal mass. Skeletal site-dependent response of bone mineral density and quantitative ultrasound parameters following a 12-month dietary intervention using dairy products fortified with calcium and vitamin D: the Postmenopausal Health Study. Bone mineral contents and plasma osteocalcin concentrations of Gambian children 12 and 24 mo after the withdrawal of a calcium supplement. A two-year program of aerobics and weight training enhances bone mineral density of young women. Increased periosteal circumference remains present 12 months after an exercise intervention in preschool children. Calcium-enriched foods and bone mass growth in prepubertal girls: a randomized, double-blind, placebo-controlled trial. Effect of a general school-based physical activity intervention on bone mineral content and density: a cluster-randomized controlled trial. Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Calcium supplementation provides an extended window of opportunity for bone mass accretion after menarche. Prediction of bone mass density variation by bone remodeling markers in postmenopausal women with vitamin D insufficiency treated with calcium and vitamin D supplementation. Bone mineralization in children and adolescents with a milk allergy. Effects of exercise on bone mineral density in calcium-replete postmenopausal women with and without hormone replacement therapy Calcium and cholecalciferol supplementation provides no added benefit to nutritional counseling to improve bone mineral density in survivors of childhood acute lymphoblastic leukemia (ALL). Effect of habitual dietary calcium intake on calcium supplementation in 12-14-y-old girls. Amelioration of hemiplegia-associated osteopenia more than 4 years after stroke by 1 alpha-hydroxyvitamin D3 and calcium supplementation. Role of physical activity in the development of skeletal mass in children. Effect of milk and calcium supplementation on bone density and bone turnover in pregnant Chinese women: a randomized controlled trail Does vitamin D supplementation of healthy Danish Caucasian girls affect bone turnover and bone mineralization? Effect of calcium supplementation in pregnancy on maternal bone outcomes in women with a low calcium intake123 A co-twin study of the effect of calcium supplementation on bone density during adolescence The skeletal benefits of calcium- and vitamin D3-fortified milk are sustained in older men after withdrawal of supplementation: an 18-mo follow-up study. Vitamin D supplementation after parathyroidectomy: effect on bone mineral density-a randomized double-blind study. Vitamin D Is a Major Determinant of Bone Mineral Density at School Age Skeletal benefits from calcium supplementation are limited in children with calcium intakes near 800 mg daily Benefits of milk powder supplementation on bone accretion in Chinese children Dehydroepiandrosterone replacement therapy in older adults: 1- and 2-y effects on bone. The effect of combined calcium and cholecalciferol supplementation on bone mineral density in elderly women with moderate chronic kidney disease The effect of high-dose vitamin D3 supplementation on bone mineral density in subjects with prediabetes 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 Correlates of Quantitative Ultrasound in the Women’s Healthy Lifestyle Project
 Gain in bone mineral mass in prepubertal girls 3–5 years after discontinuation of calcium supplementation: a follow-up study A combination of prebiotic short- and long-chain inulin-type fructans enhances calcium absorption and bone mineralization in young adolescents. Treatment with alendronate plus calcium, alendronate alone, or calcium alone for postmenopausal low bone mineral density Randomized controlled trial of calcium supplementation in healthy, nonosteoporotic, older men. Dietary acid load is associated with lower bone mineral density in men with low intake of dietary calcium. Effect of micronutrient supplement on health and nutritional status of schoolchildren: bone health and body composition. Effects of calcium and vitamin D supplementation on hip bone mineral density and calcium-related analytes in elderly ambulatory Australian women: a five-year randomized controlled trial. Calcium supplementation suppresses bone turnover during weight reduction in postmenopausal women. Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels, low bone mass, and physical frailty. The effect of calcium supplementation and tanner stage on bone density, content and area in teenage women Milk supplementation prevents bone loss in postmenopausal Chinese women over 3 years. Effect of calcium and vitamin D supplementation on bone mineral density in women aged 65–71 years: a 3-year randomized population-based trial (OSTPRE-FPS) Effect of low-dose calcium supplements on bone loss in perimenopausal and postmenopausal Asian women: a randomized controlled trial. Dairy intakes affect bone density in the elderly. Effect of supplementation with cholecalciferol and calcium on 2-y bone mass accrual in HIV-infected children and adolescents: a randomized clinical trial. Bone mineral density in prepubertal children with beta-thalassemia: correlation with growth and hormonal data. Effect of a randomized controlled exercise trial on bone outcomes: influence of adjuvant endocrine therapy Calcium Plus Vitamin D Supplementation Has Limited Effects on Femoral Geometric Strength in Older Postmenopausal Women: The Women’s Health Initiative Double-blind, controlled calcium supplementation and bone mineral accretion in children accustomed to a low-calcium diet. A 1-y walking program and increased dietary calcium in postmenopausal women: effects on bone. Parent/Child Training to Increase Preteens' Calcium, Physical Activity, and Bone Density: A Controlled Trial Calcium intake in health maintenance – a systematic review Effect of vitamin K supplementation on bone loss in elderly men and women. One year of oral calcium supplementation maintains cortical bone density in young adult female distance runners. Effect of calcium plus vitamin D supplementation during pregnancy in Brazilian adolescent mothers: a randomized, placebo-controlled trial. Vitamin K Supplement Along with Vitamin D and Calcium Reduced Serum Concentration of Undercarboxylated Osteocalcin While Increasing Bone Mineral Density in Korean Postmenopausal Women over Sixty-Years-Old Bone turnover and density in obese premenopausal women during moderate weight loss and calcium supplementation. Milk supplementation of the diet of postmenopausal Chinese women on a low calcium intake retards bone loss. Determinants of bone mineral density in older men. Effects of 1α-hydroxyvitamin D3 on lumbar bone mineral density and vertebral fractures in patients with postmenopausal osteoporosis Calcium and vitamin D for osteoprotection in children with new-onset nephrotic syndrome treated with steroids: a prospective, randomized, controlled, interventional study
BACKGROUND Rural Gambian children have poor growth , delayed puberty , a low bone mineral content , and a low calcium intake . OBJECTIVE We investigated the effect of a calcium supplement on bone mineral accretion in rural Gambian children . DESIGN A r and omized , double-blind , placebo-controlled study was conducted in 160 children ( 80 boys , 80 girls ) aged 8.3 - 11.9 y.  Bone mineral content ( BMC ) , bone mineral density ( BMD ) , and BMC adjusted for bone width , body weight , and height ( size-adjusted BMC ) were measured at the midshaft and distal radius . Each child received either 1000 mg Ca/d ( as calcium carbonate ) or a placebo 5 d/wk for 12 mo . Supplementation increased calcium intake from 342 to 1056 mg/d ( 8.6 to 26.4 mmol/d ) . RESULTS Calcium supplementation result ed in a higher BMC , BMD , and size-adjusted BMC ( & xmacr ; difference + /- SE ) : midshaft radius- BMC ( 3.0 + /- 1.4 % ; P = 0.034 ) , BMD ( 4.5 + /- 0.9 % ; P < /= 0.0001 ) , and size-adjusted BMC ( 4.6 + /- 0.9 % ; P < /= 0.0001 ) ; distal radius- BMC ( 8 . 4 + /- 3.2 % ; P = 0.009 ) , BMD ( 7.0 + /- 2.7 % ; P = 0.011 ) , and size-adjusted BMC ( 5.5 + /- 2.7 % ; P = 0.042 ) . Supplementation had no significant effect on height , weight , or bone width at the midshaft radius or distal radius . At the end of the study , the calcium group had a significantly lower mean plasma osteocalcin concentration than the placebo group after adjustment for baseline concentration , sex , and pubertal status ( -21.9 + /- 6.5 % ; P = 0.001 ) . CONCLUSIONS Increased calcium intake result ed in increased bone mineral status , possibly in association with a decreased bone remodeling space . Further studies are needed to determine whether an increased calcium intake has long-term benefits in Gambian children High calcium intake combined with physical activity during childhood have been shown to improve bone mass accrual and bone mineral density . Our aim was to study the combined effect of calcium and exercise on  bone gain in children . Two milk-powder products containing either 800 mg of calcium phosphate ( calcium ) or not ( placebo ) were r and omly allocated to 113 healthy premenarchal girls on a daily basis for 1 year . The group was composed of 63 exercise ( 7.2 + /- 4 hours of exercise/week ) and 50 sedentary ( 1.2 + /- 0.8 hours of exercise/week ) children . The final experiment had 4 groups : exercise/calcium ( n = 12 ) , exercise/placebo ( n = 42 ) , sedentary/calcium ( n = 10 ) , and sedentary/placebo ( n = 21 ) . Bone mineral density ( BMD ) at 6 skeletal sites and body composition were determined by DXA . Bone age was calculated and the daily spontaneous calcium intake was assessed by a frequency question naire . All the tests were performed at baseline and 1 year by the same observer . BMD gains were significantly greater in the exercise/calcium group than in other groups at the total body ( increase of 6.3 % , p < 0.05 ) , lumbar spine ( 11 % , p < 0.05 ) , femoral neck ( 8.2 % , p < 0.02 ) , and Ward 's triangle ( 9.3 % , p < 0.01 ) . There was no difference between the other groups . These data suggest that calcium supplementation increases the effect of physical exercise on bone mineral acquisition in the period preceding puberty , and that calcium supplementation without physical activity does not improve the BMD acquisition during this period . Physical exercise that stimulates bone accretion needs a high calcium intake to be completely effective BACKGROUND Short-term studies established that calcium influences bone accretion during growth . Whether long-term supplementation influences bone accretion in young adults is not known . OBJECTIVE This study evaluated the long-term effects of calcium supplementation on bone accretion among females from childhood to young adulthood . DESIGN A 4-y r and omized clinical trial recruited 354 females in pubertal stage 2 and optionally was extended for an additional 3 y. The mean dietary calcium intake of the participants over 7 y was approximately 830 mg/d ;  calcium-supplemented persons received an additional approximately 670 mg/d . Primary outcome variables were distal and proximal radius bone mineral density ( BMD ) , total-body BMD ( TBBMD ) , and metacarpal cortical indexes . RESULTS Multivariate analyses of the primary outcomes indicated that  calcium-supplementation  effects vary over time . Follow-up univariate analyses indicated that all primary outcomes were significantly larger in the supplemented group than in the placebo group at the year 4 endpoint . However , at the year 7 endpoint , this effect vanished for TBBMD and distal radius BMD . Longitudinal models for TBBMD and proximal radius BMD , according to the time since menarche , showed a highly significant effect of supplementation during the pubertal growth spurt and a diminishing effect thereafter . Post hoc stratifications by compliance-adjusted total calcium intake and by final stature or metacarpal total cross-sectional area showed that calcium effects depend on compliance and body frame . CONCLUSIONS Calcium supplementation significantly influenced bone accretion  in young females during the pubertal growth spurt . By young adulthood , significant effects remained at metacarpals and at the forearm of tall persons , which indicated that the calcium requirement for growth is associated with skeletal size . These results may be important for both primary prevention of osteoporosis and prevention of bone fragility fractures during growth BACKGROUND Maximal bone acquisition in adolescent girls through dietary and lifestyle practice s is advocated to prevent or minimize the development of osteoporosis and its associated complications in later life . Longitudinal investigations of bone acquisition in children and adolescents have utilized areal bone mineral density ( BMD , mg/cm(2 ) ) as a measure of bone mass and strength . Peripheral quantitative computed tomography ( pQCT ) , which provides a three-dimensional display of data , separate analyses of bone compartments , and bone mass in terms of volumetric BMD ( vBMD , mg/cm(3 ) ) , has recently been introduced for clinical use . OBJECTIVE To assess the impact of a 12-month daily calcium supplement on total and trabecular bone acquisition as measured by pQCT in preadolescent girls . DESIGN Early adolescent Caucasian girls ( aged 12 years , Tanner Stage 2 ) were enrolled in a r and omized trial of daily calcium supplement ( TX , 800 mg calcium carbonate and 400 IU vitamin D ) or placebo ( C ) . Body weight , height , and distal tibia measurements by pQCT were obtained at enrollment , 6 and 12 months . Pubertal status and physical activity records were assessed at baseline and 12 months . Three-day food intake records were completed every three months . RESULTS Seventy-one girls completed the 12-month trial ( TX=35 , C=36 ) . No differences were found for age , weight , height , body mass index , pubertal maturation , or reported physical activity at enrollment or during the study . Average intakes during the study were 1524 mg calcium and 496 IU vitamin D ( TX ) versus 865 mg calcium and 160 IU vitamin D ( C ) per day . Baseline total bone values were similar , however , trabecular values were greater in TX girls despite r and omization . Percent changes were calculated to adjust for baseline differences . Because of the small cortical thickness at the 10 % site ( mean values < 1.6 mm ) , cortical mass and density were not analyzed . The percent changes for trabecular bone mineral content ( BMC , mg ) and vBMD were significantly greater in TX girls ( + 4.1 % BMC and + 1.0 % vBMD TX versus -1.6 % BMC and -2.0 % vBMD C , p<0.006 ; ANCOVA ) after 12 months of supplement . Trabecular bone area ( BA , cm(2 ) ) and total bone change , however , did not differ between groups . CONCLUSIONS Daily calcium and vitamin D supplementation promotes greater trabecular BMC and vBMD acquisition in preadolescent girls . The single site selected for pQCT evaluation in this study did not allow evaluation of the cortical bone compartment . Future studies that utilize the pQCT technique need to incorporate multiple measurement sites to better assess total , cortical , and trabecular bone Childhood and adolescence is the period of most rapid skeletal growth in an individual 's lifetime . A greater peak bone mass achieved in the first 2 - 3 decades of life , may protect against the risk of osteoporotic fracture in later life . The aim of this r and omized , controlled study was to assess in pre-pubertal boys and girls ( aged 8 - 10 years ) the effect of 18 months of a calcium enriched , cocoa flavoured product on bone density , bone growth and bone size in New Zeal and children . One hundred and fifty four pre-pubertal boys and girls ( aged 8 - 10 years ) were r and omized to receive a high calcium dairy drink or a control drink reconstituted with water for 18 months . They were assessed at baseline and then every 6 months for the first 18 months , while they were having the supplement ; they were then followed up 12 months after supplementation had finished . Bone mineral density and bone mineral content were assessed at the total body , hip and spine . Indicators of bone size ( vertebral width and height ) were also measured at the spine . Anthropometric data was collected , medical history question naires were administered ( including the Tanner or pubertal stage question naire ) , dietary calcium intake was assessed with a calcium food frequency question naire and calcium supplement compliance was determined . There was no significant difference between the 2 groups for bone mineral density or bone mineral content at any time point . There was no difference in vertebral height or width at any stage of the study , indicating no additional influence on bone size at the lumbar vertebrae . There were no significant differences between height , weight , lean mass or fat mass at any time point . Both groups had higher habitual calcium intakes than recommended for this age group going into the study and throughout the study . In this 2(1/2 ) year study ( 18 months supplementation , 1 year follow-up ) we did not observe a difference in bone mineral density in pre-pubertal children . This was probably due to their high habitual dietary calcium intake whereby minimal addition of calcium to the diet reached the threshold level where no further benefit was seen . There were no significant differences between the two groups in body composition . Growth and the mean height and weight remained between the 50th and 75th percentile for their age . We have shown calcium supplementation in children with high habitual dietary calcium intake appears not to have additional effects on bone mass . Calcium supplementation needs to be targeted in those children with low habitual dietary calcium intake Summary Background Bone mineral density ( BMD ) is largely genetically determined and this influence is most powerful in the period of rapid skeletal development in childhood and late adolescence but environmental factors such as exercise and dietary calcium intake may influence up to 20 % . Aims of the study The aims of the study were to examine healthy late adolescent females for the effects and benefits of a high calcium intake from dairy product foods on bone mineral density , body composition , lipids and biochemistry . The secondary aim is determine whether a high intake of dairy product foods in the diet is acceptable for this age group long term . Methods Ninety-one teenage girls who participated in a two-year r and omised controlled study on the effect of dairy food supplementation on dietary patterns , body composition and bone density in post-pubertal teenage girls were approached one year after the cessation of the study to determine the effects of the cessation of dairy supplements on bone mineral density , dietary habits , biochemical markers , body composition and blood lipids . Bone mineral density and bone mineral content were assessed at the hip , spine and total body . Anthropometric data were collected , and exercise , Tanner , dietary assessment , preference and compliance question naires were administered . Lipid profiles , hydroxyproline excretion and urinary calcium and sodium excretion measurements were performed . Results There were no significant differences between the 2 groups for height , weight , lean and fat mass . The supplemented group had significantly higher calcium , phosphorus and protein intake during the supplementation period ( p<0.001 ) . No differences were seen between the groups 12 months after supplementation finished . There were no significant differences in exercise level , preference or acceptability of dairy products or in the lipids and bone markers between baseline the end of supplementation and 1 year follow-up . There was a significant increase in trochanter ( 4.6 % ) , lumbar spine ( 1.5 % ) and femoral neck ( 4.8 % ) BMD ( p<0.05 ) in the high calcium group at the end of supplementation . There was an increase in bone mineral content at the trochanter ( p<0.05 ) and lumbar spine ; however the latter was not statistically significant , in the high calcium group at the end of supplementation . There was no difference in vertebral height or width at any stage of the study , indicating no influence on bone size . Conclusions In this 3 year study ( 2 years of supplementation , 1 year follow-up ) , teenage girls , aged 15–18 years , were able to significantly increase their BMD at the trochanter , femoral neck and lumbar spine when supplemented with dairy product foods to a mean calcium intake of 1160 mg/d . There was also an effect seen on the BMC particularly at the trochanter and to a lesser extent at the lumbar spine . The dietary calcium intake achieved did not adversely affect body weight , fat and lean mass or blood lipid profiles . Twelve months after the supplementation finished the girls had returned to their baseline diet , indicating self- selection of a high dairy product diet may be hard to achieve BACKGROUND We conducted a r and omized , placebo-controlled , double-blind trial to test the hypothesis that vitamin D(3 ) supplementation would prevent bone loss in calcium-replete , African American postmenopausal women . METHODS Two hundred eight healthy black postmenopausal women , 50 to 75 years of age , were assigned to receive either placebo or 20 microg/d ( 800 IU ) of vitamin D(3 ) . Calcium supplements were provided to ensure a total calcium intake of 1200 to 1500 mg/d . After 2 years , the vitamin D(3 ) dose was increased to 50 microg/d ( 2000 IU ) in the active group , and the study continued for an additional year . Bone mineral density ( BMD ) was measured every 6 months . Markers of bone turnover , vitamin D metabolites , and parathyroid hormone ( PTH ) levels were measured in serum . RESULTS There were no significant differences in BMD between the active and control groups throughout the study . There was also no relationship between serum 25-hydroxyvitamin D levels attained and rates of bone loss . There was an increase in BMD of the total body , hip , and radius at 1 year in both groups . Over the 3 years , BMD declined at these sites by 0.26 % to 0.55 % per year . The BMD of the lumbar spine increased slightly in the placebo and active groups . There were no persistent changes in serum PTH levels or the markers of bone turnover , although there was a transient decline in PTH in both groups at 3 months . No significant adverse events were attributed to vitamin D supplementation . CONCLUSIONS There was no observed effect of vitamin D(3 ) supplementation on bone loss or bone turnover markers in calcium-replete , postmenopausal African American women . Further studies are needed to determine if these findings are applicable to women of other ethnic groups A r and omized controlled trial was carried out to determine whether calcium supplementation and load-bearing exercise can increase or maintain bone mass in the elderly . Fifty Chinese women , aged 62–92 years , living in a hostel for the elderly in Hong Kong were r and omized to enter one of four treatment groups : ( I ) calcium supplementation of 800 mg ( as calcium lactate gluconate ) daily ; ( II ) load-bearing exercise four times a week plus a daily placebo tablet ; ( III ) calcium supplementation daily and load-bearing exercise four times a week ; ( IV ) a placebo tablet daily . The interventions went on for 10 months . The bone mineral density ( BMD ) was measured at three sites in the hip ( femoral neck , Ward 's triangle and intertrochanteric area ) and the L2–4 level of the spine . The percentage change in BMD in 10 months was used as the main outcome measurement . The parathyroid hormone level and indices of bone metabolism were also measured before and after 10 months of intervention . The BMD at Ward 's triangle and the intertrochanteric area increased significantly in subjects on calcium supplement ( p<0.05 ) , but there was no significant change at the spine and femoral neck . Exercise had no effect on bone loss at any site . However , the results of two-way analysis of variance showed a significant joint effect of calcium supplements and exercise  at the femoral neck ( p<0.05 ) , but not at the other sites . The parathyroid hormone levels fell significantly in subjects on calcium supplements (p<0.01).Calcium supplement in the form of calcium lactate gluconate was adequately absorbed in elderly Chinese women with a calcium intake of less than 300 mg per day . It was effective in reducing bone loss at the hip , and there may be interaction effects with exercise in maintaining bone density Background Limited information is available on ways to influence osteoporosis risk in premenopausal women . This study tested four hypotheses regarding the effects of individualized bone density ( BMD ) feedback and different educational interventions on osteoporosis preventive behavior and BMD in pre-menopausal women , namely : that women are more likely to change calcium intake and physical activity if their BMD is low ; that group education will be more efficacious at changing behavior than an information leaflet ; that BMD feedback and group education have independent effects on behavior and BMD ; and , that women who improve their physical activity or calcium intake will have a change in bone mass over 2 years that is better than those who do not alter their behavior . Methods We performed a 2-year r and omized controlled trial of BMD feedback according to T-score and either an osteoporosis information leaflet or small group education in a population -based r and om sample of 470 healthy women aged 25–44 years ( response rate 64 % ) . Main outcome measures were dietary calcium intake , calcium supplement use , smoking behavior , physical activity , endurance fitness , lower limb strength and BMD . We used paired t-tests , one-way ANOVA and linear regression techniques for data analysis . Results Women who had feedback of low BMD had a greater increase in femoral neck BMD than those with normal BMD ( 1.6 % p.a . vs. 0.7 % p.a . , p = 0.0001 ) , but there was no difference in lumbar spine BMD change between these groups ( 0.1 % p.a . vs. 0.08 % p.a . , p = 0.9 ) . Both educational interventions had similar increases in femoral neck BMD ( Leaflet = + 1.0 % p.a . , Osteoporosis self-management course = + 1.3 % p.a . , p = 0.4 ) . Femoral neck BMD change was only significantly associated with starting calcium supplements ( 1.3 % p.a , 95%CI + 0.49 , + 2.17 ) and persistent self-reported change in physical activity levels ( 0.7 % p.a . , 95%CI + 0.22 , + 1.22 ) . Conclusion Individualized BMD feedback combined with a minimal educational intervention is effective at increasing hip but not spine bone density in premenopausal women . The changes in behavior through which this was mediated are potentially important in the prevention of other diseases , thus measuring BMD at a young age may have substantial public health benefits , particularly if these changes are sustained BACKGROUND Increased vitamin D intake may preserve or increase bone mineral density ( BMD ) in older persons . OBJECTIVE A 2-y double-blind study was undertaken to determine whether weekly administration of 10 000 units of vitamin D(2 ) maintained or increased BMD in younger postmenopausal women more efficiently than did calcium supplements alone . DESIGN One hundred eighty-seven women who were > or= 1 y postmenopausal were r and omly assigned to take either 1000 mg Ca/d after the evening meal or 1000 mg Ca/d plus 10 000 U vitamin D(2)/wk in a double-blind , placebo-controlled format . The BMD of the proximal forearm , lumbar spine , femoral neck , Ward 's triangle , and femoral trochanter was measured at 6-mo intervals by osteodensitometry . RESULTS During the 2-y period , there was no significant difference in the change in BMD at any site between the subjects taking calcium supplements and those taking calcium plus vitamin D(2 ) . Both groups significantly ( P < 0.005 ) gained BMD in Ward 's triangle and the femoral trochanter but significantly ( P < 0.005 ) lost bone in the proximal radius . There was no significant change in the lumbar spine or femoral neck BMD . CONCLUSION In younger postmenopausal women ( age : 56 y ) whose average baseline serum 25-hydroxyvitamin D concentration was well within the normal range , the addition of 10 000 U vitamin D(2)/wk to calcium supplementation at 1000 mg/d did not confer benefits on BMD beyond those achieved with calcium supplementation alone BACKGROUND Supplementation with calcium and vitamin D reduces bone loss and prevents fractures in elderly people , but it is not known whether any lasting benefit remains if the supplements are discontinued . OBJECTIVE The objective was to determine whether gains in bone mineral density ( BMD ) induced by calcium and vitamin D supplementation persist after supplement withdrawal . DESIGN Two-hundred ninety-five healthy , elderly men and women ( aged > /=68 y ) who had completed a 3-y r and omized , placebo-controlled trial of calcium and vitamin D supplementation were followed for an additional 2 y during which no study supplements were given .  BMD was measured by dual-energy X-ray absorptiometry , and biochemical variables related to calcium metabolism and bone turnover were measured . RESULTS In the 128 men , supplement-induced increases in spinal and femoral neck BMD were lost within 2 y of supplement discontinuation , but small benefits in total-body BMD remained . In the 167 women , there were no lasting benefits in total-body BMD or at any bone site . Consistent with the observations on BMD , the bone turnover rates in both men and women ( as measured by serum osteocalcin concentrations ) returned to their original higher concentrations within the same 2-y period . CONCLUSION Discontinued calcium and vitamin D supplementation has limited cumulative effect on bone mass in men and women aged > /=68 A 14-y follow-up of 581 children who took part in a r and omized controlled trial of the effect of a milk supplement on growth of children was conducted to investigate the supplement 's effect on adult bone mineral content ( BMC ) and density ( BMD ) . BMC and BMD of the nondominant forearm were measured by single-photon absorptiometry in 371 subjects ( 64 % ) aged 20 - 23 y , at a proximal site ( shaft of radius and ulna ) and at a distal site near the wrist .  BMC s and BMDs tended to be higher in the intervention group ( NS ) . Cross-sectionally , BMD was positively associated with body weight ( P less than 0.01 ) in both sexes ; inversely associated with alcohol consumption ( P less than 0.05 ) , and positively with manual occupation ( NS ) in men ; positively associated with current intakes of calcium ( P less than 0.05 ) , vitamin D ( P less than 0.01 ) , and sports activity during adolescence ( P less than 0.01 ) , and inversely with parity ( NS ) in women . In multiple linear-regression analysis body weight and sports activity during adolescence were stronger determinants of female BMD than was diet Two related studies were conducted to assess the associations between markers of skeletal modeling and remodeling in healthy children . Members of monozygotic twin pairs , aged 6 - 14 , enrolled in a clinical trial of calcium supplementation  , were studied at the end of the period of supplementation and for 3 years thereafter . Supplemented children had significantly higher rates of gain in bone mineral density ( BMD ) ( + 3 % on average ) during the period of supplementation accompanied by significantly lower concentrations of serum osteocalcin ( OC , -15 % ) . During postsupplement follow-up , both differences in BMD and OC disappeared . Black females , age matched to the baseline ages of the white children , had significantly lower serum concentrations of both OC and tartrate-resistant acid phosphatase ( TRAP ) at all ages and higher BMDs . When stratified on serum TRAP concentrations , regardless of race , children with lower concentrations had significantly higher BMDs , and no racial differences were apparent . In regression models accounting for 70 - 80 % of the variability in BMD in children , body size and TRAP , but not race , remained significantly associated with BMD . The skeletal advantages seen with calcium supplementation and black race appear to be associated with reduced rates of skeletal turnover . Given that markers of turnover during growth reflect both skeletal modeling and remodeling , and there is no apparent advantage to reduced skeletal modeling , it seems probable that reduced remodeling is the factor that accounts for the increases in bone mass The aim of the current study was to examine whether calcium supplementation could prevent bone loss in postmenopausal women or more favourable outcomes could be obtained via the consumption of dairy products fortified with calcium and vitamin D3 . For this purpose changes in bone mineral density ( BMD ) at different skeletal sites , assessed by dual-energy X-ray absorptiometry , as well as in quantitative ultrasound ( QUS ) parameters of the calcaneus over 12 months were estimated . A population of 101 postmenopausal women ( 55 - 65 years old ) was r and omized into a dairy group ( DG : n 39 ) , receiving approximately 1200 mg calcium/d and 7.5 microg vitamin D3/d through fortified dairy products ; a calcium-supplemented group ( CaG : n 26 ) provided with a calcium supplement of 600 mg/d ; and a control group ( CG : n 36 ) . Over the intervention period the DG was found to have more favourable changes in pelvis ( P=0.040 ) , total spine ( P<0.001 ) and total body BMD ( P<0.001 ) than the other groups . A significant increase was also observed for DG in lumbar spine BMD ( 2.0 % ; 95 % CI 0.5 , 3.5 ) although it did not differentiate significantly compared to the other groups . No significant differences were observed with respect to the changes in QUS parameters . The current study revealed that recommended intakes of vitamin D3 and calcium via fortified dairy products for 12 months can induce favourable changes in pelvis , total spine and total body BMD in postmenopausal women but not in QUS parameters . No such favourable changes were observed via supplementation of calcium alone BACKGROUND Our r and omized , placebo-controlled supplementation study of 160 rural Gambian children aged 8.3 - 11.9 y showed that an increase in calcium intake of 714 mg/d for 12 mo result ed in a 5 % increase in forearm bone mineral acquisition and a 22 % decrease in plasma osteocalcin concentration , a bone formation marker , but had no effect on height or bone dimensions . OBJECTIVE We investigated whether these results were sustained after supplement withdrawal . DESIGN All participants were followed up 12 ( FU1 ) and 24 ( FU2 ) mo after supplementation ended . Bone mineral content ( BMC ) , bone mineral density ( BMD ) , and BMC adjusted for bone width , body weight , and height ( size-adjusted BMC ) were measured at the midshaft and distal radius . Plasma osteocalcin concentration was measured at FU1 . RESULTS At follow-up , the calcium group had greater bone mineral status than did the placebo group at the midshaft radius ( mean difference + /- SE ) , FU1 : BMC ( 4.7 + /- 1.6 % ; P = 0.004 ) , BMD ( 5.1 + /- 1.1 % ; P < /= 0.0001 ) , size-adjusted BMC ( 5.0 + /- 1.1 % ; P < /= 0.0001 ) ; FU2 : BMC ( 3.8 + /- 1.6 % ; P = 0.02 ) , BMD ( 2.7 + /- 1.3 % ; P = 0.04 ) , size-adjusted BMC ( 2.5 + /- 1.3 % ; P = 0.06 ) . Similar differentials were observed at the distal radius but were not significant . No significant differences in plasma osteocalcin concentrations ( FU1 : -0.5 + /- 6.5 % ; P = 0.9 ) were observed between groups . CONCLUSION Although some of the effects of calcium supplementation were still evident at follow-up , further studies are required to determine whether short-term increases in calcium intake have lasting benefits for Gambian children Previous research suggests that physical activity may have a beneficial effect on  bone mineral density ( BMD ) in women . This relationship was explored in a 2-year , r and omized , intervention trial investigating the efficacy of exercise and calcium supplementation on increasing peak bone mass in young women . One hundred and twenty-seven subjects ( ages of 20 - 35 years ) were r and omly assigned either to an exercise program that contained both aerobics and weight training components or to a stretching program . Calcium supplementation ( up to 1500 mg/day including dietary intake ) or placebo was given in a double-blinded design to all subjects . Spinal trabecular BMD was determined using quantitative computed tomography ( QCT ) . Spinal integral , femoral neck , and trochanteric BMD were measured by dual X-ray absorptiometry ( DXA ) and calcaneal BMD by single photon absorptiometry ( SPA ) . Fitness variables included maximal aerobic capacity ( VO2max ) , and isokinetic muscle performance of the trunk and thigh . Measurements were made at baseline , 1 year , and 2 years . Sixty-three subjects ( 32 exercise , 31 stretching ) completed the study , and all the measured bone parameters indicated a positive influence of the exercise intervention . There were significant positive differences in BMD between the exercise and stretching groups for spinal trabecular ( 2.5 % ) , femoral neck ( 2.4 % ) , femoral trochanteric ( 2.3 % ) , and calcaneal ( 6.4 % ) measurements . The exercise group demonstrated a significant gain in BMD for spinal integral ( 1.3 + /- 2.8 % , p < 0.02 ) , femoral trochanteric ( 2.6 + /- 6.1 % , p < 0.05 ) , and calcaneal ( 5.6 + /- 5.1 , p < 0.01 ) measurements . In contrast to exercise , the calcium intervention had no positive effect on any of the bone parameters . In regard to fitness parameters , the exercise group completed the study with significant gains in VO2max and isokinetic ( peak torque ) values for the knee flexion and extension and trunk extension . This study indicates that over a 2-year period , a combined regimen of aerobics and weight training has beneficial effects on BMD and fitness parameters in young women . However , the addition of daily calcium supplementation does not add significant benefit to the intervention We previously reported that calcium intake enhanced the leg bone response to physical activity of preschool children in a 12-month r and omized trial of calcium supplementation and physical activity . To determine whether the intervention-induced changes in leg bone mineral content and size were maintained through the subsequent 12-month follow-up period , total body bone measurements by DXA and 20 % distal tibia pQCT bone measurements were obtained at 24 months ( 12 months post-intervention ) . Children also were measured for height and weight , and accelerometer readings were obtained in a subset of children at 18 and 24 months ( 6 and 12 months post-intervention ) . Regression analyses were performed controlling for covariates and indicated that increases from 12 to 24 months were greater in the gross motor ( GM ) activity group ( bone loading , large muscle exercises ) vs. fine motor ( FM ) activity group ( arts and crafts program ) for arm bone area ( BA ) ( P < 0.01 ) , total body ( P=0.04 ) and arm ( P < 0.01 ) bone mineral content ( BMC ) . There were no differences in BA or BMC changes from 12 to 24 months by calcium supplementation . Differences in tibia periosteal circumference by pQCT persisted at 24 months ( GM 51.4 + /- 0.4 mm vs. FM 50.2 + /- 0.4 mm , P=0.03 ) with a trend for greater endosteal circumferences in the children in the GM vs. FM groups at both 12 and 24 months ( both , P=0.08 ) . There were no significant differences in cortical area or thickness by activity or supplement group at 24 months . Children in the GM group had greater accelerometer counts/day ( P=0.04 ) and more time in vigorous activity ( P=0.05 ) at 18 months compared to FM group . No differences in accelerometer readings were noted at 24 months . In conclusion , we found higher activity levels in children r and omized to gross motor vs. fine motor activities 6 months after the intervention program ceased . Whether the greater periosteal circumference that was observed 12 months post-intervention was a persistent biological bone effect or due to persistently higher activity levels is not known High calcium intake during childhood has been suggested to increase bone mass accrual , potentially result ing in a greater peak bone mass . Whether the effects of calcium supplementation on bone mass accrual vary from one skeletal region to another , and to what extent the level of spontaneous calcium intake may affect the magnitude of the response has , however , not yet been clearly established . In a double-blind , placebo-controlled study , 149 healthy prepubertal girls aged 7.9+/-0.1 yr ( mean+/-SEM ) were either allocated two food products containing 850 mg of calcium ( Ca-suppl . ) or not ( placebo ) on a daily basis for 1 yr . Areal bone mineral density ( BMD ) , bone mineral content ( BMC ) , and bone size were determined at six sites by dual-energy x-ray absorptiometry . The difference in BMD gain between calcium-supplemented ( Ca-suppl . ) and placebo was greater at radial ( metaphysis and diaphysis ) and femoral ( neck , trochanter , and diaphyses ) sites ( 7 - 12 mg/cm2 per yr ) than in the lumbar spine ( 2 mg/cm2 per yr ) . The difference in BMD gains between Ca-suppl . and placebo was greatest in girls with a spontaneous calcium intake below the median of 880 mg/d . The increase in mean BMD of the 6 sites in the low-calcium consumers was accompanied by increased gains in mean BMC , bone size , and statural height . These results suggest a possible positive effect of calcium supplementation on skeletal growth at that age . In conclusion , calcium-enriched foods significantly increased bone mass accrual in prepubertal girls , with a preferential effect in the appendicular skeleton , and greater benefit at lower spontaneous calcium intake BACKGROUND Specific physical loading leads to enhanced bone development during childhood . A general physical activity program mimicking a real-life situation was successful at increasing general physical health in children . Yet , it is not clear whether it can equally increase bone mineral mass . We performed a cluster-r and omized controlled trial in children of both gender and different pubertal stages to determine whether a school-based physical activity ( PA ) program during one school-year influences bone mineral content ( BMC ) and density ( BMD ) , irrespective of gender . METHODS Twenty-eight 1st and 5th grade ( 6 - 7 and 11 - 12 year-old ) classes were cluster r and omized to an intervention ( INT , 16 classes , n=297 ) and control ( CON ; 12 classes , n=205 ) group . The intervention consisted of a multi-component PA intervention including daily physical education with at least 10 min of jumping or strength training exercises of various intensities . Measurements included anthropometry , and BMC and BMD of total body , femoral neck , total hip and lumbar spine using dual-energy X-ray absorptiometry ( DXA ) . PA was assessed by  accelerometers and Tanner stages by question naires . Analyses were performed by a regression model adjusted for gender , baseline height and weight , baseline PA , post-intervention pubertal stage , baseline BMC , and cluster . RESULTS 275 ( 72 % ) of 380 children who initially agreed to have DXA measurements had also post-intervention DXA and PA data . Mean age of prepubertal and pubertal children at baseline was 8.7±2.1 and 11.1±0.6 years , respectively . Compared to CON , children in INT showed statistically significant increases in BMC of total body , femoral neck , and lumbar spine by 5.5 % , 5.4 % and 4.7 % ( all p<0.05 ) , respectively , and BMD of total body and lumbar spine by 8.4 % and 7.3 % ( both p<0.01 ) , respectively . There was no gender * group , but a pubertal stage * group interaction consistently favoring prepubertal children . CONCLUSION A general school-based PA intervention can increase bone health in elementary school children of both genders , particularly before puberty BACKGROUND There is currently no consensus on the effect of dietary protein intake on the skeleton , but there is some indication that low calcium intakes adversely influence the effect of dietary protein on fracture risk . OBJECTIVE The objective of the present study was to determine whether supplemental calcium citrate malate and vitamin D influence any associations between  protein intake and change in bone mineral density ( BMD ) . DESIGN Associations between protein intake and change in BMD were examined in 342 healthy men and women ( aged > or = 65 y ) who had completed a 3-y , r and omized , placebo-controlled trial of calcium and vitamin D supplementation . Protein intake was assessed at the midpoint of the study with the use of a food-frequency question naire and  BMD  was assessed every 6 mo by dual-energy X-ray absorptiometry . RESULTS The mean ( + /-SD ) protein intake of all subjects was 79.1 + /- 25.6 g/d and the mean total calcium intakes of the supplemented and placebo groups were 1346 + /- 358 and 871 + /- 413 mg/d , respectively . Higher protein intake was significantly associated with a favorable 3-y change in total-body BMD in the supplemented group ( in a model containing terms for age , sex , weight , total energy intake , and dietary calcium intake ) but not in the placebo group . The pattern of change in femoral neck BMD with increasing protein intake in the supplemented group was similar to that for the total body . CONCLUSION Increasing protein intake may have a favorable effect on change in BMD in elderly subjects supplemented with calcium citrate malate and vitamin BACKGROUND High calcium intakes during adolescence may increase bone acquisition . The magnitude of the effect of dietary calcium supplementation and the timing of its administration to achieve significant effects on bone health are still incompletely defined . OBJECTIVE The objective of this study was to assess the effect of calcium supplementation on bone mass accretion in postmenarcheal adolescent girls with low calcium intakes . DESIGN A double-blind , placebo-controlled calcium supplementation study was implemented . One hundred girls with a mean ( + /- SD ) age of 14 + /- 0.5 y with habitual calcium intakes < 800 mg/d completed a 12-mo protocol . The treatment group received a daily supplement containing 1000 mg elemental calcium .  Bone mineral density ( BMD ) and bone mineral content ( BMC ) of the total body , lumbar spine , and femoral neck were determined at inclusion , 6 mo , and 12 mo . Also measured were serum concentrations of biochemical markers of bone turnover ( osteocalcin and deoxypyridinoline ) , parathyroid hormone , and vitamin D. RESULTS The calcium-supplemented group had greater accretion of total-body BMD and lumbar spine BMD but not BMC than did the control group . Calcium supplementation appeared selectively beneficial for girls who were 2 y postmenarcheal . Calcium supplementation significantly decreased bone turnover and decreased serum parathyroid hormone concentrations . CONCLUSION Calcium supplementation of postmenarcheal girls with low calcium intakes enhances bone mineral acquisition , especially in girls > 2 y past the onset of menarche The aim of this study was to determine whether early changes in bone markers could predict long-term response in bone mineral density ( BMD ) after calcium ( 500 mg ) and vitamin D ( 400 IU ) supplementation twice daily in ambulatory elderly women with vitamin D insufficiency ( 25-hydroxyvitamin D , < 12 ng/ml ) . One hundred and ninety-two women ( mean age , 75 + /- 7 yr ) were r and omized to receive either the supplementation ( n = 95 ) or a placebo ( n = 97 ) in a double-blind , controlled clinical trial for 1 yr . In comparison with the placebo group , supplementation significantly increased BMD , normalized 25-hydroxyvitamin D and significantly decreased intact PTH and bone remodeling markers . The initial values of telopeptide cross-links were correlated with improvement in total body BMD [ urinary N-telopeptides ( NTX ) , r = 0.38 ; C-telopeptides ( CTX ) , r = 0.32 ; serum CTX , r = 0.28 ] , and the 3-month changes in the same markers were correlated with improvement in total body ( urinary N-telopeptides , r = -0.29 ; serum CTX , r = -0.26 ) and vertebral BMD ( CTX , r = -0.26 ; all P < 0.05 ) . We concluded that short-term changes in bone resorption markers can predict long-term variations in BMD in elderly women with vitamin D insufficiency receiving calcium  and vitamin D supplementation To evaluate the correlation between dietary calcium intake and mineralization of the immature skeleton 55 children and adolescents aged 5 - 14 years ( mean , 9.5 years ) with a positive radioallergosorbent test ( RAST ) for serum antibodies to cow 's milk protein were evaluated .  Bone mineral density ( BMD ) in the lumbar spine and proximal femurs were measured by dual energy X-ray absorptiometry . BMD at each site for each subject was converted to an age-adjusted Z score based on our own series of 95 normal pediatric controls .  Calcium intake was determined using a detailed food frequency question naire administered by a nutritionist during a 30 - 40-min interview . Dietary adjustments to the condition varied and result ed in a wide range of calcium intakes . Calcium supplements were taken by 22 % of the subjects and were included in the determination of daily calcium intake . The group of 55 subjects was divided into quartiles based on calcium intake ( mean + /- S.E mg calcium/day ) : Group 1 , 409 + /- 21 , Group 2 , 663 + /- 16 , Group 3 , 950 + /- 32 , Group 4 , 1437 + /- 124 . Bone density Z scores in the proximal femur serially increased across the calcium intake groups ( mean + /- S.E. ) : Group 1 , -0.16 + /- 0.31 ; Group 2 , 0.05 + /- 0.33 ; Group 3 , 0.44 + /- 0.24 ; Group 4 , 0.79 + /- 0.41 ( P = 0.03 ) . A similar pattern was found with lumbar spine BMD Z scores : Group 1 , -0.16 + /- 0.27 ; Group 2 , 0.10 + /- 0.21 ; Group 3 , 0.18 + /- 0.20 ; Group 4 , 0.30 + /- 0.25 ( P = 0.05 ) . These data add further to the evidence that dietary calcium intake is important for optimal mineralization of the growing skeleton Osteoporosis is a major public health concern . The combination of exercise , hormone replacement therapy , and calcium supplementation may have added benefits for improving bone mineral density compared to a single intervention . To test this notion , 320 healthy , non-smoking postmenopausal women , who did or did not use hormone replacement therapy ( HRT )  , were r and omized within groups to exercise or no exercise and followed for 12 months . All women received 800 mg calcium citrate supplements daily . Women who exercised performed supervised aerobic , weight-bearing and weight-lifting exercise , three times per week in community-based exercise facilities . Regional bone mineral density ( BMD ) was assessed by dual energy X-ray absorptiometry . Women who used HRT , calcium , and exercised  increased femoral neck , trochanteric and lumbar spine bone mineral density by approximately 1–2 % . Trochanteric BMD was also significantly increased by ~1.0 % in women who exercised and used calcium without HRT compared to a negligible change in women who used HRT and did not exercise . The results demonstrate that regional BMD can be improved with aerobic , weight-bearing activity combined with weight lifting at clinical ly relevant sites in postmenopausal women . The response was significant at more sites in women who used HRT , suggesting a greater benefit with hormone replacement and exercise compared to HRT alone BACKGROUND We sought to improve lumbar spine bone mineral density ( LS-BMD ) in long-term survivors of childhood acute lymphoblastic leukemia ( ALL ) using calcium and cholecalciferol supplementation . PROCEDURE This double-blind , placebo-controlled trial r and omized 275 participants ( median age , 17 [ 9 - 36.1 ] years ) with age- and gender-specific LS-BMD Z-scores < 0 to  receive nutritional counseling with supplementation of 1,000 mg/day calcium and 800 International Unit cholecalciferol or placebo for 2 years . The primary outcome was change in LS-BMD assessed by quantitative computerized tomography ( QCT ) at 24 months . Linear regression models were employed to identify the baseline risk factors for low LS-BMD and to compare LS-BMD outcomes . RESULTS Pre-r and omization LS-BMD below the mean was associated with male gender ( P = 0.0024 ) , White race ( P = 0.0003 ) , lower body mass index ( P < 0.0001 ) , and cumulative glucocorticoid doses of ≥ 5,000 mg ( P = 0.0012 ) . One hundred eighty-eight ( 68 % ) participants completed the study ; 77 % adhered to the intervention . Mean LS-BMD change did not differ between survivors r and omized to supplements ( 0.33 ± 0.57 ) or placebo ( 0.28 ± 0.56 ) . Participants aged 9 - 13 years and those 22 - 35 years had the greatest mean increases in LS-BMD ( 0.50 ± 0.66 and 0.37 ± 0.23 , respectively ) . Vitamin D insufficiency ( serum 25[OH]D < 30 ng/ml ) found in 296 ( 75 % ) , was not associated with LS-BMD outcomes ( P = 0.78 ) . CONCLUSION Cholecalciferol and calcium supplementation provides no added benefit to nutritional counseling for improving LS-BMD among adolescent and young adult survivors of ALL ( 93 % of whom had LS-BMD Z-scores above the mean at study entry ) BACKGROUND There is no agreement on how much calcium young girls need for optimal bone mineralization . OBJECTIVE We evaluated whether the effect of calcium supplementation on whole-body bone mineral accretion depends on habitual calcium intake . DESIGN This was a r and omized , double-blind , placebo-controlled , 1-y calcium intervention study of girls aged 12 - 14 y selected from a larger group according to habitual calcium intake : subgroup A ( n = 60 ) habitually consumed 1000 - 1307 mg/d ( 40th-60th percentile ) , and subgroup B ( n = 53 ) habitually consumed < 713 mg/d ( < 20th percentile ) . The girls from each subgroup were r and omly assigned to receive either 500 mg Ca/d or placebo .  Whole-body bone mineral content ( BMC ) , bone area ( BA ) , bone mineral density ( BMD ) , and BMC adjusted for BA , height , and weight ( size-adjusted BMC ) were measured at baseline and after 1 y. RESULTS There was no significant effect modification of baseline habitual calcium intake on the relation between calcium supplementation and height , weight , BMC , size-adjusted BMC , BA , BMD , or alkaline phosphatase .  Calcium supplementation had an effect on BMD ( 0.8 % ; P = 0.049 ) and tended to show signs of an effect on size-adjusted BMC ( 0.5 % ; P = 0.08 ) . CONCLUSION A modest effect of calcium supplementation on BMD was shown . However , the effect was independent of habitual calcium intake BACKGROUND AND PURPOSE It has been demonstrated that bone mass was significantly reduced on the hemiplegic side of stroke patients , which might increase their risk of hip fracture . We evaluated the efficacy of 1 alpha-hydroxyvitamin D3 [ 1 alpha (OH)D3 ] and supplemental elemental calcium in maintaining bone mass and decreasing the incidence of hip fractures after hemiplegic stroke . METHODS In a r and omized study , 64 patients with hemiplegia after stroke with a mean duration of illness of 4.8 years received either 1 microgram 1 alpha (OH)D3 daily ( treatment group , n = 30 ) or an inactive placebo ( placebo group , n = 34 ) for 6 months and were observed for this duration . Both groups received 300 mg of elemental calcium daily . The bone mineral density ( BMD ) and metacarpal index ( MCI ) in the second metacarpals were determined by computed x-ray densitometry . The incidence of hip fractures in these patients was recorded . RESULTS BMD on the hemiplegic side decreased by 2.4 % in the treatment group and 8.9 % in the placebo group ( P = .0021 ) , while BMD on the intact side increased by 3.5 % and decreased by 6.3 % in the treated and placebo groups , respectively ( P = .0177 ) . In the treatment group , the difference in BMD between hemiplegic and nonhemiplegic sides decreased significantly compared with that before r and omization . This difference increased in the placebo group . We observed a similar improvement in MCI in the treatment group but not in the placebo group . Four patients in the placebo group suffered a hip fracture compared with none in the treatment group ( P = .0362 ) . CONCLUSIONS Treatment with 1 alpha (OH)D3 and supplemental elemental calcium can reduce the risk of hip fractures and can prevent further decreases in BMD and MCI on the hemiplegic side of patients with a long-st and ing stroke . Treatment also may improve these indices on the intact side A group of 118 children , aged 5.3 - 14 years , were enrolled in a prospect i ve study of calcium supplementation and bone mass . At entry to the study , question naires regarding the child 's usual physical activity were administered to the children and their mothers . Repeated activity assessment s at 6 month intervals indicated good within-person agreement for total activity and for most individual activities . Consistent positive associations were observed between bone mineral densities ( BMD ) in the radius , spine , and hip and most activities . A summary measure ( total hours of weight-bearing activity ) was significantly related to BMD in the radius and hip , independently of age or gender effects . Self-reported sports and play activities were associated with BMD , but neither time spent watching television nor hours of physical education classes were associated either positively or negatively with skeletal mass . These data suggest that important increments in skeletal mass may result from physical activity during childhood Objective Calcium dem and is increased during pregnancy . However , few r and omized controlled trials examined the effects of calcium supplementation on bone mass during pregnancy . This study determined effects of calcium and milk supplementation on maternal bone mineral density ( BMD ) and bone turnover in pregnant Chinese women with habitual low calcium intake . Methods In this r and omized controlled trial , 36 Chinese pregnant women ( 24–31 years , 18 gestational weeks ) were r and omly assigned to the following three arms ( 12 each ) : I , usual diet ; II , “ I ” + 45 g milk powder ( containing 350 mg calcium ) ; or III , “ II ” + 600 mg calcium/day from gestational age of 20 weeks to 6 weeks post-partum ( PP ) . BMD was measured post-treatment using dual-energy X-ray absorptiometry . Dietary intakes , 24-h urinary calcium , bone resorption ( urinary hydroxyproline ) and formation ( serum osteocalcin ) biomarkers were examined at the gestational age of 20 and 34 weeks , and 6 weeks PP . Results A dose-dependent relationship was observed between calcium intake and BMDs . The BMD values were significantly higher in subjects with calcium and milk supplementation  than those in the controls at the whole body and spine ( p < 0.05 ) but not at the hip sites . We found significant decreases in changes of urinary hydroxyproline , and significant increases in serum osteocalcin during the intervention period in the calcium/milk intervention groups than those in the control group ( all p < 0.05 ) . Conclusion Calcium/milk supplementation during pregnancy is associated with greater BMD at the spine and whole body and suppresses bone resorption in Chinese women with habitual low calcium intake INTRODUCTION A high peak bone mass may be essential for reducing the risk of osteoporosis later in life and a sufficient vitamin D level during puberty may be necessary for optimal bone accretion and obtaining a high peak bone mass . Dietary intake and synthesis during winter of vitamin D might be limited but the effect of vitamin D supplementation in adolescence on bone mass is not well established . OBJECTIVE To investigate the effect of supplementation with 5 and 10 microg/day vitamin D(3 ) for 12 months in 11- to 12-year-old girls on  bone mass and bone turnover as well as the possible influence of VDR and ER genotype on the effect of the supplementation . METHODS The girls ( n=221 ) were r and omized to receive either 5 microg or 10 microg vitamin D(3 ) supplementation per day or placebo for 12 months . Whole body and lumbar spine bone mass measured by DXA and pubertal status were determined at baseline and after 12 months whereas physical activity and dietary intake of calcium and vitamin D were assessed at baseline . Serum ( S ) 25-hydroxyvitamin D ( 25OHD ) , S-osteocalcin , S-parathyroid hormone , S-calcium , S-inorganic phosphate , urinary ( U ) pyridinoline ( Pyr ) and deoxpyridinoline ( Dpyr ) were measured at baseline and after 6 and 12 months . RESULTS The S-25OHD concentration increased ( p<0.001 ) relative to the baseline values in the groups receiving either 5 microg/day ( mean+/-SD ; 11.0+/-10.3 nmol/l , baseline 41.9+/-17.6 nmol/l ) or 10 microg/day ( 13.3+/-11.8 nmol/l , baseline 44.4+/-16.6 nmol/l ) vitamin D(3 ) for 12 months compared to placebo ( -3.1+/-9.8 nmol/l , baseline 43.4+/-17.1 nmol/l ) . There was no effect of vitamin D-supplementation on biomarkers for bone turnover or on whole body or spine bone mineral augmentation . However , vitamin D supplementation increased whole body bone mineral density ( BMD ) ( p=0.007 ) and bone mineral content ( BMC ) ( p=0.048 ) in the FF VDR genotype but not in the Ff or ff VDR genotypes . CONCLUSION Supplementation with vitamin D ( 5 or 10 microg/day ) over 12 months increased the S-25OHD concentration but there was no effect on indices of bone health in the entire group of girls . However , there was an effect on BMD for a subgroup with the FF VDR genotype indicating an influence of genotype Background : Mobilization of maternal bone mineral partly supplies calcium for fetal and neonatal bone growth and development . Objective : We investigated whether pregnant women with low calcium intakes may have a more extensive skeletal response postpartum that may compromise their short- or long-term bone health . Design : In a subset of participants ( n = 125 ) in a double-blind , r and omized , placebo-controlled trial ( International Trial Registry : IS RCT N96502494 ) in pregnant women in The Gambia , West Africa , with low calcium intakes ( ≈350 mg Ca/d ) , we measured bone mineral status of the whole body , lumbar spine , and hip by using dual-energy X-ray absorptiometry and measured bone mineral status of the forearm by using single-photon absorptiometry at 2 , 13 , and 52 wk lactation . We collected blood and urine from the subjects at 20 wk gestation and at 13 wk postpartum . Participants received calcium carbonate ( 1500 mg Ca/d ) or a matching placebo from 20 wk gestation to parturition ; participants did not consume supplements during lactation . Results : Women who received the calcium supplement in pregnancy had significantly lower bone mineral content ( BMC ) , bone area ( BA ) , and bone mineral density ( BMD ) at the hip throughout 12 mo lactation ( mean ± SE difference : BMC = −10.7 ± 3.7 % , P = 0.005 ; BA = −3.8 ± 1.9 % , P = 0.05 ; BMD = −6.9 ± 2.6 % , P = 0.01 ) . The women also experienced greater decreases in bone mineral during lactation at the lumbar spine and distal radius and had biochemical changes consistent with greater bone mineral mobilization . Conclusions : Calcium supplementation  in pregnant women with low calcium intakes may disrupt metabolic adaptation and may not benefit maternal bone health . Further study is required to determine if such effects persist long term or elicit compensatory changes in bone structure The effect of calcium supplementation on bone mineral density ( BMD ) was evaluated in female twin pairs aged 10–17 years with a mean age of 14 years . Forty-two twin pairs ( 22 monozygotic , 20 dizygotic ; ( including one monozygotic pair from a set of triplets ) completed at least 6 months of the intervention : 37 pairs to 12 months and 28 pairs to 18 months . BMD was measured by dual-energy X-ray absorptiometry ( DXA ) . In a double-blind manner , one twin in each pair was r and omly assigned to receive daily a 1000 mg effervescent calcium tablet ( S and ocal 1000 ) , and the other a placebo tablet similar in taste and appearance to the calcium supplement but containing no calcium .  Compliance ( at least 80 % tablets consumed ) , as measured by tablet count , was 85 % in the placebo group and 83 % in the calcium group over the 18 months of the study , on average increasing dietary calcium to over 1600 mg/day . There was no within-pair difference in the change in height or weight . When the effect of calcium supplementation  on BMD was compared with placebo at approximately 6 , 12 and 18 months , it was found that there was a 0.015±0.007 g/ cm2 greater increase in BMD ( 1.62±0.84 % ) at the spine in those on calcium after 18 months . At the end of the first 6 months there was a significant within-pair difference of 1.53±0.56 % at the spine and 1.27±0.50 % at the hip . However , there were no significant differences in the changes in BMD after the initial effect over the first 6 months . Therefore , we found an increase in BMD at the spine  with calcium supplementation in females with a mean age of 14 years . The greatest effect was seen in the first 6 months ; thereafter the difference was maintained , but there was no accelerated increase in BMD  associated with calcium supplementation . The continuance of the intervention until the attainment of peak bone mass and follow-up after cessation of calcium supplementation will be important in clarifying the optimal timing for increased dietary calcium and the sustained , long-term effects of this intervention BACKGROUND In a previous 2-y r and omized controlled trial , we showed that calcium- and vitamin D3-fortified milk stopped or slowed bone loss at several clinical ly relevant skeletal sites in older men . OBJECTIVE The present study aim ed to determine whether the skeletal benefits of the fortified milk were sustained after withdrawal of the supplementation . DESIGN One hundred nine men > 50 y old who had completed a 2-y fortified milk trial were followed for an additional 18 mo , during which no fortified milk was provided . Bone mineral density ( BMD ) of the total hip , femoral neck , lumbar spine , and forearm was measured by using dual-energy X-ray absorptiometry . RESULTS Comparison of the mean changes from baseline between the groups ( adjusted for baseline age , BMD , total calcium intake , and change in weight ) showed that the net beneficial effects of fortified milk on femoral neck and ultradistal radius BMD at the end of the intervention ( 1.8 % and 1.5 % , respectively ; P < 0.01 for both ) were sustained at 18-mo follow-up ( P < 0.05 for both ) . The nonsignificant between-group differences at the total hip ( 0.8 % ; P = 0.17 ) also persisted at follow-up ( 0.7 % ; P = 0.10 ) , but there were no lasting benefits at the lumbar spine . The average total dietary calcium intake in the milk supplementation group at follow-up approximated recommended amounts for Australian men > 50 y old ( 1000 mg/d ) but did not differ significantly from that in the control subjects ( 1021 versus 890 mg/d ) . CONCLUSION Supplementation with calcium- and vitamin D3-fortified milk for 2 y may provide some sustained benefits for BMD  in older men after withdrawal of supplementation Patients with primary hyperparathyroidism ( PHPT ) have higher bone turnover , lower bone mineral density ( BMD ) , and an increased risk of fractures . They also have a high incidence of low vitamin D levels ( 25-OH-vitamin D < 50 nmol/L ) that could worsen the negative effect on the bone . In this double-blinded clinical trial , 150 patients with PHPT were r and omized , after successful parathyroidectomy ( PTX ) , to 1-year daily treatment with either cholecalciferol 1600 IU and calcium carbonate 1000 mg ( D+ ) or calcium carbonate alone ( D- ) . BMD was measured in the lumbar spine , femoral neck , total hip , distal and 33 % radius using dual-energy X-ray absorptiometry ( DXA ) before surgery and after 1 year of study medication . Median age was 60 ( range 30 - 80 ) years and there were 119 ( 79 % ) women and 31 ( 21 % ) men ; 76 % had 25-OH-D < 50 nmol/L before PTX and 50 % had persistent elevated parathyroid hormone ( PTH ) 6 weeks after PTX . A similar increase in BMD in the lumbar spine , femoral neck , and total hip was observed in both groups ( D+ : 3.6 % , 3.2 % , and 2.7 % , p<0.001 , respectively ; and D- : 3.0 % , 2.3 % , and 2.1 % , respectively , p<0.001 ) . Patients with vitamin D supplementation also increased their BMD in distal radius ( median 2.0 % ; interquartile range , -1.7 % to 5.4 % ; p=0.013 ) . The changes in BMD , especially in the hips , were correlated to the baseline concentrations of PTH , ionized calcium , and bone markers ( p<0.001 ) . A benefit from vitamin D substitution was observed among patients with a persistent postoperative PTH elevation , who also improved their BMD at 33 % radius and radius ultradistal ( p<0.05 ) . In conclusion , except for a minor improvement of radius BMD , our data show no beneficial effect on BMD or bone turnover markers of vitamin D supplementation after PTX . Preoperative PTH seems to have the strongest association with improvement in BMD Background Vitamin D insufficiency in children may have long-term skeletal consequences as vitamin D affects calcium absorption , bone mineralization and bone mass attainment . Methodology /Principal Findings This school-based study investigated vitamin D status and its association with vitamin D intake and bone health in 195 Finnish children and adolescents ( age range 7–19 years ) . Clinical characteristics , physical activity and dietary vitamin D intake were evaluated . Blood and urine sample s were collected for serum 25-hydroxyvitamin D ( 25-OHD ) and other parameters of calcium homeostasis . Bone mineral density ( BMD ) and body composition were measured with dual-energy X-ray absorptiometry ( DXA ) . Altogether 71 % of the subjects were vitamin D insufficient ( 25-OHD < 50 nmol/L ) . The median 25-OHD was 41 nmol/L for girls and 45 nmol/L for boys , and the respective median vitamin D intakes 9.1 µg/day and 10 µg/day . In regression analysis , after adjusting for relevant factors , 25-OHD concentration explained 5.6 % of the variance in lumbar BMD ; 25-OHD and exercise together explained 7.6 % of the variance in total hip BMD and 17 % of the variance in whole body BMD . S-25-OHD was an independent determinant of lumbar spine and whole body BMD and in magnitude surpassed the effects of physical activity . Conclusions / Significance Vitamin D insufficiency was common even when vitamin D intake exceeded the recommended daily intake . Vitamin D status was a key determinant of BMD . The findings suggest urgent need to increase vitamin D intake to optimize bone health in children Introduction and HypothesisCalcium supplementation enhances bone mass accrual during administration , with a sustained benefit observed using milk-based calcium but not calcium salts . We tested the hypothesis that calcium from milk minerals but not calcium carbonate will be sustained after supplementation was discontinued . Methods Ninety-nine pre-pubertal boys and girls aged 5–11 years were followed for 12 months after being r and omized to receive 800 mg/day of calcium from milk minerals ( MM ) or calcium carbonate ( CC ) , or a placebo ( Pla ) in a 10-month double blind study . Total body and regional BMC , and femoral shaft bone dimensions were measured using dual energy x-ray absorptiometry . Group differences were determined using ANCOVA . Results In the intention to treat analysis of the entire sample , no group differences were observed in increments in BMC or bone dimensions during or after supplementation . In those children who remained pre-pubertal , greater gains in pelvis BMC in the milk mineral group than controls were sustained ( 37.9 versus 29.3 % respectively , p<0.02 ) . Conclusion In healthy children consuming about 800 mg calcium daily , calcium supplementation with milk minerals or calcium carbonate does not appear to be produce biologically meaningful benefits to skeletal health . A benefit of calcium supplementation in pre-pubertal was evident , but inconclusive , with the biological significance of the effect of calcium supplementation at the pelvis , and the longevity of this effect to be determined Low dietary calcium intake has been demonstrated to be a risk factor for hip and vertebral fractures in studies conducted among Hong Kong Chinese . Few studies have demonstrated the effect of milk supplementation in bone accretion in Chinese children . The aim was to examine the effects of milk powder supplementation in enhancing bone accretion in Chinese children . Three hundred and forty-four children , aged 9–10 years old , were r and omized to receive milk powder equivalent to 1300 mg and 650 mg calcium , and to a control group , respectively . Bone mineral density ( BMD ) at the proximal femur , lumbar spine and total body were measured at 6 months , 12 months and 18 months . The treatment effects were modeled using linear mixed effect models and compared using linear contrast F-tests , by intention-to-treat . Subjects r and omized to milk powder equivalent to 1300 mg calcium had significantly higher increase in BMD at both the total hip ( 7.4±0.4 % in treatment group versus 6.3±0.4 % in the control ) and the spine ( 8.4±0.5 % in the treatment group versus 7.0±0.5 % in the control group ) . Subjects r and omized to milk powder equivalent to 650 mg calcium had smaller increases in BMD at the total hip and spine , although the increase in BMD at the total body was significantly higher ( 3.1±0.3 % in treatment group versus 2.4±0.2 % in controls ) . It is concluded that supplementing the diet of Chinese children with milk powder was effective in enhancing bone accretion BACKGROUND Age-related reductions in serum dehydroepi and rosterone ( DHEA ) concentrations may be involved in bone mineral density ( BMD ) losses . OBJECTIVE The objective was to determine whether DHEA supplementation in older adults improves BMD when co-administered with vitamin D and calcium . DESIGN In year 1 , a r and omized trial was conducted in which men ( n = 55 ) and women ( n = 58 ) aged 65 - 75 y took 50 mg/d oral DHEA supplements or placebo . In year 2 , all participants took open-label DHEA ( 50 mg/d ) . During both years , all participants received vitamin D ( 16 microg/d ) and calcium ( 700 mg/d ) supplements . BMD was measured by using dual-energy X-ray absorptiometry . Concentrations of hormones and bone turnover markers were measured in serum . RESULTS In men , no difference between groups occurred in any BMD measures or in bone turnover markers during year 1 or year 2 . The free testosterone index and estradiol increased in the DHEA group only . In women , spine BMD increased by 1.7 + /- 0.6 % ( P = 0.0003 ) during year 1 and by 3.6 + /- 0.7 % after 2 y of supplementation in the DHEA group ; however , in the placebo group , spine BMD was unchanged during year 1 but increased to 2.6 + /- 0.9 % above baseline during year 2 after the crossover to DHEA . Hip BMD did not change . Testosterone , estradiol , and insulin-like growth factor 1 increased in the DHEA group only . In both groups , serum concentrations of bone turnover markers decreased during year 1 and remained low during year 2 , but did not differ between groups . CONCLUSION DHEA supplementation in older women , but not in men , improves spine BMD when co-administered with vitamin D and calcium . This trial was registered at clinical trials.gov as NCT00182975 Aims : To examine the effect of combined calcium and vitamin D3 supplementation on bone mineral density ( BMD ) in patients with chronic kidney disease ( CKD ) . Methods : We performed a post-hoc analysis of the DECALYOS II , a 2-year r and omized , double-blind , placebo-controlled  study of 610 women r and omized to : calcium-vitamin D3 fixed combination , calcium plus vitamin D3 separate combination , or placebo . Both active treatment groups received the same daily amount of calcium ( 1,200 mg ) and vitamin D3 ( 800 IU ) . BMD of the distal radius was measured by single X-ray absorptiometry at baseline , 12 and 24 months . Results : At baseline 47.2 % , 36.4 % and 16.4 % of the study population had an eGFR ≥ 60 , 45 – 59 , and < 45 ml/min/1.73 m2 , respectively . Both active regimens vs.  placebo markedly increased serum 25-hydroxyvitamin D levels from baseline in all eGFR groups ( p < 0.0001 ) . Analysis of variance demonstrated an overall treatment effect on distal radius BMD ( p = 0.005 ) , with the active treatment groups showing a lower rate of BMD loss when compared to the placebo group . The effects of the intervention on BMD did not differ significantly according to baseline eGFR ( interaction p > 0.22 for all time points ) . Conclusion : Combined calcium and vitamin D3 supplementation was effective in reducing rate of BMD loss in women with moderate CKD Summary The rationale of this study was to determine the effect of high-dose vitamin D3 supplementation on bone mineral density ( BMD ) .  Prediabetic males given vitamin D had significantly less reduction in BMD at the femoral neck compared to the controls . The clinical implication s of our findings require further investigation . Introduction Type 2 diabetes mellitus is associated with increased fracture risk , and recent studies show crosstalk between bone and glucose metabolism . Few studies have investigated the effect of vitamin D supplementation on the bone without additional calcium . In the present study , we aim ed to determine whether a high dose of vitamin D3 could improve bone mass density ( BMD ) in prediabetic subjects . Methods The current study was conducted as a secondary research on a previously performed trial , in which 511 subjects with prediabetes were r and omized to vitamin D3 ( 20,000 IU per week ) versus placebo for 5 years  . BMD was measured using dual-energy X-ray absorptiometry ( DEXA ) . Results Two hundred and fifty-six subjects were r and omized to vitamin D and 255 to placebo . Mean baseline serum 25-hydroxyvitamin D ( 25(OH)D ) level was 60 nmol/L. Two hundred and two and 214 in the vitamin D and placebo groups , respectively , completed BMD measurements , whereas one in each group was excluded due to use of bisphosphonates . Males given vitamin D had significantly less reduction in BMD at the femoral neck measurement site compared to the controls ( 0.000 versus − 0.010 g/cm2 , p = 0.008 ) . No significant differences between intervention groups were seen at the total hip measurement site , regarding both males and females . Conclusions Vitamin D3 supplementation alone may be beneficial in males with prediabetes , but confirmatory studies are needed 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 Abstract : Quantitative ultrasound ( QUS ) assessment of bone is a strong predictor of hip fractures and is currently an FDA -approved tool to identify women at risk of osteoporosis . However , few studies have investigated the lifestyle and genetic correlates of QUS in women . This study investigated the cross-sectional associates of several lifestyle , demographic and genetic factors with calcaneal QUS parameters ( broadb and ultrasound attenuation ( BUA ) and speed of sound ( SOS ) ) in 393 women aged 45–53 years .  Leisure-time and historical physical activity , dietary calcium and protein , body composition , vitamin D receptor genotypes , menopause status , other health behaviors , calcaneal QUS parameters and bone mineral density ( BMD ) were assessed at a single clinic visit .  Lean mass , recent physical activity and African-American race were the strongest correlates of SOS whereas dietary protein , calcium and recent physical activity were the strongest correlates of BUA . These predictors explained 13 % and 6 % of the variance in SOS and BUA , respectively . Smoking , alcohol intake , education , hormone replacement therapy , calcium and vitamin D supplements , historical physical activity and vitamin D receptor genotypes were not significantly associated with BUA or SOS . Lean body mass and premenopausal status were the strongest correlates of lumbar BMD whereas lean body mass , physical activity , African-American race and body mass index were significantly related to femoral neck BMD . Physical activity remained predictive of SOS after controlling for lumbar BMD . The spectrum and magnitude of risk factors for SOS and BUA , including lean body mass , physical activity , race , protein and calcium intake , parallel previously observed predictors of BMD BACKGROUND Calcium supplementation  during childhood and adolescence increases bone-mass accrual . Whether or not this benefit persists after discontinuation of supplementation is not known . We previously showed a favourable effect of milk-extracted calcium phosphate incorporated in various foods on accumulation of bone mineral mass in 8-year-old girls . We now report the results of a follow-up study undertaken more than 3 years after the end of calcium supplementation . METHODS Anthropometric and bone variables were measured in 116 of the 144 girls whose data had been studied at the end of the supplementation period . The mean time elapsed between the end of the intervention period and this follow-up measurement was 3.5 years . Areal bone mineral density was measured by dual-energy X-ray absorptiometry at the same six skeletal sites as those studied during the intervention phase . FINDINGS We were able to remeasure 62 and 54 girls of the calcium-supplemented and placebo groups , respectively . The increase from baseline in the overall mean bone mineral density of the six skeletal sites was still highly significant ( calcium-supplemented group 179 mg/cm(2 ) [ SE 8 ] vs placebo group 151 mg/cm(2 ) [ 7 ] , p=0.012 ) . A significant difference in favour of the supplemented group was also seen with respect to mean bone mineral content ( p=0.031 ) and mean bone area ( p=0.04 ) . Difference in pubertal maturation did not seem to account for the recorded differences . INTERPRETATION Our results suggest that this form of milk-extracted calcium phosphate taken during the prepubertal period can modify the trajectory of bone mass growth and cause a long-st and ing increase in bone mass accrual , which lasts beyond the end of supplementation BACKGROUND Short-term studies in adolescents have generally shown an enhancement of calcium absorption by inulin-type fructans ( prebiotics ) . Results have been inconsistent ; however , and no studies have been conducted to determine whether this effect persists with long-term use . OBJECTIVE The objective was to assess the effects on calcium absorption and bone mineral accretion after 8 wk and 1 y of supplementation with an inulin-type fructan . DESIGN Pubertal adolescents were r and omly assigned to receive 8 g/d of a mixed short and long degree of polymerization inulin-type fructan product ( fructan group ) or maltodextrin placebo ( control group ) .  Bone mineral content and bone mineral density were measured before r and omization and after 1 y. Calcium absorption was measured with the use of stable isotopes at baseline and 8 wk and 1 y after supplementation . Polymorphisms of the Fok1 vitamin D receptor gene were determined . RESULTS Calcium absorption was significantly greater in the fructan group than in the control group at 8 wk ( difference : 8.5 + /- 1.6 % ; P < 0.001 ) and at 1 y ( difference : 5.9 + /- 2.8 % ; P = 0.04 ) . An interaction with Fok1 genotype was present such that subjects with an ff genotype had the least initial response to fructan . After 1 y , the fructan group had a greater increment in both whole-body bone mineral content ( difference : 35 + /- 16 g ; P = 0.03 ) and whole-body bone mineral density ( difference : 0.015 + /- 0.004 g/cm(2 ) ; P = 0.01 ) than did the control group . CONCLUSION Daily consumption of a combination of prebiotic short- and long-chain inulin-type fructans significantly increases calcium absorption and enhances bone mineralization during pubertal growth . Effects of dietary factors on calcium absorption may be modulated by genetic factors , including specific vitamin D receptor gene polymorphisms 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 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 High dietary acid load ( DAL ) may be detrimental to bone mineral density ( BMD ) . The objectives of the study were to : ( 1 ) evaluate the cross-sectional relation between DAL and BMD ; and ( 2 ) determine whether calcium intake modifies this association . Men ( n = 1218 ) and women ( n = 907 ) aged ≥60 years were included from the National Health and Nutrition Examination Survey 2005 - 2008 .  Nutrient intake from 2 , 24-hour recalls was used to calculate net endogenous acid production ( NEAP ) and potential renal acid load  ( PRAL ) ( mEq/d ) . PRAL was calculated from dietary calcium ( PRALdiet ) and diet + supplemental calcium ( PRALtotal ) . Tests for linear trend in adjusted mean BMD of the hip and lumbar spine were performed across energy-adjusted NEAP and PRAL quartiles . Modification by calcium intake ( dietary or total ) above or below 800 mg/d was assessed by interaction terms . Overall , mean age was 69 ± 0.3 years . Among women , there was no association between NEAP and BMD  . PRALdiet was positively associated with proximal femur BMD ( p trend = 0.04 ) . No associations were observed with PRALtotal at any BMD site ( p range , 0.38 - 0.82 ) . Among men , no significant associations were observed between BMD and NEAP or PRAL . However , an interaction between PRALdiet and calcium intake was observed with proximal femur BMD ( p = 0.08 ) . An inverse association between PRALdiet and proximal femur BMD was detected among men with < 800 mg/d dietary calcium ( p = 0.02 ) ; no associations were found among men with ≥800 mg/d ( p = 0.98 ) . A significant interaction with PRALtotal was not observed . In conclusion , when supplemental calcium is considered , there is no association between DAL and  BMD among adults . Men with low dietary calcium showed an inverse relation with PRAL at the proximal femur ; in women no interaction was observed . This study highlights the importance of calcium intake in counteracting the adverse effect of DAL on bone health . Further research should determine the relation between DAL and change in BMD with very low calcium intake OBJECTIVE We investigated the effect of a micronutrient-enriched beverage on body composition , bone mineral content ( BMC ) , bone area , and bone mineral density ( BMD ) at various sites in schoolchildren . METHODS A double-blind , placebo-controlled , matched-pair , cluster , r and omization study was carried out in residential schoolchildren 6 to 16 y of age who lived near Hyderabad , India . Children ( n = 268 ) were selected r and omly from two classes of each grade ( 1 to 9 ) and were provided a micronutrient-enriched beverage ( n = 146 ) or a placebo drink ( n = 122 ) . Bone parameters such as BMC , BMD , and bone area at various sites and the entire body were measured with dual-energy X-ray absorptiometry at the beginning and end of the study . Increments of outcome variables were subjected to paired t test with appropriate corrections to assess the effect of the supplement on bone health . RESULTS After 14 mo , increments for height , weight , fat-free mass , percentage of fat , whole-body BMC , whole-body bone area , and BMD at the neck of the femur were significantly greater ( P < 0.05 ) in the supplemented group than in the placebo group . CONCLUSIONS The micronutrient-rich supplement increased tissue growth and skeletal shell in apparently normal children in the 14-mo period . It did not increase whole-body or site-specific BMD except at the neck of the femur . Amounts of calcium and other nutrients contained in the supplement were inadequate for tissue growth with density increases . This study raises important questions about the nutrient requirements of Indian children who consume a diet of cereals and pulses CONTEXT Effects of long-term calcium , with or without vitamin D , on  hip bone mineral density ( BMD ) and bone turnover in sunny climates have not been reported . OBJECTIVE The aim was to evaluate the effect of vitamin D added to calcium supplementation on hip dual-energy x-ray absorptiometry BMD and calcium-related analytes . DESIGN , SETTING , AND PARTICIPANTS The study was a 5-yr r and omized , controlled , double-blind trial of 120 community-dwelling women aged 70 - 80 yr . INTERVENTIONS The interventions were 1200 mg/d calcium with placebo vitamin D ( Ca group ) or with 1000 IU/d vitamin D2 ( CaD group ) , or double placebo ( control ) . MAIN OUTCOME MEASURES Hip BMD , plasma 25-hydroxyvitamin D , biomarkers of bone turnover , PTH , and intestinal calcium absorption were measured . RESULTS Hip BMD was preserved in CaD ( -0.17 % ) and Ca ( 0.19 % ) groups but not controls ( -1.27 % ) at yr 1 and maintained in the CaD group only at yr 3 and 5 . The beneficial effects were mainly in those with baseline 25-hydroxyvitamin D levels below the median ( 68 nmol/liter ) . At yr 1 , compared with controls , the Ca and CaD groups had 6.8 and 11.3 % lower plasma alkaline phosphatase , respectively ( P < or=0.02 ) , and 28.7 and 34.5 % lower urinary deoxypyridinoline to creatinine ratio , respectively ( P < or=0.05 ) . At 5 yr , this suppression was maintained only in the CaD group . CaD reduced PTH at 3 and 5 yr cf . controls ( 27.8 and 31.3 % , P < or=0.005 ) in those with baseline PTH levels above the median ( 3.6 pmol/liter ) . Therapy did not affect intestinal calcium absorption at high carrier loads . CONCLUSIONS Addition of vitamin D to calcium has long-term beneficial effects on bone density in elderly women living in a sunny climate , probably mediated by a long-term reduction in bone turnover rate Bone mobilization , lowering of bone mineral density ( BMD ) , and osteoporotic fractures are recognized in postmenopausal women with weight loss . Because a high-calcium intake suppresses bone loss in peri- and postmenopausal women , the present r and omized , double-blind , placebo-controlled study was design ed to test the hypothesis that calcium supplementation prevents net bone mobilization and consequent bone mineral loss during voluntary weight reduction in obese postmenopausal women . Subjects were placed on a moderate energy-restricted diet and either calcium supplementation ( 1 g/day ) or placebo for 6 months . Body weight , bone turnover markers ( pyridinium cross-links ) , osteocalcin , and parathyroid hormone ( PTH ) were measured at treatment weeks 1 - 5 , 7 , 10 , 13 , 16 , 20 , and 25 . Total body BMD , insulin-like growth factor , 25-hydroxyvitamin D , and sex hormone binding globulin ( SHBG ) were measured at baseline and week 25 . The calcium supplemented ( n = 15 ; age 60.9 + /- 9.4 years , body mass index [ BMI ] 33.2 + /- 4.6 kg/m2 ) and placebo ( n = 16 ; age 55.8 + /- 8.3 years , BMI 32.9 + /- 4.5 kg/m2 ) groups lost similar amounts of weight over the study interval ( 10.2 + /- 5.3 % vs. 10.0 + /- 5.2 % ) and both groups increased SHBG ( p < 0.001 ) . There was a statistical effect of calcium supplementation during weight loss to suppress pyridinium cross-links , osteocalcin , and PTH ( p < 0.05 , < 0.01 , and < 0.05 , respectively ) . Loss of BMD tended to be greater in the placebo group by 1.4 % ( p < 0.08 ) after weight loss . One gram per day calcium supplementation normalizes the increased calcium-PTH axis activity and the elevated bone turnover rate observed during moderate voluntary energy restriction in postmenopausal women OBJECTIVES To investigate the effects of testosterone supplementation on bone , body composition , muscle , physical function , and safety in older men . DESIGN Double-blind , r and omized , placebo-controlled trial . SETTING A major medical institution . PARTICIPANTS One hundred thirty-one men ( mean age 77.1 + /- 7.6 ) with low testosterone , history of fracture , or bone mineral density ( BMD ) T-score less than -2.0 and frailty . INTERVENTION Participants received 5 mg/d of testosterone or placebo for 12 to 24 months ; all received calcium ( 1500 mg/d diet and supplement ) and cholecalciferol ( 1,000 IU/d ) . MEASUREMENTS BMD of hip , lumbar spine , and mid-radius ; body composition ; sex hormones , calcium-regulating hormones ; bone turnover markers ; strength ; physical performance ; and safety parameters . RESULTS Ninety-nine men ( 75.6 % ) completed 12 months , and 62 ( 47.3 % ) completed end therapy ( mean 23 months ; range 16 - 24 months for 62 who completed therapy ) . Study adherence was 54 % , with 40 % of subjects maintaining 70 % or greater adherence . Testosterone and bioavailable testosterone levels at 12 months were 583 ng/dL and 157 ng/dL , respectively , in the treatment group . BMD on testosterone  increased 1.4 % at the femoral neck and 3.2 % at the lumbar spine ( P=.005 ) and decreased 1.3 % at the mid-radius ( P<.001 ) . There was an increase in lean mass and a decrease in fat mass in the testosterone group but no differences in strength or physical performance . There were no differences in safety parameters . CONCLUSION Older , frail men receiving  testosterone replacement increased testosterone levels and had favorable changes in body composition , modest changes in axial BMD , and no substantial changes in physical function One hundred and twelve Caucasian girls , 11.9±0.5 years of age at entry , were r and omized into a 24-month , double-masked , placebo-controlled trial to determine the effect of calcium supplementation on bone mineral content , bone area and bone density . Supplementation was 500 mg calcium as calcium citrate malate ( CCM ) per day . Controls received placebo pills , and compliance of both groups averaged 72 % . Bone mineral content , bone mineral area and bone mineral density of the lumbar spine and total body were measured by dual energy X-ray absorptiometry ( DXA ) . Calcium intake from dietary sources averaged 983 mg/day for the entire study group . The supplemented group received , on average , an additional 360 mg calcium/day from CCM . At baseline and after 24 months , the two groups did not differ with respect to anthropometric measurements , urinary reproductive hormone levels or any measurement of pubertal progression . The supplemented group had greater increases of total body bone measures : content 39.9 % versus 35.7 % ( p=0.01 ) , area 24.2 % versus 22.5 % ( p=0.15 ) and density 12.2 % versus 10.1 % ( p=0.005 ) . Region-of-interest analyses showed that the supplemented group had greater gains compared with the control group for bone mineral density , content and area . In particular , in the lumbar spine and pelvis , the gains made by the supplemented group were 12%–24 % greater than the increases made by the control group . Bone acquisition rates in the two study groups were further compared by subdividing the groups into those with below- or above-median values for Tanner score and dietary calcium intake . In subjects with below-median Tanner scores , bone acquisition was not affected by calcium supplementation or dietary calicum level . However , the calcium supplemented subjects with above-median Tanner had higher bone acqusition rates than the placebo group with above-median Tanner scores . Relative to the placebo group , the supplemented group had increased yearly gains of bone content , area and density which represented about 1.5 % of adult female values . Such increases , if held to adult skeletal maturity , could provide protection against future risk of osteoporotic fractures Previously published results from a 2 year r and omized , controlled clinical trial on supplementing the diet of postmenopausal Chinese women with  high-calcium milk powder  ( containing 800 mg of calcium ) showed that bone loss , as measured by bone mineral density ( BMD ) , was prevented . To determine whether the effect of calcium supplementation could be sustained , the study was extended for 1 additional year . According to the intention-to-treat analysis , the differences in the rate of bone loss ( percentage decrease in control group -- percentage decrease in milk supplementation group ) in the third year of the study were : total body BMD , 0.23 % ( 95 % confidence interval [ CI ] 0.07%-0.39 % ) ; total spine BMD , 0.31 % ( 95 % CI - 0.02%-0.65 % ) ; and total hip BMD , 0.44 % ( 95 % CI 0.19%-0.69 % ) . Analysis by the per- protocol method showed a similar effect size . These results indicate that the effects of milk supplementation in preventing  bone loss in postmenopausal Chinese women were sustained after 2 years Summary The Osteoporosis Risk Factor and Prevention-Fracture Prevention Study ( OSTPRE-FPS ) was a r and omized population -based open trial ( n = 593 ) . The supplementation group ( n = 287 ) received daily cholecalciferol 800 IU + calcium 1,000 mg for 3 years while the control group ( n = 306 ) received neither supplementation nor placebo . Daily vitamin D and calcium supplementation have a positive effect on the skeleton in ambulatory postmenopausal women . Introduction Vitamin D deficiency is common in the elderly , and vitamin D levels are associated with low bone mineral density ( BMD ) . The working hypothesis was that vitamin D and calcium supplementation could prevent bone loss in ambulatory postmenopausal women . Methods The OSTPRE-FPS was a r and omized population -based open trial with a 3-year follow-up in 3,432 women ( aged 66 to 71 years ) . A r and omly selected sub sample of 593 subjects underwent BMD measurements . The supplementation group ( n = 287 ) received daily cholecalciferol 800 IU + calcium 1,000 mg for 3 years while the control group ( n = 306 ) received neither supplementation nor placebo . Results In the intention-to-treat analysis , total body BMD ( n = 362 ) increased significantly more in the intervention group than in the control group ( 0.84 % vs. 0.19 % , p = 0.011 ) . The BMD change differences at the lumbar spine ( p = 0.372 ) , femoral neck ( p = 0.188 ) , trochanter ( p = 0.085 ) , and total proximal femur ( p = 0.070 ) were statistically nonsignificant . Analyses in compliant women ( ≥80 % of use ) result ed in stronger and statistically significant effects at the total body and femoral regions . Conclusion Daily vitamin D and calcium supplementation have a positive effect on the skeleton in ambulatory postmenopausal women with adequate nutritional calcium intake Current st and ard-dose calcium supplements ( eg , 1000 mg/d ) may increase the risk for cardiovascular events . Effectiveness of lower-dose supplements in preventing bone loss should thus be considered . This study aim ed to assess whether calcium supplements of 500 or 250 mg/d effectively prevent bone loss in perimenopausal and postmenopausal Japanese women . We recruited 450 Japanese women between 50 and 75 years of age . They were r and omly assigned to receive 500 mg of calcium ( as calcium carbonate ) , 250 mg of calcium , or placebo daily . Medical examinations conducted three times over a 2-year follow-up period assessed bone mineral density ( BMD ) of the lumbar spine and femoral neck . One-factor repeated measures ANOVA was used for statistical tests . Subgroup analyses were also conducted . Average  total daily calcium intake at baseline for the 418 subjects who underwent follow-up examinations was 493 mg/d . Intention-to-treat analysis showed less dramatic decreases in spinal BMD for the 500-mg/d calcium supplement group compared to the placebo group ( 1.2 % difference over 2 years , p = 0.027 ) . Per- protocol analysis ( ≥80 % compliance ) revealed that spinal BMD for the 500-mg/d and 250-mg/d calcium supplement groups decreased less than the placebo group ( 1.6 % , p = 0.010 and 1.0 % , p = 0.078 , respectively ) , and that femoral neck BMD for the 500-mg/d calcium supplement group decreased less relative to the placebo group ( 1.0 % , p = 0.077 ) . A low-dose calcium supplement of 500 mg/d can effectively slow lumbar spine bone loss  in perimenopausal and postmenopausal women with habitually low calcium intake , but its effect on the femoral neck is less certain . Calcium supplementation dosage should thus be reassessed . ( Clinical Trials Registry number : UMIN000001176 ) BACKGROUND Race and sex differences in the effect of diet on bone mineral density ( BMD ) at the hip in the elderly are unknown . OBJECTIVES This study related cross-sectional nutrient and dairy product consumption to hip BMD in white and black men and women aged > 60 y and evaluated the influence of nutrient and dairy product consumption on changes in BMD in a white cohort participating in a calcium , vitamin D , or placebo trial . DESIGN The Health Habits and History Question naire was used in 289 white women and 116 white men who participated in the trial and in 265 black women and 75 black men to predict total hip and femoral neck BMD or  changes in BMD . RESULTS Blacks had higher calcium intakes than did whites ( 700 and 654 mg/d , respectively ; P = 0.0094 ) , and men had higher calcium intakes than did women ( 735 and 655 mg/d , respectively ; P = 0.0007 ) . For men , the correlation between total hip BMD and dairy calcium intake after adjustment for age , race , and weight was 0.23 ( P < 0.005 ) ; this relation was not significant in women ( r = 0.02 , P = 0.12 ) . Similar results were found for femoral neck BMD . In the longitudinal study , calcium supplementation reduced bone loss from the total hip and femoral neck in those who consumed < 1.5 servings of dairy products/d and were < 72 y old . CONCLUSIONS Cross-sectional results indicated that higher dairy product consumption is associated with greater hip BMD in men , but not in women . Calcium supplementation protected both men and women from bone loss in the longitudinal study of whites BACKGROUND Skeletal abnormalities have been reported in HIV-infected children and adolescents . Although the etiology is not well understood , vitamin D deficiency may be involved . OBJECTIVE The study objective was to evaluate the effect of vitamin D and calcium supplementation on bone mass accrual in HIV-infected youth . DESIGN Perinatally HIV-infected children were r and omly assigned to receive vitamin D ( 100,000 IU cholecalciferol given every 2 mo ) and calcium ( 1 g/d ) ( supplemented group ) or double placebo ( placebo group ) for 2 y. The total-body bone mineral content ( TB BMC ) , total-body bone mineral density ( TBBMD ) , spine bone mineral content ( S BMC ) , and spine bone mineral density ( SBMD ) were assessed by using dual-energy X-ray absorptiometry at baseline and at 2 annual follow-up visits . RESULTS Fifty-nine participants , aged 6 - 16 y , were r and omly assigned to either the supplemented ( n = 30 ) or the placebo ( n = 29 ) group . At enrollment , supplemented and placebo groups did not differ with respect to age , sex , dietary intakes of vitamin D and calcium , mean baseline serum 25-hydroxyvitamin D [ 25(OH)D ] concentration , TB BMC , TBBMD , S BMC , or SBMD . Significant increases in serum 25(OH)D were observed in the supplemented group but not in the placebo group . TB BMC , TBBMD , S BMC , and SBMD increased significantly at 1 and 2 y in both groups . No between-group differences were observed at any time before or after adjustment for stage of sexual maturation by mixed linear model analysis . CONCLUSION One gram of calcium per day and oral cholecalciferol at a dosage of 100,000 IU every 2 mo administered to HIV-infected children and adolescents did not affect bone mass accrual despite significant increases in serum 25(OH)D concentrations . This trial was registered at clinical trials.gov as NCT00724178 Patients with beta-thalassemia major ( beta-thalassemia ) frequently have bone disorders of multifactorial etiology . We attempted to analyze the relationship between the bone mineral density ( [ BMD ] measured by dual-photon absorptiometry ) and auxanologic parameters , degree of siderosis , function of the growth hormone (GH)/insulin-like growth factor-I (IGF-I)/IGF-binding protein-3 ( IGFBP3 ) axis , calcium-phosphate balance , parathyroid hormone ( PTH ) , and cytokines ( interleukin-1beta [ IL-1 ] and tumor necrosis factor-alpha [ TNF-alpha ] ) in 30 prepubertal children with beta-thalassemia major and 15 age-matched children with constitutional short stature ( CSS ) , who have normal glucose tolerance and thyroid function . Children with beta-thalassemia had a significantly decreased BMD and mean BMD% for age and sex ( 0.75+/-0.24 g/cm2 and 71%+/-10 % , respectively ) versus children with CSS ( 1.06+/-0.3 g/cm2 and 92%+/-7 % , respectively ) . Thalassemic patients had significantly lower circulating concentrations of IGF-I and IGFBP3 ( 49+/-21 ng/mL and 1.2+/-0.25 mg/L , respectively ) compared with control children ( 153+/-42 ng/mL and 2.1+/-0.37 mg/L , respectively ) . The GH response to provocation by clonidine and glucagon was defective ( peak GH < 7 microg/L ) in 12 of the 30 thalassemic children . Serum concentrations of IL-1beta and TNF-alpha did not differ among the two study groups . Hypocalcemia was detected in five of the 30 thalassemic patients :  hypoparathyroidism was diagnosed in two of the five and rickets in the other three . BMD was highly correlated with the circulating concentrations of IGF-I and IGFBP3 , as well as with the auxanologic parameters ( age , weight , height , height st and ard deviation score [ HSDS ] , and body mass index [ BMI ] ) . It is suggested that increasing the circulating IGF-I concentration through aggressive nutritional therapy and /or GH/IGF-I therapy with supplementation with vitamin D and /or calcium might improve bone growth and mineralization and prevent the development of osteoporosis and consequent fractures in these patients . Such therapy requires blinded controlled trials Abstract Bone loss is a significant clinical problem for female cancer survivors ( FCS ) and increases fracture risk . The aim of the Yale Fitness Intervention Trial ( Yale FIT ) was to determine the effects of a 12-month aerobic – resistance exercise intervention compared to a home-based physical activity group on bone outcomes [ bone mineral density ( BMD ) ] and biomarkers bone turnover ) . Early postmenopausal FCS ( N = 154 ) were r and omized to the exercise intervention ( 3 times/week ) or to a home-based physical activity group . Calcium ( 1200 mg ) and Vitamin D ( 400 IU ) supplements were provided to both groups . BMD was measured at baseline and 12 months . No significant difference in BMD was observed for the exercise vs home-based group . However , subjects on  Tamoxifen or no endocrine therapy did not significantly lose BMD , with the exception of the femoral neck ( FN ) . In contrast subjects on aromatase inhibitors ( AIs ) had significant BMD loss at all sites . The majority of subjects had sufficient serum levels of Vitamin D ( > 20 ng/mL ) but there was significantly less bone loss in subjects in the 20–29 ng/mL range at the LS ( p = 0.01 ) , hip ( p = 0.03 ) , and GT ( p = 0.008 ) compared to lower or higher levels . Exercise stimulates bone remodeling but the intervention was not superior for BMD outcomes at one year . The dose of the osteogenic stimulus in the intervention has been effective in preserving BMD in healthy postmenopausal women but it may be inadequate for survivors with chemotherapy-induced menopause and for those on adjuvant AI therapy Calcium plus vitamin D ( CaD ) supplementation has a modest but significant effect on slowing loss of femoral bone mass and reducing risk of hip fractures in adherent postmenopausal women . The goal of this study was to determine if CaD supplementation influences hip structural parameters that are associated with fracture risk . We studied 1,970 postmenopausal women enrolled in the Women ’s Health Initiative r and omized controlled trial of CaD at one of three bone mineral density ( BMD ) clinical centers . Hip structural analysis software measured BMD and strength parameters on DXA scans at three regions : femoral narrow neck , intertrochanter , and shaft . R and om effects models were used to test the average differences in hip BMD and geometry between intervention and placebo . There was greater preservation of hip BMD at the narrow neck with CaD relative to placebo across 6 years of intervention . CaD also altered the underlying cross-sectional geometry at the narrow neck in the direction of greater strength , with small increases in cross-sectional area and section modulus and a decrease in buckling ratio with CaD relative to placebo . While trends at both the intertrochanter and shaft regions were similar to those noted at the narrow neck , no significant intervention effects were evident . There was no significant interaction of  CaD and age or baseline calcium levels for hip structural properties . CaD supplementation is associated with modest beneficial effects on hip structural features at the narrow neck , which may explain some of the benefit of CaD in reducing hip fracture risk A r and omized , double-blind , controlled calcium supplementation trial was conducted for 18 mo to determine its effects on bone acquisition and height increment in 162 7-y-old Chinese children ( 87 boys and 75 girls ) with habitually low calcium intakes ( 280 mg/d ) . Distal one-third radial bone mineral content ( BMC ) , area bone density ( BMC /bone width ) , and height were evaluated every 6 mo . Baseline dietary intakes , serum 25-hydroxycholecalciferol , and physical activity  were determined . The study group received 300 mg Ca/d as calcium carbonate ; control subjects received placebo tablets . After 18 mo the study group had significantly greater gains in BMC ( 16.5 % vs 13.97 % ; P = 0.02 ) and BMC /bone width ( 9.45 % vs 6.31 % ; P = 0.0008 ) than the control subjects . The findings confirm a positive effect of calcium intake on bone acquisition but no effect on height increment . Whether a higher bone mass attained at age 8 - 9 y would be maintained and beneficial to future peak bone mass requires longitudinal investigation . Further study is warranted to determine calcium requirements for Chinese children The effects of a supervised 1-y walking program and increased dietary calcium ( milk supplement , 831 mg/d , vs placebo drink , 41 mg/d ) on bones were examined in 36 postmenopausal women ( 60.2 + /- 6.5 y ) .  Trabecular bone-mineral density ( BMD ) of the lumbar spine ( L1-L3 ) , measured by computed tomography , increased by 0.5 % in exercising women ( n = 18 ) and decreased by 7.0 % in sedentary women ( n = 18 ; P = 0.02 ) . Femoral-neck BMD measured by dual-photon absorptiometry ( DPA ) increased by 2.0 % in women consuming high dietary calcium ( n = 18 ) and decreased by 1.1 % in those on moderate calcium intake ( n = 18 ; P = 0.001 ) . Neither exercise nor  dietary calcium  had an effect on lumbar spine ( L2-L4 ) measured by DPA , distal radius measured by single-photon absorptiometry , or total body calcium measured by in vivo neutron activation . The varying proportions and rates of turnover of trabecular and cortical bone from one site to another suggest that exercise and high dietary calcium may preferentially alter bone density at different skeletal sites Purpose . To test effects of  parent/child training design ed to increase calcium intake , bone-loading physical activity ( PA )  , and bone density . Design . Two-group r and omized controlled trial . Setting . Family-based intervention delivered at research center . Subjects . 117 healthy children aged 10–13 years ( 58.1 % female , 42.7 % Hispanic , 40.2 % White ) . Ninety-seven percent of participants had at least one parent graduate from high school and 37.2 % had at least one parent graduate from a 4-year university . Intervention . Children and parents were r and omly assigned to diet and exercise ( experimental ) or injury prevention ( control ) interventions . Children were taught in eight weekly classes how to engage in bone-loading PA and eat calcium-rich foods or avoid injuries . Parents were taught behavior management techniques to modify children 's behaviors . Measures . Measures at baseline and at 3 , 9 , and 12 months included 24-hour diet and PA recalls , and bone mineral density ( BMD ) by dual-energy x-ray absorptiometry . Analysis . Analysis of variance and generalized estimating equations ( GEE ) assessed group by time differences . Comparisons were conducted separately for boys and girls . Results . For boys , cross-sectional differences between experimental and control groups were achieved for 3- and 9-month calcium intake ( 1352 vs. 1052 mg/day , 1298 vs. 970 mg/day , p < .05 ) . For girls , marginal cross-sectional differences were achieved for high-impact PA at 12 months ( p < .10 ) . For calcium intake , a significant group by time interaction was observed from pretest to posttest for the full sample ( p = .008 ) and for girls ( p = .006 ) but not for boys . No significant group by time differences in calcium were observed across the follow-up period . No group by time differences were observed for  high-impact PA  . Among boys , longitudinal group by time differences reached significance for total hip BMD ( p = .045 ) and femoral neck BMD ( p = .033 ) , even after adjusting for skeletal growth . Similar differential increases were observed among boys for bone mineral content ( BMC ) at the hip ( p = .068 ) and total body ( p = .054 ) regions . No significant group by time interaction effects were observed for girls at any bone site for BMD . For BMC , control girls showed a significant increase ( p = .03 ) in spine BMC compared to intervention girls . Conclusion . This study demonstrated that parent/preteen training can increase calcium intake and attenuate the decline in high-impact PA . Results suggest that more powerful interventions are needed to increase activity levels and maximize bone mineral accrual during preadolescent years Background Calcium ( Ca ) is an essential nutrient for the human body . Despite lively research , there is uncertainty about Ca requirements in terms of desirable health outcomes including an upper intake level above which the potential for harm increases . Objectives The aim was to conduct a review to up date requirements and desirable or harmful health effects of Ca on the current scientific evidence . Methods We search ed Medline and Swemed from January 2000 to December 2011 and included all systematic review s that reported Ca supplementation or usual Ca intake on health outcomes . Meta-analyses , r and omized clinical trials and cohort studies were included in the second search between May 2009 and March 2011 and an additional search covering studies till the end of 2011 . This review concentrated on studies reporting independent effects of Ca , although a few recent trials report sole effects of Ca on health outcomes , most trials use Ca in combination with vitamin D vs. placebo . Results In total , we review ed 38 studies addressing the effects of Ca on bone , pregnancy-related outcomes , cancers , cardiovascular outcomes , obesity , and mortality .  There was a lot of heterogeneity in the study protocol s , which made it difficult to draw any strong conclusions . According to the literature , high Ca intake seems to have a small positive effect on bone mineral content ( BMC ) or bone mineral density ( BMD ) in children and postmenopausal women . We did not find any consistent evidence on the effects of Ca on bone health in premenopausal women or men . Also , the evidence that Ca supplementation reduces fracture incidence is scarce and inconsistent . Maternal diet may influence the peak bone mass of offspring but more studies are required . There was no overall effect of Ca intake on cancers . Ca was associated with a decreased risk of breast cancer and a slightly increased risk of prostate cancer in two of the three studies . No associations were found with other cancers . We found no consistent association between cardiovascular outcomes and  Ca  intake except for blood pressure . A small decrease of 2–4 mmHg in systolic blood pressure was found in pregnant and in hypertensive subjects with Ca supplementation . Review ed studies did not show consistent evidence relating Ca intake to either mortality or obesity . Conclusion Based on this evidence , there is no need to change the Nordic recommendations for Ca intake . However , due to heterogeneity in the studies it is difficult to interpret the results and provide single summary statement CONTEXT Vitamin K has been implicated in bone health , primarily in observational studies . However , little is known about the role of phylloquinone supplementation on prevention of bone loss in men and women . OBJECTIVE The objective of this study was to determine the effect of 3-yr phylloquinone supplementation on change in bone mineral density ( BMD ) of the femoral neck bone in older men and women who were calcium and vitamin D replete . DESIGN , PARTICIPANTS , AND INTERVENTION In this 3-yr , double-blind , controlled trial , 452 men and women ( 60 - 80 yr ) were r and omized equally to receive a multivitamin that contained either 500 mug/d or no phylloquinone plus a daily calcium ( 600 mg elemental calcium ) and vitamin D ( 400 IU ) supplement . MAIN OUTCOME MEASURES Measurements of the femoral neck , spine ( L2-L4 ) , and total-body BMD , bone turnover , and vitamins K and D status were measured every 6 - 12 months . Intent-to-treat analysis was used to compare change in measures in 401 participants who completed the trial . RESULTS There were no differences in changes in BMD measurements at any of the anatomical sites measured between the two groups . The group that received the phylloquinone supplement had significantly higher phylloquinone and significantly lower percent undercarboxylated osteocalcin concentrations compared with the group that did not receive phylloquinone . No other biochemical measures differed between the two groups . CONCLUSIONS Phylloquinone supplementation in a dose attainable in the diet does not confer any additional benefit for bone health at the spine or hip when taken with recommended amounts of calcium and vitamin We conducted a double-blind , placebo-controlled , r and omized trial to determine whether 1 year of supplemental calcium intake would augment hip [ greater trochanter , GT , femoral neck ( FN ) , total hip ( TH ) ] , spine ( LS ) , and femoral mid-shaft ( Fmr ) BMD in female distance runners . Twenty-three women ( age : 23.7 + /- 4.7 yrs , height : 165.6 + /- 6.3 cm , weight : 55.7 + /- 6.1 kg ) were r and omly assigned to receive either 1000 mg/d of supplemental calcium ( N = 13 ) or placebo tablets ( N = 10 ) for 1 year . BMD was determined by DXA ( Hologic 1000-W ) and tablet compliance by self-report logs . Compliance averaged 79 % and 71 % for supplement and placebo groups , respectively . Calcium supplementation did not affect hip or spine BMD , but did prevent loss at the femoral mid-shaft ( GT : -0.5 % vs. 0.2 % , FN : 0.9 % vs. 1.1 % , TH : -0.3 % vs. 0.2 % , LS : 0.3 % vs. 1.2 % , Fmr : 0.1 % vs. -1.8 % , for calcium vs. placebo , respectively ) . We conclude that the addition of 800 mg/d of supplemental calcium to the diet of young adult female distance runners with habitual calcium intakes of approximately 1000 mg/d , prevents cortical but not trabecular bone loss BACKGROUND Pregnancy and lactation in adolescents with habitually low calcium intake may adversely affect maternal bone mass . OBJECTIVE We investigated the effect of calcium plus vitamin D supplementation during pregnancy on bone mass during lactation in Brazilian adolescent mothers with low-calcium diets ( ∼600 mg/d ) . DESIGN Pregnant adolescents ( 14 - 19 y ) r and omly received daily calcium ( 600 mg ) plus vitamin D3 ( 200 IU ) ( n = 30 ) or a placebo ( n = 26 ) from 26 wk of pregnancy ( baseline ) until parturition . The bone mineral content ( BMC ) , bone area ( BA ) , and bone mineral density ( BMD ) at the total body , lumbar spine , and hip ( total and femoral neck ) were evaluated by using dual-energy X-ray absorptiometry at 5 and 20 wk postpartum . Serum hormones and 25-hydroxyvitamin D [ 25(OH)D ] were measured . Group comparisons were adjusted for significant covariates . RESULTS The mean serum 25(OH)D concentration was 59 nmol/L at baseline . In comparison with the placebo , 25(OH)D tended to be 14 - 15 nmol/L higher postpartum in the supplemented group ( P = 0.08 ) . Total body and hip BMC and BMD decreased over time ( P ≤ 0.005 ) in both groups with a group × time interaction at the femoral neck ( P < 0.04 ) . Supplemented mothers had higher lumbar spine BA ( 6.7 % ; P = 0.002 ) and lumbar spine BMC ( 7.9 % , P = 0.08 ) than did mothers who consumed the placebo at 5 wk postpartum . At 20 wk postpartum , differences between groups were more evident , with higher lumbar spine BMC ( 13.9 % ) , lumbar spine BA ( 6.2 % ) , and lumbar spine BMD ( 10.6 % ) in the supplemented group ( P ≤ 0.008 ) . CONCLUSIONS Calcium plus vitamin D supplementation during pregnancy of adolescents with low calcium intake  results in higher lumbar spine bone mass and a reduced rate of femoral neck bone loss during lactation . Additional studies are required to determine whether bone effects are temporary or long-lasting . This trial was registered at clinical trials.gov as NCT01732328 There are inconsistent findings on the effects of vitamin K on bone mineral density ( BMD ) and undercarboxylated osteocalcin ( UcOC ) . The present intervention study evaluated the effect in subjects over 60-yr-old . The vitamin K group ( vitamin K + vitamin D + calcium supplement ; 15 mg of vitamin K2 [ menatetrenone ] three times daily , 400 IU of vitamin D once a day , and 315 mg of calcium twice daily ) and the control group ( vitamin D + calcium supplement ) were r and omly assigned . During the six months of treatment , seventy eight women participated ( 38 in the vitamin K group and 40 in the control group ) and 45 women completed the study . The baseline characteristics of study participants did not differ between the vitamin K and the control groups . In a per protocol analysis after 6 months , L3 bone mineral density has increased statistically significantly in the vitamin K group compared to the control group ( 0.01 ± 0.03 g/cm2 vs -0.008 ± 0.04 g/cm2 , P = 0.049 ) . UcOC concentration was also significantly decreased in the vitamin K group ( -1.6 ± 1.6 ng/dL vs -0.4 ± 1.1 ng/dL , P = 0.008 ) . In conclusion , addition of vitamin K to vitamin D and calcium supplements in the postmenopausal Korean women increase the L3 BMD and reduce the UcOC concentration Bone turnover is increased during weight loss in postmenopausal women and can be suppressed with calcium supplementation . In this study , we assessed the influence of energy restriction with and without calcium supplementation ( 1 g/day ) in premenopausal women . Thirty-eight obese premenopausal women ( body mass index [ BMI ] of 35.0 + /- 3.9 kg/m2 ) completed a 6-month study of either moderate weight loss or weight maintenance . During weight loss , women were r and omly assigned to either a calcium supplementation ( n = 14 ) or placebo group ( n = 14 ) and lost 7.5 + /- 2.5 % of their body weight . The control group of women ( n = 10 ) maintained their body weight . Total body and lumbar bone mineral density ( LBMD ) and content were measured by dual-energy X-ray absorptiometry ( DXA ) at baseline and after weight loss . Throughout the study , blood and urine sample s were collected to measure bone turnover markers and hormones . During moderate energy restriction , dietary calcium intake decreased ( p < 0.05 ) and the bone resorption marker deoxypyridinoline ( DPD ) increased slightly ( p < or = 0.05 ) without evidence of bone loss .  Calcium supplementation during weight loss tended to increase lumbar BMD by 1.7 % ( p = 0.05 ) compared with the placebo or weight maintenance groups . In contrast to our previous findings in postmenopausal women , premenopausal obese women who consume a low calcium diet do not lose bone over a 6-month period , whether their weight is stable or decreasing moderately 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 Osteoporosis is a significant health problem and contributor to disability and premature mortality among older men . Incidence rates for hip fracture have stabilized in women , but continue to increase in men . A major risk factor for hip fracture is bone mineral density level . The determinants of bone mineral density ( BMD ) are well defined in women , but not in men . The primary goal of the current research was to increase our underst and ing of the determinants of BMD of the proximal femur in a large community-based sample of older male volunteers . Eligibility requirements included age of 50 years or older , ambulatory , and not having undergone a bilateral hip replacement . Five hundred twenty-three men , mean mean age 66.6 years , met all eligibility requirements and participated in the Study of Osteoporotic Risk in Men or STORM . Information on demographics , medical history , anthropometry , leisure-time and occupational physical activity , muscular strength , cigarette smoking , alcohol consumption , dietary calcium intake , and medication use ( thiazide diuretics and glucocorticoids ) were obtained by question naire , interview , and examination , BMD of the proximal femur ( femoral neck , greater trochanter , and Ward 's triangle ) was measured by dual-energy X-ray absorptiometry using the Hologic QDR-1000 and QDR-2000 . The cross-sectional determinants of BMD included age , blond hair color , current body weight , thiazide diuretic use , historical physical activity , and quadriceps strength . Several variables commonly thought to be determinants of BMD were not related to BMD in this population of older men , including current cigarette smoking , alcohol consumption , current leisure-time physical activity , dietary calcium intake , vitamin D use , and caffeine intake . However , failure to find associations among BMD and some of the potential determinants may be due to lack of statistical power . Identification of the determinants of BMD could lead to the development of interventions aim ed at maximizing BMD in men and could potentially decrease the risk of hip fractures The effects of 1α-hydroxyvitamin D3 [ 1α(OH)D3 ] on bone mineral density , fracture incidence , and bone metabolism were evaluated by a double-blind , placebo-controlled study . Eighty postmenopausal osteoporotic Japanese women ( 71.9±7.3 years , mean±SD ) were r and omly assigned to 1 μg of 1α(OH)D3 daily or inactive placebo for 1 year . All patients were given supplemental calcium ( 300 mg of elemental calcium daily ) . Lumbar ( L2–L4 ) bone mineral density ( BMD ) determined by dual energy X-ray absorptiometry increased 0.65 % with 1α(OH)D3 treatment and decreased 1.14 % with placebo ( P=0.037 ) . BMD in both the femoral neck and Ward 's triangle did not yield any significant differences between the two groups , whereas trochanter BMD in the 1α(OH)D3-treated group increased 4.20 % and decreased 2.37 % with placebo ( P=0.055 ) . X-ray analysis demonstrated that new vertebral fractures occurred in two patients with 1α(OH)D3 and in seven patients with placebo . The vertebral fracture rate in the treated group was significantly less ( 75/1000 patient years ) than in the control group ( 277/1000 patient years ; P=0.029 ) . Hypercalcemia ( 12.1 mg/100 ml ) occurred in one patient receiving 1α(OH)D3 ; however , the serum calcium level in this patient promptly decreased to the reference range after cessation of the treatment . There were no significant changes in serum creatinine level in either group . A significant increase in urinary excretion of calcium was found but there was no significant change in urinary excretion of hydroxyproline in the treated group . The serum level of bone-derived alkaline phosphatase activity significantly decreased by−26±26 ( mU/ml ) after the treatment ( P=0.003 ) . These results indicate that 1α(OH)D3 treatment is effective for maintaining trabecular bone mass and prevents further vertebral fractures without any serious adverse effects in postmenopausal osteoporosis Background There are no robust guidelines on strategies to prevent the adverse skeletal effects of glucocorticoids in children . Objectives To evaluate the role of prophylactic calcium and vitamin D on bone health in children with new-onset nephrotic syndrome ( NS ) treated with short-term ( 12 weeks ) , high-dose glucocorticoids . Methods Prospect i ve , r and omized , controlled , single blind , interventional study conducted on 41 steroid-naïve pre-pubertal children ( 29 boys , 12 girls ) . All children received prednisolone for 12 weeks ( 60 mg/m2/day daily for 6 weeks , followed by 40 mg/m2/day alternate days for 6 weeks ) . Recruited children were r and omized into the intervention group ( IG ; vitamin D 1,000 IU/day and elemental calcium 500 mg/day ) and the control group ( CG ) . Bone mineral content ( BMC ) and bone mineral density ( BMD ) at the lumbar spine ( L1–L4 ) were estimated at baseline and at 12 weeks . Mean percentage changes in BMC and BMD in IG and CG were compared . Results Children in the IG showed an increase of 11.2 % in BMC versus the CG , who showed an 8.9 % fall ( p < 0.0001 ) . Net intervention-attributable difference in BMC was 20.1 % . BMD increased in both groups ( IG 2.8 % vs CG 0.74 % ) , but the difference was not statistically significant ( p = 0.27 ) . Conclusions Short-term , high-dose glucocorticoid therapy decreases the BMC of the lumbar spine in steroid-naïve children with NS .  Vitamin D and calcium co-administration not only prevents this decline , but also enhances BMC of the lumbar spine
There was no effect of calcium supplementation  on femoral neck or lumbar spine BMD .
There was no evidence of effect modification by baseline calcium intake , sex , ethnicity , physical activity or pubertal stage .
While there is a small effect of calcium supplementation in the upper limb , the increase in BMD which results is unlikely to result in a clinical ly significant decrease in fracture risk .
The results do not support the use of calcium supplementation  in healthy children as a public health intervention .
These results can not be extrapolated to children with medical conditions affecting bone metabolism
BACKGROUND Clinical trials have shown that  calcium supplementation in children can increase  bone mineral density ( BMD ) although this effect may not be maintained .
There has been no quantitative systematic review of this intervention .
To determine the effectiveness of calcium supplementation for improving BMD  in children .
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To determine if any effect varies by sex , pubertal stage , ethnicity or level of physical activity , and if any effect persists after supplementation is ceased .