[Optimization of calcium intake for the prevention of osteoporosis and osteoporotic fractures: a review of the evidence]. Milk, dietary calcium, and bone fractures in women: a 12-year prospective study. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Hypertension-related dietary patterns of rural older adults. Is dietary counselling effective in increasing dietary calcium, protein and energy intake in patients with osteoporotic fractures? A randomized controlled clinical trial. Calcium supplementation and bone mineral density in adolescent girls. Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Does calcium supplementation prevent bone stress injuries? A clinical trial. Dietary calcium and vitamin D intake in relation to osteoporotic fracture risk. Calcium, diet and fracture risk: a prospective study of 1898 incident fractures among 34 696 British women and men. Calcium supplementation and increases in bone mineral density in children. Effect of calcium or 25OH vitamin D3 dietary supplementation on bone loss at the hip in men and women over the age of 60. Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care Cluster-Randomized Non-Inferiority Trial to Compare Supplement Consumption and Adherence to Different Dosing Regimens for Antenatal Calcium and Iron-Folic Acid Supplementation to Prevent Preeclampsia and Anaemia: Rationale and Design of the Micronutrient Initiative Study Vitamin D and health in adults in Australia and New Zealand: a position statement. Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. 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Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial Effects of dairy products on bone and body composition in pubertal girls. Calcium Intake and Lung Cancer Risk Among Female Nonsmokers: A Report from the Shanghai Women's Health Study Dietary Iron, Zinc, and Calcium and the Risk of Lung Cancer The association of calcium and vitamin D with risk of colorectal adenomas. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. Calcium Supplementation and the Risk of Preeclampsia in Ecuadorian Pregnant Teenagers Dairy Products, Calcium Intake, and Risk of Prostate Cancer in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial [Comparative study of dietary intake and nutritional status in elderly women with and without hip fracture]. A Simplified Regimen Compared with WHO Guidelines Decreases Antenatal Calcium Supplement Intake for Prevention of Preeclampsia in a Cluster-Randomized Noninferiority Trial in Rural Kenya. Beneficial effect of soy isoflavones on bone mineral content was modified by years since menopause, body weight, and calcium intake: a double-blind, randomized, controlled trial Dietary factors and the risk of incident kidney stones in younger women: Nurses' Health Study II. Effects of Calcium Supplementation on Body Weight and Adiposity in Overweight and Obese Adults Maternal calcium supplementation and fetal bone mineralization. Treatment with alendronate plus calcium, alendronate alone, or calcium alone for postmenopausal low bone mineral density Vitamin D3 and calcium to prevent hip fractures in elderly women. Calcium supplements for the prevention of colorectal adenomas. Calcium Polyp Prevention Study Group. 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. The Women's Health Initiative calcium-vitamin D trial: overview and baseline characteristics of participants. The effects of dieting on food and nutrient intake of lactating women. Intakes of calcium and vitamin D and risk of colorectal cancer in women. Supplementation with 1000 IU vitamin D/d leads to parathyroid hormone suppression, but not increased fractional calcium absorption, in 4-8-y-old children: a double-blind randomized controlled trial.
One of the main focuses of lifestyle modification for the prevention of osteoporosis and osteoporotic fractures  in Japan is improvement in dietary calcium intake . However , virtually no r and omized controlled trial to assess the preventive effects of administration of calcium on the risk of fractures has been conducted in Japan . In this study , we review ed all the scientific papers currently available from medical literature data bases to propose evidence -based recommendations on the preventive procedures for osteoporosis . The result of the present systematic review gives the evidence showing that calcium supplementation or optimal dietary calcium intake increases bone density in childhood and adolescence and reduces the risk of fracture due to osteoporosis in the elderly people regardless of the gender . The evidence also supports the current health policy guiding the elderly to increase their dietary calcium intake in daily life OBJECTIVES This study examined whether higher intakes of milk and other calcium-rich foods during adult years can reduce the risk of  osteoporotic fractures .  METHODS This was a 12-year prospect i ve study among 77761 women , aged 34 through 59 years in 1980 , who had never used calcium supplements .  Dietary intake was assessed with a food-frequency question naire in 1980 , 1984 , and 1986 . Fractures of the proximal femur ( n = 133 ) and distal radius ( n = 1046 ) from low or moderate trauma were self-reported on biennial question naires . RESULTS We found no evidence that higher intakes of milk or calcium from food sources reduce fracture incidence . Women who drank two or more glasses of milk per day had relative risks of 1.45 for hip fracture ( 95 % confidence interval [ CI ] = 0.87 , 2.43 ) and 1.05 for forearm fracture ( 95 % CI = 0.88 , 1.25 ) when compared with women consuming one glass or less per week . Likewise , higher intakes of total  dietary calcium or calcium from dairy foods were not associated with decreased risk of hip or forearm fracture . CONCLUSIONS These data do not support the hypothesis that higher consumption of milk or other food sources of calcium  by adult women protects against hip or forearm fractures BACKGROUND Short trials of calcium supplementation show that it reduces loss of bone density in postmenopausal women ; longer observational studies do not generally find a lower risk of hip fracture with higher-calcium diets . Fewer studies have focused on vitamin D in preventing postmenopausal osteoporosis or fractures . OBJECTIVE We assessed relations between postmenopausal hip fracture risk and calcium , vitamin D , and milk consumption . DESIGN In an 18-y prospect i ve analysis in 72 337 postmenopausal women , dietary intake and nutritional supplement use were assessed at baseline in 1980 and up date d several times during follow-up . We identified 603 incident hip fractures result ing from low or moderate trauma .  Relative risks ( RRs ) from proportional hazards models were controlled for other dietary and nondietary factors . RESULTS Women consuming > or = 12.5 microg vitamin D/d from food plus supplements had a 37 % lower risk of hip fracture ( RR = 0.63 ; 95 % CI : 0.42 , 0.94 ) than did women consuming < 3.5 microg/d . Total calcium intake was not associated with hip fracture risk ( RR = 0.96 ; 95 % CI : 0.68 , 1.34 for > or = 1200 compared with < 600 mg/d ) . Milk consumption was also not associated with a lower risk of hip fracture ( P for trend = 0.21 ) . CONCLUSIONS An adequate vitamin D intake is associated with a lower risk of osteoporotic hip fractures in postmenopausal women . Neither milk nor a high-calcium diet appears to reduce risk . Because women commonly consume less than the recommended intake of vitamin D , supplement use or dark fish consumption may be prudent BACKGROUND Prevalence of hypertension is greater in older adults , and increased intake of fruits , vegetables , and dairy-good sources of potassium , calcium , and magnesium-can reduce blood pressure . This study examined the hypertension-related dietary patterns of older adults . METHODS A cohort of 180 Pennsylvania adults ( aged > /=65 ) , 90 with hypertension , were r and omly selected from the Geisinger Rural Aging Study ( GRAS ) . Data were collected by trained interviewers at a home visit . Dietary assessment used five 24-h recalls . We compared the characteristics and dietary intake of people with hypertension to those without hypertension and compared their intakes to current recommendations . RESULTS Mean intakes of all participants were less than two thirds of the DRI for calcium and magnesium and fell far short of the 3,500 mg of potassium recommended for prevention and treatment of hypertension . Participants with hypertension consumed less sodium than controls . Both groups ate fewer fruits and vegetables than recommended but reached the dairy recommendation . Calcium intake was mainly from high-fat dairy products , beans were the top source of potassium and magnesium . CONCLUSIONS Older adults with hypertension should be guided to choose more low-fat dairy products and other low-fat calcium sources and to increase intakes of beans , dark green leafy vegetables , and other potassium and magnesium sources To determine the feasibility of increasing the calcium , protein and calorie intake of osteoporotic fracture patients by repeated dietary counselling delivered by a dietitian , a r and omized controlled trial was conducted . Among 189 patients presenting with osteoporotic fractures to an Orthopaedics and Traumatology Department of a large regional hospital , 98 patients were r and omized to the intervention group and 91 were r and omized to the control group ( with usual care ) . Intervention group received three sessions of dietary counselling with tailored made recommendations over a period of 4 months , while the control group only received dietary assessment and pamphlets on the prevention of osteoporosis . Almost all subjects in both intervention and control groups had calcium intake below the recommended level of 1000 mg at baseline . Half and 60 % of subjects in both groups had total energy and protein intake below recommended levels respectively . The mean weights of control and intervention groups at baseline were 51.5 and 50.9 kg respectively , while the body mass index ( BMI ) were 22.6 ( kg m(-2 ) ) and 22.6 ( kg m(-2 ) ) respectively . After dietary intervention , significant increase of intake was seen in calcium intake ( P = 0.0095 by t-test ) in the intervention group . No significant increase was seen in protein or calorie intake . No significant change was observed in the body weight or BMI although there was a positive trend in the intervention group for all these parameters . We concluded that there was general malnutrition in Chinese elderly who presented with osteoporotic fractures . Dietary calcium could be increased by repeated professional dietary counselling . Future studies with longer duration and more objective clinical outcomes will be helpful to further demonstrate the long-term effects of dietary intervention on osteoporosis and other chronic diseases OBJECTIVE To evaluate the effect of calcium supplementation on bone acquisition in adolescent white girls . DESIGN A r and omized , double-blind , placebo-controlled trial of the effect of 18 months of calcium supplementation on bone density and bone mass . SUBJECTS Ninety-four girls with a mean age of 11.9 + 0.5 years at study entry . SETTING University hospital in a small town . INTERVENTIONS Calcium supplementation , 500 mg/d calcium as calcium citrate malate ; controls received placebo pills . MAIN OUTCOME MEASURES Bone mineral density and bone mineral content of the lumbar spine and total body were measured by dual-energy x-ray absorptiometry and calcium excretion from 24-hour urine specimens . RESULTS Calcium intake from dietary sources averaged 960 mg/d for the entire study group . The supplemented group received , on average , an additional 354 mg/d of calcium . The supplemented group compared with the placebo group had greater increases of lumbar spine bone density ( 18.7 % vs 15.8 % ; P = .03 ) , lumbar spine bone mineral content ( 39.4 % vs 34.7 % ; P = .06 ) , total body bone mineral density ( 9.6 % vs 8.3 % ; P = .05 ) , and 24-hour urinary calcium excretion ( 90.4 vs 72.9 mg/d ; P = .02 ) , respectively . CONCLUSIONS Increasing daily calcium intake from 80 % of the recommended daily allowance to 110 % via supplementation with calcium citrate malate result ed in significant increases in total body and spinal bone density in adolescent girls . The increase of 24 g of bone gain per year among the supplemented group translates to an additional 1.3 % skeletal mass per year during adolescent growth , which may provide protection against future osteoporotic fracture Dietary data from a prospect i ve study were used to relate factors influencing calcium balance ( estimates of dietary calcium intake , protein intake from nondairy animal sources ( meat , fish , and eggs ) , and coffee consumption ) to the incidence of  hip fracture . During the years 1977 - 1983 , women and men born between 1925 and 1940 and living in one of three Norwegian counties were invited to a  cardiovascular screening that included a dietary survey . The attendance rate at screening was 91.1 % , and 90.7 % of these persons ( 19,752 women and 20,035 men ) filled in and returned a semiquantitative dietary question naire . This cohort was followed for an average of 11.4 years ( range , 0.01 - 13.8 years ) with respect to hip fracture , defined as cervical or trochanteric fracture . During follow-up , 213 hip fractures were identified , excluding fractures associated with high-energy trauma and metastatic bone disease . There was no clear association between  calcium intake or nondairy animal protein intake  and hip fracture in this cohort . However , an elevated risk of fracture was found in women with a high intake of protein from nondairy animal sources in the presence of low calcium intake ( relative risk = 1.96 ( 95 % confidence interval 1.09 - 3.56 ) for the highest quarter of nondairy protein intake and the lowest quarter of calcium intake vs. the three lower quarters of protein intake and the three higher quarters of calcium intake ) . Women who drank nine or more cups of coffee per day also had an increased risk of fracture , while there was no association between coffee consumption and hip fracture in men . Although these findings do not necessarily imply causal relations , they suggest the presence of risk factors for hip fracture that act through a negative calcium balance in this population 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 This study investigated the effect of calcium supplementation in preventing  bone stress injuries . Healthy male military recruits ( N = 1,398 ) served as subjects , of which 247 were r and omly allocated to an experimental group ( E ) while 1,151 served as a control group ( C ) . For 9 weeks both groups wore the same footwear and had the same physical training program . The baseline dietary intake of calcium in 50 r and omly selected subjects of each group was assessed using a 24-hr dietary record . The E group received a daily calcium supplement while the C group did not . Injuries were monitored in all subjects by a panel of doctors who followed specific diagnostic criteria . The mean weekly injury incidence for all overuse injuries , but specifically tibial stress syndrome and stress fractures , was similar in both groups . Mean baseline daily dietary calcium intake was above 800 mg in both subgroups . This study demonstrated that large-scale calcium supplementation ( 500 mg/day ) beyond usual dietary intake did not influence the risk of developing bone stress injuries during a 9-wk physical training program in these young military recruits The etiologic role of dietary calcium and vitamin D intake in primary prevention of  osteoporotic fractures is uncertain , despite considerable research efforts . With the aim to examine these associations with an improved precision , we used data from a large population -based prospect i ve cohort study in central Sweden . We estimated nutrient intake from a self-administered food-frequency question naire filled in by 60,689 women , aged 40 - 74 years at baseline during 1987 - 1990 . During follow-up , we observed 3986 women with a fracture at any site and 1535 with a hip fracture .  Rate ratio of fractures ( RR ) and 95 % CI were estimated using Cox proportional hazards models . We found no dose-response association between dietary calcium intake and fracture risk . The age-adjusted RR of hip fracture was 1.01 ( 95 % CI 0.96 - 1.06 ) per 300 mg calcium/day and the corresponding risk of any osteoporotic fracture was 0.99 ( 95 % CI 0.96 - 1.03 ) . Furthermore , women with an estimated calcium intake below 400 mg/day and those with a calcium intake higher than 1200 mg/day both had a similar age-adjusted hip fracture risk as those with intermediate calcium intakes : RR 1.07 ( 95 % CI 0.92 - 1.24 ) and RR 1.00 ( 95 % CI 0.79 - 1.27 ) , respectively . Vitamin D intake was not associated with fracture risk . Furthermore , women in the highest quintiles compared to the lowest quintiles of both calcium and vitamin D intake had an age-adjusted RR of 1.02 for all fractures ( 95 % CI 0.88 - 1.17 ) . Dietary calcium or vitamin D intakes estimated at middle and older age do not seem to be of major importance for the primary prevention of osteoporotic fractures in women OBJECTIVE The risk factors for fractures are incompletely understood . An outst and ing question concerns the optimal amount of dietary calcium needed to minimise the risk of fracture . DESIGN We examined the associations of dietary calcium and other nutrients with self-reported fracture risk in a prospect i ve cohort study . Nutrient intakes were estimated using a semi-quantitative food-frequency question naire administered at recruitment . SETTING The UK . PARTICIPANTS A total of 26 749 women and 7947 men aged 20 - 89 years . RESULTS Over an average of 5.2 years of follow-up , 1555 women and 343 men reported one or more fractures , 72 % of these result ing from a fall . Among women , fracture risk was higher at lower calcium intakes , with a relative risk of 1.75 ( 95 % confidence interval ( CI ) 1.33 - 2.29 ) among women with a calcium intake of < 525 mg day- 1 compared with women with a calcium intake of at least 1200 mg day- 1 ( test for linear trend , P < 0.001 ) . The association of  dietary calcium with fracture risk was stronger among women aged under 50 years at recruitment than among women aged 50 and above .  Dietary calcium intake was not associated with fracture risk in men . Fracture risk was not related to the dietary intake of any other nutrient examined . CONCLUSION In this population , women with a low dietary calcium intake had an increased risk of bone fracture , and this association was more marked among younger women than among older women BACKGROUND Increased dietary intake of calcium during childhood , usually as calcium in milk , is associated with increased bone mass in adulthood ; the increase in mass is important in modifying the later risk of fracture . Whether the increase is due to the calcium content of milk , however , is not certain . METHODS We conducted a three-year , double-blind , placebo-controlled trial of the effect of calcium supplementation ( 1000 mg of calcium citrate malate per day ) on bone mineral density in 70 pairs of identical twins ( mean [ + /- SD ] age , 10 + /- 2 years ; range , 6 to 14 ) . In each pair , one twin served as a control for the other ; 45 pairs completed the study .  Bone mineral density was measured by photon absorptiometry at two sites in the radius ( at base line , six months , and one , two , and three years ) and at three sites in the hip and in the spine ( at base line and three years ) . RESULTS The mean daily calcium intake of the twins given placebo was 908 mg , and that of the twins given calcium supplements was 1612 mg ( 894 mg from the diet and 718 mg from the supplement ) . Among the 22 twin pairs who were prepubertal throughout the study , the twins given supplements had significantly greater increases in bone mineral density at both radial sites ( mean difference in the increase in bone mineral density : midshaft radius , 5.1 percent [ 95 percent confidence interval , 1.5 to 8.7 percent ] ; distal radius , 3.8 percent [ 95 percent confidence interval , 1.4 to 6.2 percent ] ) and in the lumbar spine ( increase , 2.8 percent [ 95 percent confidence interval , 1.1 to 4.5 percent ] ) after three years ; the differences in the increases at two of three femoral sites approached significance ( Ward 's triangle in the femoral neck , 2.9 percent ; greater trochanter , 3.5 percent ) . Among the 23 pairs who went through puberty or were postpubertal , the twins given supplements received no benefit . CONCLUSIONS In prepubertal children whose average dietary intake of calcium approximated the recommended dietary allowance , calcium supplementation increased the rate of increase in bone mineral density . If the gain persists , peak bone density should be increased and the risk of fracture reduced Dietary supplements that prevent bone loss at the hip and that can be applied safely in the elderly are likely to reduce hip fractures . A daily dietary supplement of 750 mg calcium or 15 microg 25OH vitamin D3 on bone loss at the hip and other sites , bone turnover and calcium-regulating hormones were studied over 4 yr in elderly volunteers using a r and omized , double-blind , placebo-controlled trial . Bone mineral density ( BMD ) was measured by dual x-ray absorptiometry and bone structure by radiographs . Calcium biochemistry and bone turnover markers were measured in blood and urine . The 316 women entering the trial had a mean age of 73.7 yr and the 122 men of 75.9 yr . Baseline median calcium intake was 546 mg/day , and median serum 25OH vitamin D3 was 59 nmol/L. On placebo , loss of BMD at total hip was 2 % and femoral medulla expansion was 3 % over 4 yr . Calcium reduced bone loss , secondary hyperparathyroidism , and bone turnover . 25OH vitamin D3 was intermediate between placebo and calcium . Fracture rates and drop-out rates were similar among groups , and there were no serious adverse events with either supplement . A calcium supplement of 750 mg/day prevents loss of BMD , reduces femoral medullary expansion , secondary hyperparathyroidism , and high bone turnover . A supplement of 15 microg/day 25OH vitamin D3 is less effective , and because its effects are seen only at low calcium intakes , suggests that its beneficial effect is to reverse calcium insufficiency Abstract Objective To assess whether supplementation with calcium and cholecaliferol ( vitamin D3 ) reduces the risk of fracture in women with one or more risk factors for fracture of the hip . Design Pragmatic open r and omised controlled trial . Setting Practice nurse led clinics in primary care . Participants 3314 women aged 70 and over with one or more risk factors for hip fracture : any previous fracture , low body weight ( < 58 kg ) , smoker , family history of hip fracture , or fair or poor self reported health . Intervention Daily oral supplementation using 1000 mg calcium with 800 IU cholecaliferol and information leaflet on dietary calcium intake and prevention of falls , or leaflet only ( control group ) . Main outcome measures Primary outcome measure was all clinical fractures and secondary outcome measures were adherence to treatment , falls , and quality of life ( measured with the SF-12 ) . Results 69 % of the women who completed the follow-up question naire at 24 months were still taking supplements ( 55 % with inclusion of r and omised participants known to be alive ) . After a median follow-up of 25 months ( range 18 to 42 months ) , clinical fracture rates were lower than expected in both groups but did not significantly differ for all clinical fractures ( odds ratio for fracture in supplemented group 1.01 , 95 % confidence interval 0.71 to 1.43 ) . The odds ratio for hip fracture was 0.75 ( 0.31 to 1.78 ) . The odds of a woman having a fall at six and 12 months was 0.99 and 0.98 , respectively . Quality of life did not significantly differ between the groups . Conclusion We found no evidence that calcium and vitamin D supplementation reduces the risk of clinical fractures in women with one or more risk factors for hip fracture . Registration IS RCT N26118436 , controlled trials registry Background : To prevent pre-eclampsia in population s with insufficient dietary calcium ( Ca ) intake , the World Health Organisation ( WHO ) recommends routine Ca supplementation during antenatal care ( ANC ) . WHO guidelines suggest a complex dosing regimen , requiring as many as 5 pill-taking events per day when combined with iron and folic acid ( IFA ) supplements . Poor adherence may undermine public health effectiveness , so simpler regimens may be preferable . This trial will compare the effect of the WHO-recommended ( higher-dose ) regimen vs. a simpler , lower-dose regimen on supplement consumption and pill-taking behaviours in Kenyan ANC clients . Design and methods : This is a parallel , non-inferiority , cluster-r and omized trial ; we examined 16 primary care health facilities in Kenya , 1047 pregnant women between 16 - 30 weeks gestational age . Higher-dose regimen : 1.5 g elemental calcium in 3 separate doses ( 500 mg Ca/pill ) and IFA ( 60 mg Fe + 400 µg folic acid ) taken with evening dose . Lower-dose regimen : 1.0 g calcium in 2 separate doses ( 500 mg Ca/pill ) with IFA taken as above . Measurements : Primary outcome is Ca pills consumed per day , measured by pill counts . Secondary outcomes include IFA pills consumed per day , client knowledge , motivation , social support , and satisfaction , measured at 4 to 10 weeks post-enrolment . Statistical analyses : Unit of r and omization is the healthcare facility ; unit of analysis is individual client . Intent-to-treat analysis will be implemented with multi-level models to account for clustering . Expected public health impact : If pregnant women prescribed lower doses of Ca ingest as many pills as women prescribed the WHO-recommended regimen , developing a lower-dose recommendation for antenatal Ca and IFA supplementation programs could save re sources . Significance for public health Pre-eclampsia is a leading cause of maternal mortality . Based on clinical evidence of significant reduction in risk of pre-eclampsia , the WHO recommends including calcium ( Ca ) supplementation in antenatal care services in setting s with inadequate dietary Ca intakes . A high daily amount of Ca administered in a complex dosing regimen is recommended to maximize efficacy and bioavailability . Factors such as client adherence , motivation , cost and logistical complexities may undermine effectiveness when implemented in public health programs . This cluster-r and omized trial will compare Ca supplement consumption between higher and lower-dose regimens delivered through antenatal care in Kenya , integrated with iron-folic acid supplementation . If a lower-dose regimen improves adherence , women ’s Ca supplement consumption may be comparable to that achieved under a complex , higher-dose regimen . Evidence gained from this trial will guide public health planning for antenatal calcium supplementation programs to maximize benefits through reducing logistical , cost and adherence barriers The prevalence of vitamin D deficiency varies , with the groups at greatest risk including housebound , community-dwelling older and /or disabled people , those in residential care , dark-skinned people ( particularly those modestly dressed ) , and other people who regularly avoid sun exposure or work indoors . Most adults are unlikely to obtain more than 5%-10 % of their vitamin D requirement from dietary sources . The main source of vitamin D for people residing in Australia and New Zeal and is exposure to sunlight . A serum 25-hydroxyvitamin D ( 25-OHD ) level of ≥ 50 nmol/L at the end of winter ( 10 - 20 nmol/L higher at the end of summer , to allow for seasonal decrease ) is required for optimal musculoskeletal health . Although it is likely that higher serum 25-OHD levels play a role in the prevention of some disease states , there is insufficient evidence from r and omised controlled trials to recommend higher targets . For moderately fair-skinned people , a walk with arms exposed for 6 - 7 minutes mid morning or mid afternoon in summer , and with as much bare skin exposed as feasible for 7 - 40 minutes ( depending on latitude ) at noon in winter , on most days , is likely to be helpful in maintaining adequate vitamin D levels in the body . When sun exposure is minimal , vitamin D intake from dietary sources and supplementation of at least 600 IU ( 15 µg ) per day for people aged ≤ 70 years and 800 IU ( 20 µg ) per day for those aged > 70 years is recommended . People in high-risk groups may require higher doses . There is good evidence that vitamin D plus calcium supplementation  effectively reduces fractures and falls in older men and women BACKGROUND Increased dietary calcium intake has been proposed as a population -based public health intervention to prevent osteoporotic fractures . We have examined whether calcium supplementation decreases clinical fracture risk in elderly women and its mechanism of action . METHODS Five-year , double-blind , placebo-controlled study of 1460 women recruited from the population and older than 70 years ( mean age , 75 years ) who were r and omized to receive calcium carbonate , 600 mg twice per day , or identical placebo .  The primary end points included clinical incident osteoporotic fractures , vertebral deformity , and adverse events ascertained in 5 years . Bone structure was also measured using dual x-ray absorptiometry of the hip and whole body , quantitative ultrasonography of the heel , and peripheral quantitative computed tomography of the distal radius . RESULTS Among our patients , 16.1 % sustained 1 or more clinical osteoporotic fractures . In the intention-to-treat analysis , calcium supplementation did not significantly reduce fracture risk ( hazard ratio , 0.87 ; 95 % confidence interval , 0.67 - 1.12 ) . However , 830 patients ( 56.8 % ) who took 80 % or more of their tablets ( calcium or placebo ) per year had reduced fracture incidence in the calcium compared with the placebo groups ( 10.2 % vs 15.4 % ; hazard ratio , 0.66 ; 95 % confidence interval , 0.45 - 0.97 ) . Calcium-treated patients had improved quantitative ultrasonography findings of the heel , femoral neck and whole-body dual x-ray absorptiometry data , and bone strength compared with placebo-treated patients . Of the 92 000 adverse events recorded , constipation was the only event increased by the treatment ( calcium group , 13.4 % ; placebo group , 9.1 % ) . CONCLUSION Supplementation with calcium carbonate tablets supplying 1200 mg/d is ineffective as a public health intervention in preventing clinical fractures in the ambulatory elderly population owing to poor long-term compliance , but it is effective in those patients who are compliant Excess dietary proteins and " acid ash " diets have been suspected to increase the risk of osteoporosis , but experimental and epidemiological evidence is mixed . We aim ed to determine whether the association between protein intake and the overall acid-base equilibrium of the diet ( as renal net acid excretion [ RNAE ] estimate ) and fracture risk vary according to calcium intake . During an average of 8.37 + /- 1.73 yr of follow-up , 2408 women reported a fracture ( excluding high-impact trauma ) among 36,217 postmenopausal women from the E3N prospect i ve study . We used Cox regression models to study the interaction between calcium and , respectively , proteins and RNAE , from the 1993 dietary question naire for fracture risk determination , adjusting for potential confounders . There was no overall association between fracture risk and total protein or RNAE . However , in the lowest quartile of calcium ( < 400 mg/1000 kcal ) , high protein intake was associated with a significant increased fracture risk ( RR = 1.51 for highest versus lowest quartile ; 95 % CI , 1.17 - 1.94 ) . An increasing fracture risk with increasing animal protein intake was also observed ( trend , p < 0.0001 ) . A similar pattern of interaction for fracture risk was observed between RNAE and calcium . In this Western population of postmenopausal women with normal to high protein intake and fairly high calcium intake , there was no overall association between total protein or RNAE and fracture risk . However , there was some evidence that high protein-high acid ash diets were associated with an increased risk of fracture when calcium intake was low ( < 400 mg/1000 kcal ) OBJECTIVE To study the effect of calcium supplementation during pregnancy on blood pressure and maternal and neonatal outcomes . METHOD A total of 524 healthy primigravidas with a blood pressure less than 140/90 mm Hg were r and omly assigned between the 12th and 25th weeks to receive 2 g of elemental calcium or placebo and were followed-up until delivery . RESULTS The incidence of pre-eclampsia was significantly less in the calcium than in the placebo group ( 4.0 % vs 12.0 % ; odds ratio [ OR ] , 0.31 ; 95 % confidence interval [ CI ] , 0.15 - 0.63 ) ; the mean systolic and diastolic blood pressures at study completion were different in the calcium and placebo group ( P=0.007 and P=0.02 ) . The risk for preterm delivery was less in the calcium ( 7.0 % ) than in the placebo ( 12.7 % ) group ( OR , 0.51 ; 95 % CI , 0.28 - 0.93 ) . The mean baseline calcium intake was 313.83+/-203.25 mg/day ( range , 85.71 - 910.71 mg/day ) , which is lower than the recommended dietary intake of 1000 mg , and the 24-hour urinary calcium excretion was 130.82+/-67.44 mg/dL ( range , 40.5 - 387 mg/dL ) . CONCLUSION Calcium supplementation appears to reduce the occurrence of pre-eclampsia and preterm delivery in primigravidas who have a daily dietary calcium intake less than the recommended dietary allowances OBJECTIVE This study was made to : ( i ) identify the prevalence of low calcium intakes in a paediatric population with loosely defined ' milk allergy ' ; and ( ii ) assess long-term ( mean 21 months later ) changes in calcium intake following a single nutrition counselling session with those patients initially found to have a low intake . METHODOLOGY Calcium intake was assessed in a cross-sectional study of 58 patients ages 5 - 16 years ( mean 9.9 years ) with IgG radioallergosorbent test ( RAST ) class II or higher for cow 's milk protein . Those 31 patients found to have a low calcium intake were prospect ively re-evaluated 12 - 30 months later following a single nutrition counselling session . RESULTS  Calcium intake was < recommended dietary allowance ( RDA ) for 31 of 58 ( 53 % ) patients . The patient 's perception of their intake was unreliable ; 44 % of those who rated their calcium intake fair or good did not meet their RDA . Taking a calcium supplement did not ensure adequate intake ; 21 % of those taking supplements still did not meet their RDA . Milk intake predicted calcium intake ; 8 % of those who did not drink milk vs 68 % of those who did drink at least some milk met their RDA without supplementation . The 31 patients with low intakes received counselling and were re-evaluated at an average follow-up of nearly 2 years . Calcium intake was increased a mean of 360 mg/day and use of supplements increased from 10 to 52 % of the group . Despite these positive changes , 48 % still did not meet their RDA . CONCLUSION Limited milk intake is likely to be associated with suboptimal calcium intake . Efforts should be made to educate the family about the importance of calcium and its non-dairy sources . With many families repeated discussion s of this issue may be necessary to influence calcium intake The trial is conducted to evaluate the effects of calcium on bone mineral accretion in adolescents . 161 healthy adolescents aged of 9 to 20 year-old are recruited and are r and omly divided into experimental groups in which 300 mg Ca is supplemented per day for each participant and control group . The  dietary calcium , physical activity , SMR , distal one-third radial bone mineral content ( BMC ) , bone width ( BW ) , height , weight and serum total ALP are measured at both the beginning and the end of the trial . It is found that the average calcium intake from dietary sources is 500 mg/d in both groups . Increasing daily calcium intake via calcium supplementation in adolescents results in a moderate increases of BMC , and there is a significant increase of BMC in the females during the late adolescence . No significant differences in anthropometry are observed between the two groups at the end of the study while the increase of serum ALP level in the females in experiment group is significantly lower than that in the control group during the late adolescence . It is concluded that during the pubertal years when the BMC accretion is evident , there are no significant differences in bone mass accrual between the two groups . While in the females , calcium supplementation may help enhance the bone mineral accrual during late adolescence when the BMC accretion is remarkably reduced Background : Lung cancer is the leading cause of cancer death . Little is known about whether prediagnostic nutritional factors may affect survival . We examined the associations of prediagnostic calcium intake from foods and /or supplements with lung cancer survival . Methods : The present analysis included 23,882 incident , primary lung cancer patients from 12 prospect i ve cohort studies .  Dietary calcium intake was assessed using food-frequency question naires at baseline in each cohort and st and ardized to caloric intake of 2,000 kcal/d for women and 2,500 kcal/d for men . Stratified , multivariable-adjusted Cox regression was applied to compute hazard ratios ( HR ) and 95 % confidence intervals ( CI ) . Results : The 5-year survival rates were 56 % , 21 % , and 5.7 % for localized , regional , and distant stage lung cancer , respectively . Low prediagnostic dietary calcium intake ( < 500–600 mg/d , less than half of the recommendation ) was associated with a small increase in risk of death compared with recommended calcium intakes ( 800–1,200 mg/d ) ; HR ( 95 % CI ) was 1.07 ( 1.01–1.13 ) after adjusting for age , stage , histology , grade , smoking status , pack-years , and other potential prognostic factors . The association between low calcium intake and higher lung cancer mortality was evident primarily among localized/regional stage patients , with HR ( 95 % CI ) of 1.15 ( 1.04–1.27 ) . No association was found for supplemental calcium with survival in the multivariable-adjusted model . Conclusions : This large pooled analysis is the first , to our knowledge , to indicate that low prediagnostic dietary calcium intake may be associated with poorer survival among early-stage lung cancer patients . Impact : This multinational prospect i ve study linked low calcium intake to lung cancer prognosis . Cancer Epidemiol Biomarkers Prev ; 26(7 ) ; 1060–70 . © 2017 AACR For a 50-year old caucasian woman today , the risk of a hip fracture over her remaining lifetime is about 17 % . Tomorrow the situation will clearly be worse because the continual increase in life expectancy will cause a 3-fold rise in worldwide fracture incidence over the next 60 years , particularly in women , but also in men . In addition , a secular increase in the incidence of hip fractures in individuals of the same age has been noted in both sexes by several investigators , and the cost of hip fractures is expected to dramatically increase in the next decades . Consequently , preventive strategies are urgently required . A great deal has been learned in recent years about the risk factors for hip fracture , the pathophysiology of this fracture , and the prediction of fracture risk , particularly through bone mass measurements on the hip and biochemical evaluations of parathyroid and vitamin D status . The two main determinants of hip fractures are falls and bone loss leading to an intrinsic femoral fragility . A substantial femoral bone loss continues throughout the old age , with a continuous and exponential increase in the risk of hip fracture , and any reduction or arrest of this loss will induce an important reduction in the incidence of hip fractures . A preventive effect on the risk of hip fracture may be partly achieved by using long term estrogen replacement therapy after menopause , but also by using vitamin D and calcium supplements for a late prevention in elderly people .  Vitamin D insufficiency and deficit in calcium intake are very common in elderly people living either in institutions or at home , particularly in Europe where dairy products are not fortified with vitamin D. The cumulative response to this deficit in calcium intake and low vitamin D status is a negative calcium balance which stimulates parathyroid hormone secretion . In 300 residents of nursing homes , we recently found a significant negative correlation between serum 25 OHD and log serum PTH after age-adjustment . In addition , in 446 elderly women living at home in 5 French cities and selected from the voting lists , we also found an age-adjusted relationship between serum 25 OHD and PTH concentrations . This senile secondary hyperparathyroidism is one of the determinants of femoral bone loss and can be reversed by calcium and vitamin D supplements . We have shown in a 3-year controlled prospect i ve study that the daily use of these supplements ( 1.2 g of calcium and 800 IU of vitamin D3 ) given in a large population of 3270 elderly ambulatory women living in nursing homes reduced of 23 % ( intention-to-treat analysis ) the number of hip fractures and other non vertebral fractures . In parallel , serum perathyroid hormone concentration was reduced of 28 % and low serum 25-hydroxyvitamin D concentration returned to normal values . After 18 months of treatment the bone density of the total proximal femoral region had increased 2.7 % the vitamin D3-calcium group and decreased 4.6 % in the placebo group ( p < 0.001 ) . This prevention is safe and can be recommended in people living in institutions . It could be also useful in other elderly subjects particularly at risk because of a low calcium intake , an absence of solar exposure and a previous history of falls . From the data of our study we assessed the economic consequences in terms of medical cost of this prevention . In case of treatment of all women living in nursing homes in France , this would saved FF 150000000 per year , the economic balance of prevention becoming positive as soon as the age of the beginning of the prevention reaches 73.5 years . It is now possible to partly stop bone loss in elderly people and it is never too late to prevent hip fractures with calcium and vitamin D supplements OBJECTIVE --To determine whether low dietary calcium intake and physical inactivity are risk factors for hip fracture among subjects aged 65 and over . DESIGN --Fifteen year follow up study of a large cohort of r and omly selected elderly people living in the community , who had taken part in the 1973 - 4 survey of the Department of Health and Social Security , and for whom dietary and other data were recorded at initial interview and medical assessment . SETTING --Eight areas in Britain ( Engl and ( five ) , Wales ( one ) , and Scotl and ( two ] . SUBJECTS--1688 Subjects living in the community , of whom 1419 subjects ( 720 men and 699 women ) agreed to participate . 1356 Subjects completed a seven day dietary record and 983 ( 542 men and 441 women ) agreed to be assessed by a geriatrician . RESULTS --Incidence of hip fracture increased with age and was higher in women than men . Comparison with matched controls showed no evidence that the risk of hip fracture was related to calcium intake : the odds ratio for the lowest third of dietary calcium  compared with the highest was 0.7 ( 95 % confidence interval 0.1 to 3.9 ) after adjustment for smoking and body mass index . The adjusted odds ratio for the lowest third of outdoor activity compared with the highest was 4.3 ( 0.7 to 26.8 ) , and that for grip strength was 3.9 ( 0.7 to 23.0 ) . CONCLUSIONS --Reduced intake of dietary calcium does not seem to be a risk factor for hip fracture . Further evidence is provided that physical activity in the elderly protects against hip fracture 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 BACKGROUND Adequate intakes of calcium and vitamin D reduce bone loss and fracture risk in the elderly . Other nutrients also affect bone health , and adequate intakes may influence bone turnover and balance . OBJECTIVE We compared the long-term effects on bone turnover markers and calciotropic hormones of a multinutrient supplement , a calcium and vitamin D supplement , and dietary instruction aim ed at increasing calcium intake through foods . DESIGN Ninety-nine healthy postmenopausal women participated in a 3-y , r and omized trial , receiving either 1 ) supplemental calcium ( 1450 mg/d ) and vitamin D [ 10 microg ( 400 IU)/d ] , 2 ) calcium , vitamin D , and other nutrients ( multinutrient supplement ) , or 3 ) dietary instruction ( dietary control group ) . Data are from 83 subjects who completed the trial . RESULTS Increases over baseline in calcium intakes and serum 25-hydroxyvitamin D concentrations were sustained over 3 y in all treatment groups . Circulating parathyroid hormone concentrations were reduced at year 1 in all treatment groups but trended toward baseline thereafter . Bone turnover markers followed a similar pattern , and none of the changes in biochemical concentrations differed significantly between groups . CONCLUSIONS All 3 interventions offer long-term feasibility for increasing calcium intake and serum 25-hydroxyvitamin D concentrations . The dietary addition of micronutrients implicated in skeletal physiology confers no obvious bone-sparing effect in healthy postmenopausal women beyond that of calcium and vitamin D alone . The attenuation over time in suppression of parathyroid hormone and bone turnover might help explain why nutrient intervention tends to have less of a bone-sparing effect than do skeletally active medications such as estrogen or bisphosphonates BACKGROUND Decreased ability to absorb calcium with age limits adaptation to low calcium intake and is thought to lead to secondary hyperparathyroidism and increased risk for hip and other fractures . However , the associations between fractional calcium absorption , dietary calcium intake , and risk for fracture have never been studied . OBJECTIVE To determine whether low fractional calcium absorption in women with low calcium intake increases the risk for subsequent hip and other nonspine  fractures . DESIGN Prospect i ve cohort study . SETTING Four clinical centers in Baltimore County , Maryl and ; Portl and , Oregon ; Minneapolis , Minnesota ; and the Monongahela Valley , Pennsylvania . PARTICIPANTS 5452 nonblack women 69 years of age or older participating in the fourth examination of the Study of Osteoporotic Fractures . MEASUREMENTS Fractional calcium absorption was measured by using a 3-hour single isotope ( 45Ca ) technique . Incident fractures were identified prospect ively and were confirmed by radiographic report . RESULTS During an average of 4.8 years , 729 women ( 13 % ) experienced at least one nonspine fracture  ;  153 of these women had hip fractures . After adjustment for age , women with lower fractional calcium absorption were at increased risk for hip fracture ( relative risk per 1-SD [ 7.7 % ] decrease in fractional calcium absorption , 1.24 [ 95 % CI , 1.05 to 1.48 ] ) . Women with low fractional calcium absorption and low calcium intake were at greatest risk for subsequent hip fracture ; among women whose dietary calcium intake was less than 400 mg/d , those who had fractional calcium absorption at or below the median value of 32.3 % had a 2.5-fold ( CI , 1.29-fold to 4.69-fold ) increase in risk for hip fracture compared with those who had greater absorption efficiency . Fractional calcium absorption was not related to risk for other nonspine fractures ( relative risk per 1-SD [ 7.7 % ] decrease in fractional calcium absorption , 1.05 [ CI , 0.96 to 1.14 ] ) . CONCLUSIONS In elderly women , low fractional calcium absorption in the setting of low calcium intake increases the risk for hip fracture . Our findings support the hypothesis of type II osteoporosis , which postulates that decreased calcium absorption is an important risk factor for hip fracture in older persons 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 Elderly women are at increased risk for bone loss and fractures . In previous cross-sectional and longitudinal studies of women residing in northern latitudes , bone loss was most pronounced during winter months and in those consuming less than 1 g calcium per day . In this study we sought to test the hypothesis that calcium supplementation by either calcium carbonate or dietary means would prevent seasonal bone loss and preserve bone mass . Sixty older postmenopausal women without osteoporosis were r and omized to one of three treatment arms : Dietary milk supplementation ( D-4 glasses of milk/day ) , Calcium carbonate ( CaCO3 - 1000 mg/day in two divided doses ) , or placebo ( P ) . After 2 yr , placebo-treated women consumed a mean of 683 mg/day of calcium and lost 3.0 % of their greater trochanteric ( GT ) bone mineral density ( BMD ) ( P < 0.03 vs. baseline ) ; Dietary supplemented women averaged a calcium intake of 1028 mg/day and sustained minimal loss from the GT ( -1.5 % ; P = 0.30 ) , whereas CaCO3-treated women ( total Ca intake , 1633 mg/day ) suffered no bone loss from the GT and showed a significant increase in spinal and femoral neck BMD ( P < 0.05 ) . Femoral bone loss occurred exclusively during the two winters of the study ( i.e. total loss , -3.2 % ; P < 0.02 in placebo-treated women ) with virtually no change in GT BMD during summer . Serum 25-OH vitamin D declined by more than 20 % ( P < 0.001 ) in all groups during the winter months but returned to baseline in summer ; PTH levels rose approximately 20 % ( P < 0.001 ) during winter but did not return to baseline during the summers . Urine N-telopeptide and osteocalcin levels increased significantly but only in the P-treated women and only during winter . Serum insulin growth factor binding protein 4 , an inhibitory insulin growth factor binding protein , rose 15 % ( P < 0.03 ) from summer to winter , but this increase was significant only in those women consuming < 1000 mg/day of calcium . By multivariate analysis , total calcium intake was the strongest predictor of bone loss from the hip . Urinary N-telopeptide also closely correlated with GT BMD but only during winter ( P = 0.003 ) . We conclude that calcium supplementation prevents bone loss  in elderly women by suppressing bone turnover during the winter when serum 25-OH vitamin D declines and serum PTH increases . The precise amount of calcium necessary to preserve BMD in elderly women requires further studies , although in this study , at least 1000 mg/day of supplemental calcium was adequate prophylaxis against femoral bone loss Summary Supplementation with elemental calcium 500 mg/day alone for 2 years is able to decrease bone turnover and is effective in retarding bone loss at lumbar spine and slowing bone loss at femoral neck in elderly Thai women who had low dietary calcium intake . Introduction Most elderly Thais have a total dietary calcium intake of less than the recommended amount . The aim of the study was to investigate the effect of calcium supplementation on bone mineral density and biochemical indices of bone remodeling in Thai postmenopausal women . Methods Four hundred and four healthy postmenopausal women 60 years old or older without osteoporosis were recruited and conducted in a r and omized , double-blinded , placebo-controlled trial . They were r and omly given elementary calcium 500 mg/day or placebo for 2 years . Dietary calcium intake was calculated from the nutrient compositional analysis of the 3-day food records . Serum 25 hydroxyvitamin D was measured by radioimmunoassay and bone turnover markers were determined by electrochemiluminescence immunoassay . Results The age of the subjects was 65.8 ± 4.4 years . All baseline characteristics of the subjects in the calcium-supplemented group and the placebo group were not statistically different . At the end of the study , significant decreases in serum C-terminal telopeptide of type I collagen and serum total procollagen type I amino terminal propeptide in the calcium-supplemented group were observed , while there was no change in the placebo group . In addition , plasma parathyroid hormone decreased , although not significantly , only in the calcium-supplemented group . Percent changes from baseline of lumbar spine ( L2–L4 ) bone mineral density increased 2.76 % in the calcium-supplemented group and 0.87 % in the placebo group , whereas the percent changes from baseline of femoral neck decreased 0.21 % in the calcium-supplemented group and 0.90 % in the placebo group . Conclusions Calcium supplementation is necessary for the decrease of bone turnover and prevention of bone loss in Thai elderly women Intake of calcium and /or dairy products has been associated with increased risk of prostate cancer  in some epidemiological studies . One potential biological mechanism is that high calcium intake down-regulates 1,25 dihydroxy vitamin D(3 ) , which may increase cell proliferation in the prostate . We examined the association between calcium , dairy intake , and prostate cancer incidence in the Cancer Prevention Study II Nutrition Cohort , a prospect i ve cohort of elderly United States adults . Participants in the study completed a detailed question naire on diet , medical history , and lifestyle at enrollment in 1992 - 1993 . After excluding men with a history of cancer or incomplete dietary information , 65,321 men remained for analysis . During follow-up through August 31 , 1999 , we documented 3811 cases of incident prostate cancer . Multivariate-adjusted rate ratios ( RRs ) were calculated using Cox proportional hazards models . Total calcium intake ( from diet and supplements ) was associated with modestly increased risk of prostate cancer [ RR = 1.2 , 95 % confidence interval ( CI ) = 1.0 - 1.6 for > or=2000 versus < 700 mg/day , P trend = 0.02 ) . High dietary calcium intake ( > or=2000 versus < 700 mg/day ) was also associated with increased risk of prostate cancer ( RR = 1.6 , 95 % CI = 1.1 - 2.3 , P trend = 0.10 ) , although moderate levels of dietary calcium were not associated with increased risk . Dairy intake was not associated with prostate cancer risk . The association between prostate cancer and total calcium intake was strongest for men who reported not having prostate-specific antigen testing before 1992 ( RR = 1.5 , 95 % CI = 1.1 - 2.0 , P trend < 0.01 for > or= 2000 mg/day of total calcium ; RR = 2.1 , 95 % CI = 1.3 - 3.4 > or=2000 mg/day of dietary calcium , P trend = 0.04 ) . Our results support the hypothesis that very high calcium intake , above the recommended intake for men , may modestly increase risk of prostate cancer BACKGROUND Despite evidence from animal studies for a protective effect of higher calcium and possibly vitamin D intake against colorectal cancer , epidemiologic studies have been inconclusive . PURPOSE We investigated the associations between the intake of calcium and vitamin D and the occurrence of  colorectal cancer . METHODS In a prospect i ve study , 89 448 female registered nurses who were free of cancer responded to a mailed , semiquantitative food-frequency question naire  in 1980 ; dietary information was up date d in 1984 and 1986 . Through 1992 , 501 incident cases of colorectal cancer ( 396 colon and 105 rectal cancers ) were documented . As measures of exposure , we used nutrient intake in 1980 and also two measures of long-term intake on the basis of the three question naires : the average of intakes from the three question naires and consistent intakes , which were defined as high if women were in the upper tertile on all question naires and low if they were in the lower tertile on all question naires . To further characterize long-term intake , we conducted analyses excluding women who reported a change in their consumption of milk ( primary source of calcium and vitamin D ) in the 10 years prior to 1980 . Relative risks ( RRs ) and 95 % confidence intervals ( CIs ) were calculated using the lowest quintile of intake as a reference . The Mantel extension test was used to evaluate linear trends across the categories of nutrient intake . In multivariate analyses , the trends were tested with use of the medians of the intake as a continuous variable in the logistic model . The P values for the trends were two-sided . RESULTS On the basis of the data from the 1980 question naire alone , the multivariate RR for colorectal cancer for women in the upper versus the lower quintile were 0.80 ( 95 % CI = 0.60 - 1.07 ) for dietary calcium , 0.84 ( 95 % CI = 0.63 - 1.13 ) for dietary vitamin D ( from foods only ) , and 0.88 ( 95 % CI = 0.66 - 1.16 ) for total vitamin D ( from foods and supplements ) . After the exclusion of women who reported a change in their milk intake , the RRs for colorectal cancer for the highest versus the lowest categories of average intake were 0.74 ( 95 % CI = 0.36 - 1.50 ) for dietary calcium , 0.72 ( 95 % CI = 0.34 - 1.54 ) for dietary vitamin D , and 0.42 ( 95 % CI = 0.19 - 0.91 ) for total vitamin D. The corresponding RRs for the consistency analyses were 0.70 ( 95 % CI = 0.35 - 1.39 ) for dietary calcium , 0.59 ( 95 % CI = 0.30- 1.16 ) for dietary vitamin D , and 0.33 ( 95 % CI = 0.16 - 0.70 ) for total vitamin D. CONCLUSIONS These findings do not support a substantial inverse association between calcium intake and risk of colorectal cancer , but an inverse association between intake of total vitamin D and risk of colorectal cancer was suggested . IMPLICATION S Available evidence does not warrant an increase in calcium intake to prevent colon cancer , but longer-term studies of both calcium and especially vitamin D in relation to colorectal cancer risk are needed To assess the effect of dietary calcium intake on risk of hip fracture  , a geographically defined caucasian population in southern California was studied prospect ively . Between 1973 and 1975 , a quantified 24 hour diet recall was obtained by a dietician from 957 men and women aged 50 to 79 years at baseline . Follow-up to 1987 with mortality records and interviews showed 15 men and 18 women with hip fractures . The age-adjusted risk of hip fracture was inversely associated with dietary calcium whether considered as mg per day or as nutrient density ( mg per 1000 kcal ) . No other nutrient was consistently associated with hip fracture in any Cox proportional hazards model that included calcium . The association between  calcium  and fracture persisted after adjustment for cigarette smoking , alcohol intake , exercise , and obesity . The significant independent inverse association of  dietary calcium  with subsequent risk of hip fracture ( relative risk = 0.6 per 198 mg/1000 kcal ) strongly supports the hypothesis that increased dietary calcium intake protects against hip fracture 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 It has been suggested that a higher calcium intake might favourably modify cardiovascular risk factors . However , findings of an ultimately decreased risk of cardiovascular disease ( CVD ) are limited . Instead , recent evidence warns that taking calcium supplements might increase myocardial infa rct ion ( MI ) risk . Objective To prospect ively evaluate the associations of dietary calcium intake and calcium supplementation with MI and stroke risk and overall CVD mortality . Methods Data from 23 980 Heidelberg cohort participants of the European Prospect i ve Investigation into Cancer and Nutrition study , aged 35–64 years and free of major CVD events at recruitment , were analysed . Multivariate Cox regression models were used to estimate HRs and 95 % CIs . Results After an average follow-up time of 11 years , 354 MI and 260 stroke cases and 267 CVD deaths were documented . Compared with the lowest quartile , the third quartile of total dietary and dairy calcium intake had a significantly reduced MI risk , with a HR of 0.69 ( 95 % CI 0.50 to 0.94 ) and 0.68 ( 95 % CI 0.50 to 0.93 ) , respectively . Associations for stroke risk and CVD mortality were overall null . In comparison with non-users of any supplements , users of calcium supplements had a statistically significantly increased MI risk ( HR=1.86 ; 95 % CI 1.17 to 2.96 ) , which was more pronounced for calcium supplement only users ( HR=2.39 ; 95 % CI 1.12 to 5.12 ) . Conclusions Increasing calcium intake from diet might not confer significant cardiovascular benefits , while calcium supplements , which might raise MI risk , should be taken with caution Summary Premenopausal women with low calcium intakes consumed calcium-fortified ice cream daily for 28 days . Bone markers , NTX , CTX and PTH decreased significantly by 7 days , with some evidence of a calcium dose-dependent effect . Bone marker responses were observed within 1 h of consuming ice cream . Body weight remained constant over 28 days . Introduction Dietary calcium is important for lifelong bone health . Milk is a good source of bioavailable calcium , but consumption has declined among young adults . The aims were to determine whether calcium-fortified ice cream , a palatable source of calcium , produces significant , sustainable changes in bone turnover markers and parathyroid hormone ( PTH ) in premenopausal women with calcium intake below recommended UK levels . Methods Eighty women , ages 20–39 years ( calcium intake < 750 mg/day ) were r and omised to consume lower saturated fat/sugar ice cream containing 96 , 244 , 459 or 676 mg calcium daily for 28 days . Urinary NTX/Cr , serum CTX , PINP , 1,25D and PTH were measured ( baseline , days 1 , 7 and 28 ) . Acute changes in CTX and PTH were measured over 5 h ( n = 29 women ) . Results There were significant mean decreases by 7 days in NTX/Cr , CTX , PTH and 1,25D and increases in PINP ( one sample t tests ) , with a significant dose-dependent effect on CTX analysis of covariance . Only CTX remained suppressed at 28 days . Serum CTX and PTH decreased within 1 h. Body weight did not change significantly between baseline and 28 days . Conclusions Daily consumption of calcium-fortified ice cream by premenopausal women may significantly reduce levels of the bone resorption marker serum CTX , without stimulating weight gain . The ice cream could be incorporated into the diet to replace low-calcium snacks and thus help individuals with habitually low calcium intakes to meet recommended intakes . The 244 mg calcium preparation would provide more than a quarter of the UK daily recommended nutrient intake for premenopausal women CONTEXT Mono- and polyunsaturated fats may have opposing effects on vitamin D absorption . OBJECTIVE The purpose of this study was to determine whether intakes of different dietary fats are associated with the increase in serum 25-hydroxyvitamin D ( 25OHD ) after supplementation with vitamin D(3 ) . DESIGN , SETTING , AND PARTICIPANTS This analysis was conducted in the active treatment arm of a r and omized , double-blind , placebo-controlled trial of vitamin D and calcium supplementation to prevent bone loss and fracture . Subjects included 152 healthy men and women age 65 and older who were assigned to 700 IU/d vitamin D(3 ) and 500 mg/d calcium .  Intakes of monounsaturated fatty acids ( MUFA ) , polyunsaturated fatty acids ( PUFA ) , and saturated fatty acids ( SFA ) were estimated by food frequency question naire . MAIN OUTCOME MEASURE The change in plasma 25OHD during 2 yr  vitamin D and calcium supplementation was assessed . RESULTS The change in plasma 25OHD ( nanograms per milliliter ) during vitamin D supplementation was positively associated with MUFA , ( β = 0.94 ; P = 0.016 ) , negatively associated with PUFA , ( β = -0.93 ; P = 0.038 ) , and positively associated with the MUFA/PUFA ratio ( β = 6.46 ; P = 0.014 ) . CONCLUSION The fat composition of the diet may influence the 25OHD response to supplemental vitamin D(3 ) . Diets rich in MUFA may improve and those rich in PUFA may reduce the effectiveness of vitamin D(3 ) supplements in healthy older adults . More studies are needed to confirm these findings The effect of dietary calcium on  vertebral bone mass in women is controversial . In a r and omized study we have investigated the effect of dietary modification in the form of dairy products on vertebral bone mass in 30- to 42-yr-old premenopausal women over a 3-yr period . Twenty women increased their dietary calcium intake by an average of 610 mg/day ( P less than 0.03 ) for 3 yr , while 17 age- and weight-matched women served as controls . Calcium intake was monitored by 3-day diet histories and 24-h urinary calcium excretion . The consumption of the dairy products did not alter serum calcium or PTH levels or the fasting urinary calcium to creatinine ratio . Twenty-four-hour urinary calcium excretion increased by 28 % ( P less than 0.03 ) in the supplemented women . Dairy product intake was accompanied by increased dietary fat intake , but there were no statistically significant changes in serum cholesterol , low density lipoprotein cholesterol , or high density lipoprotein cholesterol levels . The vertebral bone density in the women consuming increased calcium did not change over the 3-yr period ( -0.4 + /- 0.9 % ) . In contrast , the vertebral bone density in the control women declined ( -2.9 + /- 0.8 % ; P less than 0.001 ) and was significantly lower than that in the supplemented group at 30 and 36 months . The study suggests that dietary modification in the form of dairy products retards vertebral bone loss in premenopausal women . Therefore , increased calcium intake in estrogen-replete premenopausal women may prevent age-related bone loss CONTEXT It is estimated that 80 % of all women have used oral contraceptives ( OCP ) , but OCP use may prevent attainment of maximal peak bone mass in young women and thus increase the risk of osteoporosis later in life . OBJECTIVE This study examined whether increased calcium intake could reduce the detrimental effects of OCP use on bone mass in young women . DESIGN The study design was a 1-yr intervention . SETTING The study was performed in a general community setting . SUBJECTS One hundred fifty-four young ( 18 - 30 yr old ) healthy women with a dietary calcium intake of less than 800 mg/d began the study , and 135 completed the trial . INTERVENTION Subjects were r and omly assigned to one of three diet intervention groups : 1 ) control , continuous established ( < 800 mg/d ) dietary calcium intake ; 2 ) medium dairy , increase calcium intake to approximately 1000 - 1100 mg/d ; and 3 ) high dairy , increase calcium intake to approximately 1200 - 1300 mg/d . R and omization was stratified by OCP use . MAIN OUTCOME MEASURES The main outcome measures were total body bone mineral density ( BMD ) and content ( BMC ) ; total hip BMD , BMC , and bone area ; and spine BMD , BMC , and bone area . RESULTS Dairy product intervention positively impacted the percentage change in total hip BMD and BMC . In addition , dairy product intake prevented a negative percentage change in total hip and spine BMD in OCP users . CONCLUSION Dairy product intake , at levels necessary to achieve the recommended intakes of calcium , protected the total hip BMD and spine BMD from loss observed in young healthy women with low calcium intakes who were using OCP BACKGROUND Clinical trials have shown that calcium supplementation modestly decreases the risk of colorectal adenomas . However , few studies have examined the effect of calcium on the risk of different types of colorectal lesions or dietary determinants of this effect . METHODS Our analysis used patients from the Calcium Polyp Prevention Study , a r and omized , double-blind , placebo-controlled chemoprevention trial among patients with a recent colorectal adenoma . Nine hundred thirty patients were r and omly assigned to calcium carbonate ( 1200 mg/day ) or placebo . Follow-up colonoscopies were conducted approximately 1 and 4 years after the qualifying examination . We used general estimating equation ( GEE ) and generalized linear regression analyses to compute risk ratios and 95 % confidence intervals ( CIs ) to assess the effect of calcium treatment versus placebo on the risk of hyperplastic polyps , tubular adenomas , and more advanced lesions . Additionally , we used GEE analyses to compare the calcium treatment effects for various types of polyps with that for tubular adenomas . We also examined the interaction between calcium treatment and baseline intake of dietary calcium , fat , and fiber . All P values were obtained using Wald tests based on the corresponding models . All tests of statistical significance were two-sided . RESULTS The calcium risk ratio for hyperplastic polyps was 0.82 ( 95 % CI = 0.67 to 1.00 ) , that for tubular adenomas was 0.89 ( 95 % CI = 0.77 to 1.03 ) , and that for histologically advanced neoplasms was 0.65 ( 95 % CI = 0.46 to 0.93 ) compared with patients assigned to placebo . There were no statistically significant differences between the risk ratio for tubular adenomas and that for other types of polyps . The effect of  calcium supplementation on adenoma risk was most pronounced among individuals with high dietary intakes of calcium and fiber and with low intake of fat , but the interactions were not statistically significant . CONCLUSION Our results suggest that calcium supplementation may have a more pronounced antineoplastic effect on advanced colorectal lesions than on other types of polyps Background : Early menopause , defined as the cessation of ovarian function before the age of 45 y , affects ∼10 % of women and is associated with higher risk of cardiovascular disease , osteoporosis , and other conditions . Few modifiable risk factors for early menopause have been identified , but emerging data suggest that high vitamin D intake may reduce risk . Objective : We evaluated how intakes of vitamin D and calcium are associated with the incidence of early menopause  in the prospect i ve Nurses ' Health Study II ( NHS2 ) . Design : Intakes of vitamin D and calcium from foods and supplements were measured every 4 y with the use of a food-frequency question naire . Cases of incident early menopause were identified from all participants who were premenopausal at baseline in 1991 ; over 1.13 million person-years , 2041 women reported having natural menopause before the age of 45 y. We used Cox proportional hazards regression to evaluate relations between intakes of vitamin D and calcium  and incident early menopause while accounting for potential confounding factors . Results : After adjustment for age , smoking , and other factors , women with the highest intake of dietary vitamin D ( quintile median : 528 IU/d ) had a significant 17 % lower risk of early menopause than women with the lowest intake [ quintile median : 148 IU/d ; HR : 0.83 ( 95 % CI : 0.72 , 0.95 ) ; P-trend = 0.03 ] . Dietary calcium intake in the highest quintile ( median : 1246 mg/d ) compared with the lowest ( median : 556 mg/d ) was associated with a borderline significantly lower risk of early menopause ( HR : 0.87 ; 95 % CI : 0.76 , 1.00 ; P-trend = 0.03 ) . Associations were stronger for vitamin D and calcium from dairy sources than from nondairy dietary sources , whereas high supplement use was not associated with lower risk . Conclusions : Findings suggest that high intakes of dietary vitamin D and calcium may be modestly associated with a lower risk of early menopause . Further studies evaluating 25-hydroxyvitamin D concentrations , other dairy constituents , and early menopause are warranted OBJECTIVE To determine whether dietary counseling to increase milk intake could produce useful changes in the calcium economy and what , if any , other nutrition-related changes might be produced . DESIGN R and omized , open trial . SUBJECTS/ SETTING Two hundred four healthy men and women , aged 55 to 85 years , who habitually consumed fewer than 1.5 servings of dairy foods per day . Six academic health centers in the United States . INTERVENTION Subjects were instructed to consume 3 servings per day of nonfat milk or 1 % milk as a part of their daily diets , or to maintain their usual diets , for a 12-week intervention period , which followed 4 weeks of baseline observations . MAIN OUTCOME MEASURES Energy and nutrient intake assessed from milk intake logs and 3-day food records ; serum calciotrophic hormone levels at baseline and at 8 and 12 weeks ; urinary excretion of calcium and N-telopeptide at 12 weeks . STATISTICAL ANALYSES Repeated- measures analysis of variance . RESULTS In the milk-supplemented group , calcium intake increased by 729 + /- 45 mg/day ( mean + /- st and ard error ) , serum parathyroid hormone level decreased by approximately 9 % , and urinary excretion of N-telopeptide , a bone resorption marker , decreased by 13 % . Urine calcium excretion increased in milk-supplemented subjects by 21 + /- 7.6 mg/day ( mean + /- st and ard error ) , less than half the amount predicted to be absorbed from the increment in calcium intake . All of these changes were significantly different from baseline values in the milk group and from the corresponding changes in the control group . Bone-specific alkaline phosphatase level ( a bone formation marker ) fell by approximately 9 % in both groups . Serum level of insulin-like growth factor-1 ( IGF-1 ) rose by 10 % in the milk group ( P < .001 ) , and the level of insulin-like growth factor binding protein-4 ( IGFBP-4 ) fell slightly ( 1.9 % ) in the milk group and rose significantly ( 7.9 % ) in the control group ( P < .05 ) . APPLICATIONS/ CONCLUSIONS The changes observed in the calcium economy through consumption of food sources of calcium are similar in kind and extent to those reported previously for calcium supplement tablets . The increase in IGF-1 level and the decrease in IBFBP-4 level are new observations that are beneficial for bone health . Important improvements in skeletal metabolism can feasibly occur in older adults by consumption of food sources of calcium . Dietitians can be confident that food works , and that desired calcium intakes can be achieved using food sources Objective To investigate associations between long term dietary intake of calcium and risk of fracture of any type , hip fractures , and osteoporosis . Design A longitudinal and prospect i ve cohort study , based on the Swedish Mammography Cohort , including a subcohort , the Swedish Mammography Cohort Clinical . Setting A population based cohort in Sweden established in 1987 . Participants 61 433 women ( born between 1914 and 1948 ) were followed up for 19 years . 5022 of these women participated in the subcohort . Main outcome measures Primary outcome measures were incident fractures of any type and hip fractures , which were identified from registry data . Secondary outcome was osteoporosis diagnosed by dual energy x ray absorptiometry in the subcohort . Diet was assessed by repeated food frequency question naires . Results During follow-up , 14 738 women ( 24 % ) experienced a first fracture of any type and among them 3871 ( 6 % ) a first hip fracture . Of the 5022 women in the subcohort , 1012 ( 20 % ) were measured as osteoporotic . The risk patterns with dietary calcium were non-linear . The crude rate of a first fracture of any type was 17.2/1000 person years at risk in the lowest quintile of calcium intake , and 14.0/1000 person years at risk in the third quintile , corresponding to a multivariable adjusted hazard ratio of 1.18 ( 95 % confidence interval 1.12 to 1.25 ) . The hazard ratio for a first hip fracture was 1.29 ( 1.17 to 1.43 ) and the odds ratio for osteoporosis was 1.47 ( 1.09 to 2.00 ) . With a low vitamin D intake , the rate of fracture in the first calcium quintile was more pronounced . The highest quintile of calcium intake did not further reduce the risk of fractures of any type , or of osteoporosis , but was associated with a higher rate of hip fracture , hazard ratio 1.19 ( 1.06 to 1.32 ) . Conclusion Gradual increases in dietary calcium intake above the first quintile in our female population were not associated with further reductions in fracture risk or osteoporosis BACKGROUND Some epidemiological studies have suggested that high dietary intake of calcium and fibre reduces colorectal carcinogenesis . Available data are not sufficient to serve as a basis for firm dietary advice . We undertook a multicentre r and omised trial to test the effect of diet supplementation with calcium and fibre on adenoma recurrence . METHODS We r and omly assigned 665 patients with a history of colorectal adenomas to three treatment groups , in a parallel design : calcium gluconolactate and carbonate ( 2 g elemental calcium daily ) , fibre ( 3.5 g ispaghula husk ) , or placebo . Participants had colonoscopy after 3 years of follow-up . The primary endpoint was adenoma recurrence . Analyses were by intention to treat . FINDINGS 23 patients died , 15 were lost to follow-up , 45 refused repeat colonoscopy , and five developed severe contraindications to colonoscopy . Among the 552 participants who completed the follow-up examination , 94 stopped treatment early . At least one adenoma developed in 28 ( 15.9 % ) of 176 patients in the calcium group , 58 ( 29.3 % ) of 198 in the fibre group , and 36 ( 20.2 % ) of 178 in the placebo group . The adjusted odds ratio for recurrence was 0.66 ( 95 % CI 0.38 - 1.17 ; p=0.16 ) for calcium treatment and 1.67 ( 1.01 - 2.76 , p=0.042 ) for the fibre treatment . The odds ratio associated with the fibre treatment was significantly higher in participants with baseline dietary calcium intake above the median than in those with intake below the median ( interaction test , p=0.028 ) INTERPRETATION Supplementation with fibre as ispaghula husk may have adverse effects on colorectal adenoma recurrence , especially in patients with high dietary calcium intake . Calcium supplementation was associated with a modest but not significant reduction in the risk of adenoma recurrence OBJECTIVE To study the effect of calcium supplementation with dairy products on the bone and body composition of pubertal girls . DESIGN R and omized control study with 12-month follow-up . SETTING General community . SUBJECTS Forty-eight white girls whose mean age was 11 years and sexual development at Tanner stage 2 . INTERVENTION One group 's diet was supplemented with dairy products to the recommended dietary allowance of 1200 mg calcium daily . The other group ate their usual diet . MAIN OUTCOME MEASURES Bone mineral content and density were measured at the radius , femoral neck , lumbar spine , and total body bone mineral by single-photon and dual-energy x-ray absorptiometry at the start of the study and after 3 , 6 , 9 , and 12 months . Body composition ( lean body mass and body fat ) was measured by dual-energy x-ray absorptiometry at the same intervals . Serum calcium , phosphate , 25-hydroxyvitamin D , 1,25-dihydroxyvitamin D , alkaline phosphatase , magnesium , and albumin concentrations were determined at the start and end of the study . The urinary calcium/creatinine ratio and hydroxyproline concentration were also determined . RESULTS The dairy group had higher intakes of calcium , phosphate , vitamin D , and protein than control subjects . The dairy group had significantly greater increases during the 1-year study in bone mineral density at the lumbar spine bones ( 22.8 % + /- 6.9 % vs 12.9 % + /- 8.3 % ) and in total body bone mineral ( 14.2 % + /- 7.0 % vs 7.6 % + /- 6.0 % ) than control subjects . Dietary calcium , phosphate , vitamin D , and protein intakes were associated with the lumbar bone density and total body bone calcium . There were no differences in serum or urinary biochemical values between the two groups at the start or end of the study . CONCLUSIONS Young girls whose dietary calcium intake was provided primarily by dairy products at or above the recommended dietary allowances had an increased rate of bone mineralization . Increased intake of dairy foods did not increase overall total or saturated fat intake and was not associated with excessive weight gain or increased body fat Background : Calcium has been implicated in carcinogenesis and linked to the risk of several cancers in epidemiologic studies ; however , few studies have investigated the association of calcium intake with lung cancer risk , particularly among nonsmokers . Methods : We evaluated the association of intakes of calcium and related minerals , assessed through a food frequency question naire , with lung cancer risk among 71,267 female nonsmokers who were cancer free at baseline in the Shanghai Women 's Health Study , a population -based , prospect i ve cohort study . Multivariate Cox regression was used to calculate hazard ratios ( HR ) and 95 % confidence intervals ( CI ) . Results : During follow-up through December 2009 ( median follow-up time : 11.2 years ) , 428 incident lung cancer cases accrued . The median intakes of dietary calcium , magnesium , and phosphorus were 441 , 266 , and 935 mg/d , respectively . Intakes of calcium , phosphorus , and the calcium-to-magnesium ( Ca : Mg ) ratio were inversely associated with lung cancer risk . The corresponding HRs ( 95 % CIs ) for the highest compared with the lowest quartile were 0.66 ( 0.48 , 0.91 ) for calcium , 0.55 ( 0.36 , 0.85 ) for phosphorus , and 0.62 ( 0.47 , 0.82 ) for the Ca : Mg ratio . No association was observed for dietary magnesium intake or the use of calcium- or vitamin D-containing supplements . Conclusions and Impact : Our study provides some of the first evidence suggesting a possible role for increasing  dietary calcium intake in lung cancer prevention among female nonsmokers , especially in population s with relatively low calcium intake . Cancer Epidemiol Biomarkers Prev ; 22(1 ) ; 50–7 . © 2012 AACR Background : Iron , zinc , and calcium are all involved in the metabolism of reactive oxygen species and may compete with each other for similar binding sites . Dietary intakes of these micronutrients have been associated with altered risks of colorectal , breast , and prostate cancers . Methods : In this Massachusetts hospital-based case – control study of 923 patients with lung cancer and 1125 healthy controls , we studied the associations between dietary iron , zinc , and calcium intake and the risk of lung cancer .  Dietary intake was assessed at the time of recruitment ( 1992 to 2000 ) with the use of a 126-item semiquantitative food-frequency question naire . We analyzed the data using multiple logistic regression models adjusting for smoking history and other potential risk factors . Results : The adjusted odds ratios of dietary iron , zinc , and calcium  from food sources were 1.45 ( 95 % confidence interval = 1.03–2.06 ) , 0.71 ( 0.50–0.99 ) , and 1.64 ( 1.17–2.29 ) , respectively , for the highest quintile versus the lowest quintile of each micronutrient . Stronger associations between micronutrients and lung cancer risk were found when iron , zinc , and calcium were included together in the same model . The associations between  dietary micronutrients intake and lung cancer risk were stronger among current smokers than among former smokers . When we examined intake from supplements as well as diet , associations were similar to those for diet alone . Conclusions : Dietary iron , zinc , and calcium may play an important role in the development of lung cancer , especially among current smokers . These results need to be confirmed in large prospect i ve studies The Polyp Prevention Trial ( PPT ) was a multicenter r and omized clinical trial design ed to determine the effects of a high-fiber , high-fruit and vegetable , low-fat diet on the recurrence of adenomatous polyps in the large bowel . Detailed dietary intake and supplement use data were collected at baseline and at each of 4 annual study visits . Adenoma recurrence was ascertained by complete colonoscopy at baseline and after 1 and 4 y. Recurrence was found in 754 of the 1905 trial participants . We evaluated the association between calcium and vitamin D intake and adenomatous polyp recurrence after adjusting for intervention group , age , gender , nonsteroidal anti-inflammatory drug use , total energy intake , and the interaction of gender and intervention group . Vitamin D models were also adjusted for the location of the clinic site . Dietary variables were adjusted for total energy intake via the residual method . There were no overall significant associations between adenoma recurrence and dietary calcium intake [ odds ratio ( OR ) for the 5th compared with the lowest quintile = 0.91 ; 95 % CI = 0.67 - 1.23 ; P-trend = 0.68 ] , total calcium intake ( OR = 0.86 ; 95 % CI = 0.62 - 1.18 ; P-trend = 0.20 ) , or  dietary vitamin D intake ( OR = 0.93 ; 95 % CI = 0.69 - 1.25 ; P-trend = 0.43 ) averaged over follow-up . Total vitamin D intake was weakly inversely associated with adenoma recurrence ( OR = 0.84 ; 95 % CI = 0.62 - 1.13 ; P-trend = 0.03 ) . Supplemental calcium and vitamin D use during follow-up also were inversely associated with adenoma recurrence ( OR for any compared with no use = 0.82 ; 95 % CI = 0.68 - 0.99 ; and OR = 0.82 ; 95 % CI = 0.68 - 0.99 ; for calcium and vitamin D , respectively ) . Slightly stronger associations were noted for the prevention of multiple recurrences . Our analyses did not suggest a significant effect modification between total calcium and total vitamin D intake ( P = 0.14 ) on risk for adenoma recurrence . This trial cohort provides some evidence that calcium and vitamin D may be inversely associated with adenoma recurrence BACKGROUND Inadequate dietary intake of calcium and vitamin D may contribute to the high prevalence of osteoporosis among older persons . METHODS We studied the effects of three years of dietary supplementation with calcium and vitamin D on bone mineral density , biochemical measures of bone metabolism , and the incidence of nonvertebral fractures in 176 men and 213 women 65 years of age or older who were living at home . They received either 500 mg of calcium plus 700 IU of vitamin D3 ( cholecalciferol ) per day or placebo .  Bone mineral density was measured by dual-energy x-ray absorptiometry , blood and urine were analyzed every six months , and cases of nonvertebral fracture were ascertained by means of interviews and verified with use of hospital records . RESULTS The mean ( + /-SD ) changes in bone mineral density in the calcium-vitamin D and placebo groups were as follows : femoral neck , + 0.50+/-4.80 and -0.70+/-5.03 percent , respectively ( P=0.02 ) ; spine,+2.12+/-4.06 and + 1.22+/-4.25 percent ( P=0.04 ) ; and total body , + 0.06+/-1.83 and -1.09+/-1.71 percent ( P<0.001 ) . The difference between the calcium-vitamin D and placebo groups was significant at all skeletal sites after one year , but it was significant only for total-body bone mineral density in the second and third years . Of 37 subjects who had nonvertebral fractures , 26 were in the placebo group and 11 were in the calcium-vitamin D group ( P=0.02 ) . CONCLUSIONS In men and women 65 years of age or older who are living in the community , dietary supplementation with calcium and vitamin D moderately reduced bone loss measured in the femoral neck , spine , and total body over the three-year study period and reduced the incidence of nonvertebral fractures Objective To determine whether increased calcium intake ( 2 g/day ) in pregnancy is effective in reducing the risk of preeclampsia in pregnant teenagers . Methods The present study was a prospect i ve , r and omized , double-blind , controlled clinical trial . Two hundred sixty teenaged pregnant girls attending the Hospital Gíneco-Obstétrico Isidro Ayora in Quito , Ecuador , were included . Selection criteria were age less than 17.5 years , nulliparity , first prenatal visit before 20 weeks ' gestation , and residency in Quito ( 2800-m altitude ) . We used a table of r and om numbers to assign 125 girls to receive 2000 mg of elemental calcium daily , beginning at 20 weeks of gestation and continuing until delivery ; 135 women in the control group received a placebo .  Blood pressure ( BP ) was measured twice every 4 weeks until delivery and at 48 hours after delivery . The diagnosis of preeclampsia was defined as BP greater than 140/90 mmHg on at least two occasions more than 6 hours apart and proteinuria greater than 30 mg/dL ( over one cross by dipstick on two occasions 4 - 24 hours apart ) . Results The average daily calcium intake in this population was approximately 51 % of the Recommended Dietary Allowance . Calcium supplementation was associated with a significantly decreased risk of preeclampsia ( risk reduction 12.35 % ; P < .001 ) , with 3.2 % ( n = 4 ) developing preeclampsia in the treatment group versus 15.5 % ( n = 21 ) in the placebo group . Moreover , calcium supplementation led to a reduction in systolic BP of 9.1 mmHg and in diastolic BP of 6.0 mmHg . Conclusion These results suggest that calcium supplementation during pregnancy in population s with low calcium intake is a safe , effective , and inexpensive preventive measure that significantly reduces the risk of preeclampsia Higher intakes of calcium and dairy products , a major source of dietary calcium , are reported to increase the risk of prostate cancer , potentially due to reductions in circulating vitamin D with increasing calcium intake . We prospect ively examined the association of dairy product and calcium intake with prostate cancer risk in 29,509 men , including 1,910 cases , in the Prostate , Lung , Colorectal , and Ovarian Cancer Screening Trial . We also evaluated the relation of calcium intake with serum 25-hydroxy-vitamin D [ 25(OH)D ] and 1,25-dihydroxy-vitamin D [ 1,25(OH)2D ] , in a Prostate , Lung , Colorectal , and Ovarian Trial sub study ( n = 275 ) .  Dietary intake was assessed using a food frequency question naire .  Baseline serum 1,25(OH)2D was determined by RIA . Greater intake of dairy products , particularly low-fat dairy products , was weakly associated with increased risk of prostate cancer [ relative risk ( RR ) , 1.12 ; 95 % confidence intervals ( CI ) , 0.97 - 1.30 ; P trend = 0.06 for > 2.75 versus ≤0.98 servings of total dairy/day ; 1.23 ( 1.07 - 1.41 ) for low-fat dairy ] . Greater dietary calcium intake was associated with increased risk of prostate cancer ( RR , 1.34 ; 95 % CI , 0.93 - 1.94 ; P trend = 0.02 for > 2,000 versus < 1,000 mg/day ) , but greater supplementary calcium intake was not associated with the risk . Associations of dairy product and dietary calcium intake were evident for nonaggressive disease ( RR , 1.20 ; 95 % CI , 0.99 - 1.46 ; P trend = 0.01 for dairy products ; 1.64 , 1.04 - 2.57 ; P trend = 0.002 for dietary calcium ) , but not aggressive disease ( RR , 1.02 ; 95 % CI , 0.81 - 1.28 for dairy products ; 0.94 , 0.49 - 1.80 for dietary calcium ) . Calcium intake was not associated with serum 25-hydroxy-vitamin D and 1,25(OH)2D concentration . In this large prospect i ve study in a prostate cancer screening trial , greater dietary intake of calcium and dairy products , particularly low-fat types , may be modestly associated with increased risks for nonaggressive prostate cancer , but was unrelated to aggressive disease . Furthermore , we found no relationship between calcium intake and circulating vitamin D. ( Cancer Epidemiol Biomarkers Prev 2007;16(12):2623–30 AIM To compare the nutritional status and dietary intake of elderly women admitted with hip fracture ( HF ) versus a control group without fracture and without known abnormalities of bone mineral density . DESIGN Descriptive and observational study . LOCATION Hospital Neurotraumatológico in Jaen ( Spain ) and three urban Primary Health Care centers in Jaen city ( San Felipe , Virgen de la Capilla and El Valle ) . PARTICIPANTS A total of 44 women with HF , which was considered osteoporotic , and a control group composed of 42 women with a similar age range , selected r and omly from the medical out patients who visit their Primary Health Care centers . MEASUREMENTS We record sociodemographic data . Dietary intake before the fracture and anthropometric variables  in the first 72hours after admission were assessed . RESULTS Patients with HF had lower weight ( 67.2±10.1 kg versus 72.0±10.1 kg , P<.05 ) , BMI ( 27.6±3.7kg/m(2 ) versus 31.3±4.6kg/m(2 ) , P<.001 ) , as well as lower arm and leg circumferences than the control patients . A significantly higher intake , in terms of macronutrients and energy consumption , was detected in the control group , as well as lower than recommended intake of calcium and vitamin D in both groups , which was more marked in patients with HF . Logistic regression found that the HF was associated with a lower BMI as well as lower intakes of protein , carbohydrates and calcium . CONCLUSIONS Adequate nutritional status and adequate intake of essential macro- and micronutrients seem to prevent osteoporotic HF Background : To prevent preeclampsia , the WHO recommends antenatal calcium supplementation in population s with inadequate habitual intake . The WHO recommends 1500 - 2000 mg Ca/d with iron-folic acid ( IFA ) taken separately , a complex pill-taking regimen . Objective : The objective of this study was to test the hypothesis that simpler regimens with lower daily dosages would lead to higher adherence and similar supplement intake . Methods : In the Micronutrient Initiative Calcium Supplementation study , we compared the mean daily supplement intake associated with 2 dosing regimens with the use of a parallel , cluster-r and omized noninferiority trial implemented in 16 primary health care facilities in rural Kenya . The st and ard regimen was 3 × 500 mg Ca/d in 3 pill-taking events , and the low-dose regimen was 2 × 500 mg Ca/d in 2 pill-taking events ; both regimens included a 200 IU cholecalciferol and calcium pill and a separate IFA pill . We enrolled 990 pregnant women between 16 and 30 wk of gestation . The primary outcome was supplemental calcium intake measured by pill counts 4 and 8 wk after recruitment . We carried out intention-to-treat analyses with the use of mixed-effect models , with regimen as the fixed effect and health care facilities as a r and om effect , by using a noninferiority margin of 125 mg Ca/d . Results : Women in facilities assigned to the st and ard regimen consumed a mean of 1198 mg Ca/d , whereas those assigned to the low-dose regimen consumed 810 mg Ca/d . The difference in intake was 388 mg Ca/d ( 95 % CI = 341 , 434 mg Ca/d ) , exceeding the prespecified margin of 125 mg Ca/d . The overall adherence rate was 80 % and did not differ between study arms . Conclusions : Contrary to our expectation , a simpler , lower-dose regimen led to significantly lower supplement intake than the regimen recommended by the WHO . Further studies are needed to precisely characterize the dose-response relation of calcium supplementation and preeclampsia risk and to examine cost effectiveness of lower and simpler regimens in program setting s. This trial was registered at clinical trials.gov as NCT02238704 Objective : Many studies have shown that soy isoflavones have an effect in preventing estrogen-related bone loss , but no data reported whether such an effect could be influenced by other important factors affecting bone loss . This study examines whether the associations between isoflavone supplementation and rates of change in bone mineral content ( BMC ) could be modified by years since menopause ( YSM ) , body weight ( BW ) , and dietary calcium intake in postmenopausal Chinese women aged 48 to 62 years . Design : A group of 203 eligible women were r and omly assigned to three treatment groups : placebo ( daily dose of 0 mg isoflavones + 500 mg calcium , n = 67 ) , mid-dose ( 40 mg isoflavones + 500 mg calcium , n = 68 ) ; and high-dose ( 80 mg isoflavones + 500 mg calcium , n = 68 ) . Bone mineral density ( BMD ) and BMC at the whole body , spine , and hip were measured by dual-energy x-ray absorptiometry at baseline and posttreatment after 1 year . YSM , BW , and dietary calcium intake stratified analyses were performed to evaluate whether the associations between isoflavones  supplementation and BMC change rates were varied with these factors . Results : Both univariate and multivariate analyses observed significant favorable effect of isoflavone supplementation on rates of change in BMC at the total hip and trochanter among later postmenopausal women ( > 4 y ) , in women with lower BW ( ≤median , 55.5 kg ) , or among women with lower level of calcium intake ( ≤median , 1095 mg/d ) . Conclusions : The independent effect of soy on the maintenance of hip BMC is more marked in women in later menopause or those with lower BW or calcium intake BACKGROUND In older women and men , greater intakes of dietary calcium , potassium , and total fluid reduce the risk of kidney stone formation , while supplemental calcium , sodium , animal protein , and sucrose may increase the risk . Recently , phytate has been suggested to play a role in stone formation . To our knowledge , no prospect i ve information on the role of dietary factors and risk of kidney stone formation is available in younger women . METHODS We prospect ively examined , during an 8-year period , the association between dietary factors and the risk of  incident symptomatic kidney stones among 96 245 female participants in the Nurses ' Health Study II ; the participants were aged 27 to 44 years and had no history of kidney stones .  Self-administered food frequency question naires were used to assess diet in 1991 and 1995 . The main outcome measure was an incident symptomatic kidney stone . Cox proportional hazards regression models were used to adjust simultaneously for various risk factors . RESULTS We documented 1223 incident symptomatic kidney stones  during 685 973 person-years of follow-up . After adjusting for relevant risk factors , a higher dietary calcium intake was associated with a reduced risk of kidney stones ( P = .007 for trend ) . The multivariate relative risk among women in the highest quintile of intake of dietary calcium compared with women in the lowest quintile was 0.73 ( 95 % confidence interval , 0.59 - 0.90 ) . Supplemental calcium intake was not associated with risk of stone formation . Phytate intake was associated with a reduced risk of stone formation . Compared with women in the lowest quintile of phytate intake , the relative risk for those in the highest quintile was 0.63 ( 95 % confidence interval , 0.51 - 0.78 ) . Other dietary factors showed the following relative risks ( 95 % confidence intervals ) among women in the highest quintile of intake compared with those in the lowest quintile : animal protein , 0.84 ( 0.68 - 1.04 ) ; fluid , 0.68 ( 0.56 - 0.83 ) ; and sucrose , 1.31 ( 1.07 - 1.60 ) . The intakes of sodium , potassium , and magnesium were not independently associated with risk after adjusting for other dietary factors . CONCLUSIONS A higher intake of dietary calcium decreases the risk of kidney stone formation in younger women , but supplemental calcium is not associated with risk . This study also suggests that some dietary risk factors may differ by age and sex . Finally , dietary phytate may be a new , important , and safe addition to our options for stone prevention Context Some data suggest that body weight is inversely associated with calcium intake , increasing the possibility that supplemental calcium might facilitate weight loss or prevent weight gain . Contribution Research ers r and omly assigned overweight and obese patients to supplemental calcium or placebo and found no between-group differences in measures of weight change . Caution Trial participants were almost all women . Implication Calcium supplementation is unlikely to prevent weight gain in persons who are overweight or obese . The Editors The high prevalence of overweight and obesity in the United States ( 1 ) has stimulated great interest in identifying approaches that may help to prevent weight gain or improve ability to lose weight . Increasing calcium intake is a potential means of weight management that has received much attention from both lay press ( 24 ) and the medical community ( 57 ) . This interest has been stimulated by a series of cross-sectional studies ( 817 ) reporting that children and adults with low reported consumption of dietary ( primarily dairy ) calcium  have greater body weight , a higher degree of adiposity , and greater risk for having components of the metabolic syndrome than those who report that they consume more calcium . Some ( 1824 ) , although not all ( 2534 ) , longitudinal investigations have also suggested that children and adults who consume a lower calcium diet tend to gain more weight than those with greater dietary or supplemental calcium intake . These data , together with some small clinical trials suggesting that weight loss during dieting may be augmented by supplemental ( 35 ) or dairy calcium ( 3538 ) , have led to expectations that substantially augmenting calcium intake might diminish body weight by 0.5 kg or more each year ( 5 , 18 , 22 , 39 ) . Two possible mechanisms for an effect of dietary calcium on body weight have been suggested . First , calcium can combine with fatty acids in the intestine to form insoluble soaps that are therefore not absorbed ( 40 , 41 ) . Second , some research ers ( 4246 ) have proposed that low dietary calcium leads to increased adipocyte triglyceride deposition ( 4749 ) . If calcium substantially affects fat accumulation , calcium supplementation could prevent additional weight and fat gain among people with high body weight . To test this hypothesis , we measured the effect of calcium carbonate supplementation for 2 years on the weight and body fat of overweight and obese adults . Methods Setting and Participants We recruited participants through advertisements posted in Bethesda , Maryl and , and spontaneous reply to newspaper and radio advertising in the Washington , DC , metropolitan area seeking healthy adult volunteers for a project to study the health effects of calcium supplementation . Men and women age 18 to 80 years were eligible to enroll if they had a body mass index ( BMI ) of 25 kg/m2 or more and did not have cerebrovascular , cardiovascular , pulmonary , renal , hepatic , endocrinologic , or other substantial medical disease . Women were ineligible if they were pregnant , were breastfeeding , or had received a recommendation from a health care professional to take calcium supplements for any condition . We excluded persons who regularly used medications known to affect body weight , had a weight loss of 3 % or more in the preceding 3 months , reported total calcium intake in excess of 3.5 g/d , used supplemental calcium in excess of 300 mg/d , used vitamin D supplements in excess of 400 IU/d , or had a history of renal stones . The institutional review board of the National Institute of Child Health and Human Development , National Institutes of Health , approved the research protocol . Each participant provided signed consent . We provided financial compensation for participants ' time and inconvenience . Design Overview We conducted a single-center , r and omized , double-blind , placebo-controlled trial from March 2002 to April 2006 . After an outpatient visit to determine eligibility and obtain initial assessment s , participants entered a 2-year , double-blind treatment period . R and omization and Interventions We r and omly assigned participants , in a 1:1 ratio , to receive either elemental calcium , 1500 mg/d ( calcium carbonate , purchased from Particle Dynamics , St. Louis , Missouri ) , or placebo , administered as 2 divided doses with meals . Investigators assigned consecutive code numbers to participants from prespecified lists stratified by race or ethnicity , sex , and BMI ( 25 to 26.99 , 27 to 29.99 , 30 to 34.99 , and 35 kg/m2 ) . The National Institutes of Health Clinical Center Pharmaceutical Development Section used permuted blocks with stratification to generate the allocations that translated code numbers into study group assignments by using a pseudo-r and om number program . The Pharmaceutical Development Section prepared placebo and calcium capsules to appear identical . Pharmacy personnel , not otherwise involved with the conduct of the study , dispensed study capsules with medication placed in containers that appeared identical and differed only by the individual participant code number . No participant , investigator , or other medical or nursing staff interacting with participants was aware of study group assignments for the duration of the trial . Initial Assessment At their prer and omization evaluation , participants reported after an overnight fast and were weighed in hospital gowns by using a digital scale ( Life Measurement Instruments , Concord , California ) that was calibrated with a known weight before each participant 's measurement . We measured height by using a stadiometer calibrated before each measurement ( Holtain , Crymych , United Kingdom ) . Research dietitians assessed abdominal and hip circumferences in triplicate to the nearest 0.1 cm , as recommended ( 50 , 51 ) , and measured triceps skinfold thickness to the nearest 0.5 mm by using Lange calipers ( Cambridge Scientific Industries , Cambridge , Maryl and ) . We measured blood pressure , obtained after a 5-minute rest period , 3 times at 5-minute intervals from seated participants by using an automated sphygmomanometer ( Dinamap-Plus , Critikon , Tampa , Florida ) . We did whole-body dual-energy x-ray absorptiometry to estimate total body fat mass ( Delphi A , software version 11.2 , Hologic , Bedford , Massachusetts ) . We measured intact parathyroid hormone concentrations with 2-site immunochemiluminometric assays ( 52 ) , and serum 25-hydroxy vitamin D levels by using a competitive binding assay ( Nichols Advantage , Nichols Diagnostic , San Clemente , California ) ( 53 ) . We asked participants with substantial vitamin D deficiency ( serum 25-hydroxy vitamin D level < 25.0 nmol/L ) to take vitamin D , 400 IU/d ( ergocalciferol ) , in a multivitamin . We assessed baseline dietary calcium intake by using a 7-day food record that a registered dietitian review ed with each participant to maximize accuracy and completeness , and analyzed for dietary calcium intake by using the Nutrition Data System for Research software , versions 4.04_32 and 4.05_33 ( University of Minnesota , Minneapolis , Minnesota ) ( 54 ) . We measured calcium intake from multivitamins or calcium supplements with a vali date d calcium question naire ( 55 ) that was review ed for completeness through an interview with a registered dietitian . We recorded the calcium content as it was listed on the label of each multivitamin or calcium supplement . We measured dietary and supplemental vitamin D intakes in the same manner . We estimated energy intake at baseline and at 2 years by using a food-frequency question naire that assessed total diet ( 5557 ) . We measured socioeconomic status by using the Hollingshead score ( 58 ) . Outcomes and Follow-up Primary efficacy end points were change in body weight and body fat mass at the end of 2 years of treatment . Secondary outcomes were fasting anthropometric measurements , body composition by dual-energy x-ray absorptiometry , and change in blood pressure , assessed yearly , along with question naire data on dietary and supplemental calcium intake ( 55 ) . In addition , we contacted participants every 3 months to complete question naires about their adherence to the medication regimen ; assess their general health ; and obtain self-reports of mood , stress , physical activity , and hunger . Every 6 months , participants returned to the clinic to exchange their unused study medication for a new supply . We used the tally of returned capsules to assess adherence . To examine adequacy of the masking procedure , participants completed a question naire at the end of the study that requested they report their best guess about their study group assignment . Statistical Analysis All reported primary data analyses were prespecified . On the basis of our previous study of observed yearly changes in body weight over time ( 59 ) , we needed a total sample size of 256 participants to detect a 0.35-kg difference per year in weight change ( that is , 0.7 kg over 2 years ) between groups with 80 % power . Participant accrual was set at 340 participants to allow 25 % loss to follow-up . We analyzed data by using SPSS for Windows , version 14.0 ( SPSS , Chicago , Illinois ) . We assessed efficacy in the intention-to-treat sample of all r and omly assigned participants . We did 2 efficacy analyses . The primary analysis used a multiple imputation model for missing data under a missing-at-r and om assumption ( 60 ) . By using NORM , version 2.03 ( The Pennsylvania State University , State College , Pennsylvania ) ( 61 , 62 ) , we included all available baseline , 1-year , and 2-year outcome measures in an imputation model along with age , sex , race , baseline serum 25-hydroxy vitamin D concentration , baseline calcium intake , and study group . We then combined the coefficients from analyses of 20 imputed data sets into a single set of estimates according to Shafer ( 62 ) and the Rubin rules ( 63 ) . To assess sensitivity of these results to the missing-at-r and om assumption , we conducted 3 additional analyses : assuming that all participants who withdrew from the study had major weight gain ( OBJECTIVE To determine the effect of maternal calcium supplementation during pregnancy on fetal bone mineralization . METHODS Healthy mothers with early ultrasound confirmation of date s and singleton pregnancies were enrolled in a double-masked study and r and omized before 22 weeks ' gestation to 2 g/day of elemental calcium or placebo until delivery . Maternal dietary intake at r and omization and at 32 - 33 weeks ' gestation was recorded with 24-hour dietary recalls . Dual-energy x-ray absorptiometry measurements of the whole body and lumbar spine of the neonates were performed before hospital discharge . RESULTS The infants of 256 women ( 128 per group ) had dual-energy x-ray absorptiometry measurements during the first week of life . There were no significant differences between treatment groups in gestational age , birth weight , or length of the infants , or in the total-body or lumbar spine bone mineral content . However , when bone mineral content was analyzed by treatment group within quintiles of maternal dietary calcium intake , total body bone mineral content ( mean + /- st and ard error of the mean ) was significantly greater in infants born to calcium-supplemented mothers ( 64.1+/-3.2 versus 55.7+/-2.7 g in the placebo group ) in the lowest quintile of dietary calcium intake ( less than 600 mg/day ) . The effect of calcium supplementation remained significant after adjustment for maternal age and maternal body mass index and after normalization for skeletal area and body length of the infant . CONCLUSION Maternal calcium supplementation of up to 2 g/day during the second and third trimesters can increase fetal bone mineralization in women with low dietary calcium intake . However , calcium supplementation in pregnant women with adequate dietary calcium intake is unlikely to result in major improvement in fetal bone mineralization 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 Hypovitaminosis D and a low calcium intake contribute to increased parathyroid function in elderly persons .  Calcium and vitamin D supplements reduce this secondary hyperparathyroidism , but whether such supplements reduce the risk of hip fractures among elderly people is not known . METHODS We studied the effects of supplementation with vitamin D3 ( cholecalciferol ) and calcium on the frequency of hip fractures and other nonvertebral fractures , identified radiologically , in 3270 healthy ambulatory women ( mean [ + /- SD ] age , 84 + /- 6 years ) . Each day for 18 months , 1634 women received tricalcium phosphate ( containing 1.2 g of elemental calcium ) and 20 micrograms ( 800 IU ) of vitamin D3 , and 1636 women received a double placebo . We measured serial serum parathyroid hormone and 25-hydroxyvitamin D ( 25(OH)D ) concentrations in 142 women and determined the femoral bone mineral density at base line and after 18 months in 56 women . RESULTS Among the women who completed the 18-month study , the number of hip fractures was 43 percent lower ( P = 0.043 ) and the total number of nonvertebral fractures was 32 percent lower ( P = 0.015 ) among the women treated with vitamin D3 and calcium than among those who received placebo . The results of analyses according to active treatment and according to intention to treat were similar . In the vitamin D3-calcium group , the mean serum parathyroid hormone concentration had decreased by 44 percent from the base-line value at 18 months ( P < 0.001 ) and the serum 25(OH)D concentration had increased by 162 percent over the base-line value ( P < 0.001 ) . The bone density of the proximal femur increased 2.7 percent in the vitamin D3-calcium group and decreased 4.6 percent in the placebo group ( P < 0.001 ) . CONCLUSIONS Supplementation with vitamin D3 and calcium reduces the risk of hip fractures and other nonvertebral fractures among elderly women BACKGROUND AND METHODS Laboratory , clinical , and epidemiologic evidence suggests that calcium may help prevent colorectal adenomas . We conducted a r and omized , double-blind trial of the effect of supplementation with calcium carbonate on the recurrence of colorectal adenomas . We r and omly assigned 930 subjects ( mean age , 61 years ; 72 percent men ) with a recent history of colorectal adenomas to receive either calcium carbonate ( 3 g [ 1200 mg of elemental calcium ] daily ) or placebo , with follow-up colonoscopies one and four years after the qualifying examination . The primary end point was the proportion of subjects in whom at least one adenoma was detected after the first follow-up endoscopy but up to ( and including ) the second follow-up examination . Risk ratios for the recurrence of adenomas were adjusted for age , sex , lifetime number of adenomas before the study , clinical center , and length of the surveillance period . RESULTS The subjects in the calcium group had a lower risk of recurrent adenomas . Among the 913 subjects who underwent at least one study colonoscopy , the adjusted risk ratio for any recurrence of adenoma with calcium as compared with placebo was 0.85 ( 95 percent confidence interval , 0.74 to 0.98 ; P=0.03 ) . The main analysis was based on the 832 subjects ( 409 in the calcium group and 423 in the placebo group ) who completed both follow-up examinations . At least one adenoma was diagnosed between the first and second follow-up endoscopies in 127 subjects in the calcium group ( 31 percent ) and 159 subjects in the placebo group ( 38 percent ) ; the adjusted risk ratio was 0.81 ( 95 percent confidence interval , 0.67 to 0.99 ; P=0.04 ) . The adjusted ratio of the average number of adenomas in the calcium group to that in the placebo group was 0.76 ( 95 percent confidence interval , 0.60 to 0.96 ; P=0.02 ) . The effect of calcium was independent of initial dietary fat and calcium intake . CONCLUSIONS Calcium supplementation is associated with a significant - though moderate - reduction in the risk of recurrent colorectal adenomas 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 Osteoporosis is a major public health issue leading to significant morbidity , loss of independence and excess loss of life . It has been estimated that 13 to 17 million postmenopausal women have low bone mass or osteoporosis ( 1 , 2 ) . This is associated with almost 1.5 million fractures annually , including 300,000 hip fractures ( 2 , 3 ) . A review of the evidence by Cumming in 1990 ( 4 ) and subsequently published r and omized clinical trials have shown that calcium and /or vitamin D supplements may play a role in the prevention and treatment of osteoporosis by slowing the rates of bone loss in postmenopausal and elderly women ( 5–9 ) . However , there are a limited number of calcium and /or vitamin D trials ( 10–13 ) and observational studies [ review of evidence by Cumming and Nevitt ( 14 ) and Kanis ( 15 ) ] , to support a role for calcium and vitamin D supplementation in the reduction of hip and other fractures . It has also been suggested that calcium and vitamin D supplementation may play a role in the reduction of colorectal cancer incidence ( 16–21 ) . To address these major health concerns of postmenopausal women , the Calcium-Vitamin D ( CaD ) trial of the Women ’s Health Initiative ( WHI ) was design ed to test the primary hypothesis that women who are r and omized to receive calcium and vitamin D supplementation will have a lower risk of hip fracture and secondarily , a lower risk of all fractures and colorectal cancer than women receiving corresponding placebo . The objective of this paper is The purpose of this report was to identify and evaluate dietary changes in women who were participating in a study on the effects of weight loss in overweight lactating women on the growth of their infants . Women were r and omly assigned at 4 weeks postpartum to either restrict energy intake by 500 kcal/day ( diet and exercise group ) or to maintain usual dietary intake ( control group ) for 10 weeks . The diet and exercise group significantly decreased fats , sweetened drinks , sweets and desserts , snack foods , and energy intake . Micronutrient intake decreased in the diet and exercise group ; however , mean intakes were not significantly different from those of the control group except for calcium and vitamin D. Both groups consumed less than 76 % of the Recommended Dietary Allowance for vitamins E and C at the end of the study . Mean intake of all other nutrients was adequate in both groups . These results suggest that overweight lactating women can restrict their energy intake by 500 kcal per day by decreasing consumption of foods high in fat and simple sugars . However , they must be advised to increase their intakes of foods high in calcium and vitamin D. Increased intake of fruits and vegetables should also be recommended to all lactating women , as well as multivitamin and calcium supplements to those who do not consume adequate amounts of these foods In vivo and in vitro studies have suggested a protective role of calcium and vitamin D in the development of colorectal cancer . However , epidemiologic data have been inconclusive . The authors prospect ively assessed intakes of calcium and vitamin D in relation to risk of colorectal cancer in a large , prospect i ve , female cohort from the US Women 's Health Study . In 1993 , 39,876 women aged > or = 45 years and free of cardiovascular disease and cancer were enrolled in the study . During an average follow-up of 10 years , 223 of 36,976 women eligible for the present study developed colorectal cancer . Intakes of calcium and vitamin D from dietary sources and supplements were assessed with a baseline food frequency question naire . Cox proportional hazards regression was used to estimate relative risks and 95 % confidence intervals . Intakes of total calcium and vitamin D  were not associated with risk of colorectal cancer ; multivariate relative risks comparing the highest with the lowest quintile were 1.20 ( 95 % confidence interval : 0.79 , 1.85 ; p for trend = 0.21 ) for total calcium and 1.34 ( 95 % confidence interval : 0.84 , 2.13 ; p for trend = 0.08 ) for total vitamin D. Intakes of both nutrients from specific types of sources , including diet and supplements , were also not significantly associated with colorectal cancer risk . Data provide little support for an association of calcium and vitamin D intake with colorectal cancer risk BACKGROUND The effects of vitamin D supplementation in healthy prepubertal children on physiologic outcomes have not been investigated . OBJECTIVE The objective was to evaluate the effects of supplementation with 1000 IU vitamin D(3)/d on calcium absorption . DESIGN In a double-blind , placebo-controlled trial , we r and omly assigned 64 children to 1000 IU vitamin D(3)/d ( n = 32 ) or placebo ( n = 32 ) for 8 wk . Stable isotopes were used to assess calcium absorption . The main outcome measure was calcium absorption before and after supplementation . RESULTS All of the data are shown as means ± SDs . At baseline , vitamin D intake was 221 ± 79 IU/d and calcium intake was 830 ± 197 mg/d . Baseline serum 25-hydroxyvitamin D [ 25(OH)D ] was not significantly correlated with fractional or total calcium absorption . After 8 wk , with baseline values used as a covariate , no differences were seen in fractional or total calcium absorption based on supplementation group ( P = 0.75 and 0.36 , respectively ) . Supplemented children had a significant increase in 25(OH)D concentrations ( from 27.7 ± 7.4 to 36.0 ± 10.3 ng/mL ; P < 0.0001 ) and a decrease in parathyroid hormone ( from 21.4 ± 10.4 to 12.9 ± 7.1 pg/mL ; P < 0.001 ) ; no significant changes in the placebo group were observed . No adverse side effects were noted in either group . CONCLUSIONS Vitamin D(3 ) supplementation at 1000 IU/d increases 25(OH)D and decreases parathyroid hormone in children with average vitamin D intakes below the dietary recommendations of the Institute of Medicine . However , no significant effects of this change on calcium absorption occurred . This trial was registered at clinical trials.gov as NCT 00868738
CONCLUSIONS Dietary calcium intake is not associated with risk of fracture , and there is no clinical trial evidence that increasing calcium intake from dietary sources prevents fractures .
OBJECTIVE To examine the evidence underpinning recommendations to increase calcium intake through dietary sources or calcium supplements to prevent fractures .