{"id":1729,"date":"2015-11-16T08:03:10","date_gmt":"2015-11-16T16:03:10","guid":{"rendered":"https:\/\/phcprimarycare.org\/?p=1729"},"modified":"2015-11-11T12:33:47","modified_gmt":"2015-11-11T20:33:47","slug":"dem-bones","status":"publish","type":"post","link":"https:\/\/phcprimarycare.org\/?p=1729","title":{"rendered":"Dem Bones"},"content":{"rendered":"

Back in February, 2013 this blog looked at the positive association\u00a0between\u00a0calcium intake and the risk of all cause death rates and cardiovascular\u00a0disease in women<\/a>.\u00a0 Older people have historically\u00a0been encouraged to obtain their calcium from dietary sources instead of supplements. \u00a0A recent systematic review of randomized controlled trials as well as observational studies by Mark Bolland et al.\u00a0concluded that there is no association with dietary intake of calcium and risk of fracture. Moreover, these authors found that the association between\u00a0calcium supplements and fracture risk is similarly weak.<\/p>\n

Interestingly, there are\u00a0only two randomized controlled studies of dietary calcium intake and fractures. Contrary to RCT evidence, there\u00a0are 50 reports from 44 cohort studies on the relationship.\u00a0 In adults older than 50, for most studies (> 75%) , no relationship between dietary calcium intake, including milk or dairy sources, and fractures of the hip, spine or forearm could be confirmed.<\/p>\n

In randomized studies, the degree of total fracture reduction associated with supplemental calcium was statistically significant with an 11% reduction (95% CI, 0.81, 0.96). However, the clinical importance of this reduction is uncertain. \u00a0When examining this relationship with specific fracture types (hip or forearm fractures), a statistically significant reduction could \u00a0not be demonstrated. \u00a0One trial1\u00a0<\/sup>in frail elderly women in residential care with low dietary calcium and low Vitamin D levels, did show decreased fracture risk (but 6 other similar trials that did not.)<\/p>\n

So, most of the studies were observational and suffer from the inherent risk of bias.\u00a0 It seems to me, the blogger, that there should be some level of calcium intake that is necessary.\u00a0 Where too much is unhealthy, zero intake would seem to be unhealthy as well (reductio ad absurdum<\/em>).\u00a0 Nonetheless, we clinicians are caught calcium carbonate and a hard place again.<\/p>\n

What\u2019s a doctor to do?\u00a0 Well, it starts with our pediatrician and family physician colleagues.\u00a0 Put the calcium in during growth.\u00a0 Even after they stop growing taller kids continue to make more bone than they lose.\u00a0\u00a0 Bone mass peaks somewhere between 18 and 25. \u00a0Seek to dispel parental concerns (and self-diagnoses)\u00a0\u00a0of lactose intolerance in those less at risk (more common in the elderly, Blacks, Asians, Hispanic, and Native Americans but much less common in Northern Europeans). \u00a0 Being products of the Kool-Aid generation, we missed out on this little piece of advice and are paying for it now.<\/p>\n

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  1. Chapuy MC, Pamphile R, Paris E, et.al Combined calcium and vitamin D3 supplementation in elderly women: Confirmation of reversal of secondary hyperparathyroidsism and hip fracture risk :\u00a0 The Decalyos II study.\u00a0 Osteroporosis Int 2002;13:257-64.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Back in February, 2013 this blog looked at the positive association\u00a0between\u00a0calcium intake and the risk of all cause death rates and cardiovascular\u00a0disease in women.\u00a0 Older people have historically\u00a0been encouraged to obtain their calcium from dietary sources instead of supplements. \u00a0A … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[1],"tags":[],"class_list":["post-1729","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\nDem Bones - PHC Primary Care Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/phcprimarycare.org\/?p=1729\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Dem Bones - 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