Calcium Supplement Use Is Associated With Less Bone Mineral Density Loss, But Does Not Lessen the Risk of Bone Fracture Across the Menopause Transition: Data From the Study of Women's Health Across the Nation.

Regan L Bailey,Shinyoung Jun,Peishan Zou,George P Mccabe,Bruce A Craig,Jane A Cauley,Connie M Weaver,Taylor C Wallace

doi:10.1002/jbm4.10246

Abstract

ABSTRACTDiet is a modifiable factor that is related to bone mass and risk for fractures; however, the use of calcium supplements for bone health is controversial, with little scientific agreement. The purpose of this analysis was to estimate the change in lumbar spine and femoral neck BMD and the risk of bone fracture by the use of calcium supplements among the Study of Women's Health Across the Nation (SWAN) participants. SWAN is a multicenter, multiethnic, community‐based longitudinal cohort designed to examine the health of women across the menopause transition (n = 1490; aged 42 to 52 years at baseline in 1996 to 1997 and followed annually until 2006 to 2008). A mixed‐effect model for repeated measures was used to estimate annualized BMD change across time between supplement users and nonusers, unadjusted or fully adjusted (age, race, height, weight, menopausal status [pre‐, early peri‐, late peri‐, and postmenopausal], DXA scanner mode, alcohol intake, vitamin D supplement use, smoking, and physical activity) and a log‐linear model with repeated measures was used to estimate the relative risk of fracture by calcium supplement use. All models were also stratified by baseline menopausal status. In fully adjusted models, calcium supplement use was associated with less annualized loss of femoral neck BMD (−0.0032 versus −0.0040 g/cm2/year; p < .001) and lumbar spine BMD (−0.0046 versus −0.0053 g/cm2/year, p = 0.021) in the complete cohort. However, this protective association of calcium supplement use with BMD loss was significant only among premenopausal women (femoral neck: −0.0032 versus −0.0042 g/cm2/year; p = 0.002; lumbar spine: −0.0038 versus −0.0050 g/cm2/year, p = 0.001); no significant differences in BMD were observed among women who were early perimenopausal by calcium supplement use at baseline. No significant differences in the relative risk of fracture were observed, regardless of baseline menopausal status. The use of calcium supplements was associated with less BMD loss over more than a decade, but was not related to the risk of incident bone fracture across the menopause transition. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Highlights

IntroductionOsteoporosis is described as a “progressive systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.”(1,2) According to newly proposed criteria for diagnosis,(3) the National Bone Health Alliance estimates that approximately 16% of men and 30% of women aged 50+ years in the United States have osteoporosis.An analysis by the National Osteoporosis Foundation (NOF) suggests that low bone mass and osteoporosis,(4,5) when combined, affects an estimated 56.6 million (54%) US adults aged 50+ years.[4]The risk of osteoporosis and related fractures increases with age, especially among women after menopause.[6,7] many factors contribute to osteoporosis among postmenopausal women, the most significant cause is a decline in estrogen concentrations that leads to a rapid reduction in bone mass and structural deterioration of bone microarchitecture. 1 of 8 nGiven the rapid aging of our population,(8) modifiable factors that contribute to bone health are of upmost importance
The risk of osteoporosis and related fractures increases with age, especially among women after menopause.[6,7] many factors contribute to osteoporosis among postmenopausal women, the most significant cause is a decline in estrogen concentrations that leads to a rapid reduction in bone mass and structural deterioration of bone microarchitecture
Data from the Women’s Health Initiative (WHI) randomized controlled trial suggest that calcium in combination with vitamin D is associated with small, but significant improvement in BMD, but is not associated with a risk for bone fracture among postmenopausal women in intention-to-treat analysis.[13] when women in the WHI were censored at the time of a protocol deviation, a significant risk reduction for hip fracture was observed (HR 0.71; 95% confidence intervals (CIs), 0.52 to 0.97).(13) conflicting advice exists about whether to supplement with calcium for primary and secondary prevention of bone disorders associated with aging and loss of sex steroid hormones

Summary

Introduction

Osteoporosis is described as a “progressive systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.”(1,2) According to newly proposed criteria for diagnosis,(3) the National Bone Health Alliance estimates that approximately 16% of men and 30% of women aged 50+ years in the United States have osteoporosis.An analysis by the National Osteoporosis Foundation (NOF) suggests that low bone mass and osteoporosis,(4,5) when combined, affects an estimated 56.6 million (54%) US adults aged 50+ years.[4]The risk of osteoporosis and related fractures increases with age, especially among women after menopause.[6,7] many factors contribute to osteoporosis among postmenopausal women, the most significant cause is a decline in estrogen concentrations that leads to a rapid reduction in bone mass and structural deterioration of bone microarchitecture. 1 of 8 nGiven the rapid aging of our population,(8) modifiable factors that contribute to bone health are of upmost importance. Data from the Women’s Health Initiative (WHI) randomized controlled trial suggest that calcium in combination with vitamin D is associated with small, but significant improvement in BMD, but is not associated with a risk for bone fracture among postmenopausal women in intention-to-treat analysis.[13]. Observational data from large longitudinal cohort studies in the United States generally do not capture measures of bone health directly and/or lack detailed information on a woman’s menopausal status and transition.[14]. Given the lack of clinical trial data in premenopausal women, the objective of this study was to estimate the annualized rate of BMD change and the risk of fractures with regard to the use of calcium supplements in a longitudinal cohort study designed to assess bone health and the menopause transition

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