In The News II

Calcium and Vitamin D Update
By Beverly Vaughn, MD, Medical Coordinator, Menopause and You

Healthcare providers have been recommending calcium to their patients to help maintain healthy bones. This is important because as women age there is naturally occurring bone loss and risk of fracture. In Feb. a report was published in the New England Journal of Medicine which found that calcium with D only slightly improved bone density and did not decrease fractures.

Why did this study come to a different conclusion?  Let's look at the elements that effected their results. The women in this study were part of the WHI study. This means that half of them were on hormone therapy. Most of the women were overweight, and some were taking bisphosphonates (i.e. Actonel or Fosamax). Each of these factors decreases the risk of fracture. Although the patients described above were evenly represented in the supplement and no supplement group; it may effect the interpretation of the results.

 The participants were instructed to take 1000 mgs of calcium and 400 IU's of vitamin D, doses which are less than what is recommended. Participants were also able to take their own calcium if they desired. Almost half of the patients did not take the full dose as prescribed. These circumstances would cloud any benefit of the study dose of calcium and D.

Two other characteristics of the study are important to bear in mind. Many of the women were under 70. Women under 70 have a lower fracture rate than older women. In a group where fracture is already low, you wouldn't expect to see much benefit from an intervention.  The number of patients at the end of the study was significantly less than at the start. There may not have been enough patients involved to see a positive result from taking the calcium and vitamin D.

The study does not provide any detail on the type of fractures. Any fracture that occurs as a result of trauma, like a car accident, is not in the same category as fragility fracture. A fragility fracture is a low impact fracture, such as one sustained when falling out of a chair. This is the type of fracture that is important to prevent by ensuring a strong skeleton.

There were groups that did benefit from the supplements. Women who took 80 % of the calcium and vitamin D had fewer fractures. Women over 60 and women who did not take their own supplements in addition to the ones provided by the study also had fewer fractures. The number of women in these groups was small and consequently did not have a significant impact on the study as a whole.

As we all age, our ability to absorb calcium diminishes. The body's cells need calcium to function. If calcium is not added to the diet, the calcium is taken from the bones and they weaken over time. Vitamin D is required to help absorb calcium. Our skin, with age, does not convert sunlight to vitamin D with ease. A dietary supplement is needed to replace what our skin can no longer accomplish.

What's the take home message? Calcium and vitamin D do have some benefit. The lesson learned is that supplements taken correctly will protect you from hip fracture.