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Calcium Supplementation with and without Hormone Replacement Therapy To Prevent Postmenopausal Bone Loss

John F. Aloia, MD; Ashok Vaswani, MD; James K. Yeh, PhD; Patrick L. Ross, PhD; Edith Flaster, MS; and F. Avraham Dilmanian, PhD
[+] Article and Author Information

From Winthrop-University Hospital, Mineola, New York, and Brookhaven National Laboratory, Upton, New York. Requests for Reprints: John F. Aloia, MD, Department of Medicine, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501. Acknowledgments: The authors thank Diane McGill, RN, for her role as coordinator and Sharon Sprintz for performance of the densitometry. Grant Support: By National Institutes of Health RO1-AR37520-05 and DOE DE AC 02 76CN-0016.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1994;120(2):97-103. doi:10.7326/0003-4819-120-2-199401150-00001
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Objective: To determine whether augmentation of dietary calcium is effective in the prevention of early postmenopausal bone loss.

Design: Three-arm, placebo-controlled, randomized parallel trial. The study duration was 2.9 ±1.1 (SD) years.

Setting: General community.

Participants: 118 healthy, white women 3 to 6 years after spontaneous menopause, recruited by community announcement.

Interventions: Random allocation to daily intake of 1700 mg of calcium (calcium carbonate given in divided doses with meals); placebo; or conjugated equine estrogens (0.625 mg; days 1 to 25), progesterone (10 mg; days 16 to 25), and 1700 mg of elemental calcium daily. Each participant received 400 IU of vitamin D daily.

Main Outcome Measures: Total body calcium measured by delayed γ neutron activation analysis and whole-body counting; bone mineral density of the spine, femur, and radius measured by photon absorptiometry.

Results: Bone mineral density declined in the placebo group for the lumbar spine ( −2.1%/y;95% CI, −3.3 to −0.9),femoral neck ( −2.0%/y;CI,-2.6 to −1.2),trochanter ( −1.6%/y;CI, −2.4 to −0.8),Ward triangle ( −2.7%/y;CI, −3.7 to −1.7),and total body calcium ( −2.0%/y;CI, −2.2 to −1.8).Rates of change were intermediate for calcium augmentation compared with placebo and estrogen-progesterone-calcium but statistically significant compared with placebo for total body calcium ( −0.5%/y;CI, −0.9 to −0.1; P = 0.006) and the femoral neck ( −0.8%/y;CI, −1.4 to −0.2; P = 0.03).

Conclusions: Although less effective than estrogen-progesterone-calcium, calcium augmentation alone significantly retards bone loss from the femoral neck and improves calcium balance in recently postmenopausal women. Dietary calcium augmentation should be recommended as a strategic option in helping to prevent early postmenopausal bone loss.

Figures

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Figure 1.
The change in total body calcium with time.

Calcium augmentation remained intermediate in effect between placebo and estrogen-progesterone-calcium throughout the 3 years of the study. HRT = hormone replacement therapy.

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Figure 2.
The biannual rate of change in bone mineral density of the femoral neck.

Calcium augmentation had a sustained beneficial effect compared with placebo. BMD = bone mineral density; HRT = hormone replacement therapy.

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Figure 3.
The biannual rates of change in bone mineral density of the lumbar spine.

The estrogen-progesterone-calcium group did not lose bone density, whereas no statistically significant benefit of calcium over placebo was found. BMD = bone mineral density; HRT = hormone replacement therapy.

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Figure 4.
Biannual measurements of bone mineral density of the radius.

The rates of change were not statistically different from zero. BMD = bone mineral density; HRT = hormone replacement therapy.

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Figure 5.
Bone mineral density of the trochanter.

Although estrogen-progesterone-calcium is superior to calcium augmentation, the slope for calcium is intermediate to the other two groups. BMD = bone mineral density; HRT = hormone replacement therapy.

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Figure 6.
Bone mineral density of the Ward triangle.

The response to calcium augmentation is similar to the intermediate effect observed for the trochanter. BMD = bone mineral density; HRT = hormone replacement therapy.

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