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Low Fractional Calcium Absorption Increases the Risk for Hip Fracture in Women with Low Calcium Intake

Kristine E. Ensrud, MD, MPH; Tu Duong, MA; Jane A. Cauley, DrPH; Robert P. Heaney, MD; Randi L. Wolf, PhD; Emily Harris, PhD; Steven R. Cummings, MD, Study of Osteoporotic Fractures Research Group*
[+] Article and Author Information

From Veterans Affairs Medical Center, Minneapolis, Minnesota; University of California, San Francisco, California; University of Pittsburgh, Pittsburgh, Pennsylvania; Creighton University, Omaha, Nebraska; and Kaiser Permanente Center for Health Research, Portland, Oregon.


Acknowledgments: The authors thank Ms. Paula Bowman for her help with preparation of the manuscript.

Grant Support: By the National Institutes of Health and by grants from the Public Health Service (AG05407, AR35582, AG05394, AR35584, and AR35583).

Requests for Single Reprints: Kristine E. Ensrud, MD, MPH, General Internal Medicine (111-0), Veterans Affairs Medical Center, One Veterans Drive, Minneapolis, MN 55417; e-mail, ensru001@tc.umn.edu.

Requests To Purchase Bulk Reprints (minimum, 100 copies): Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Dr. Ensrud: General Internal Medicine (111-0), Veterans Affairs Medical Center, One Veterans Drive, Minneapolis, MN 55417.

Ms. Duong and Dr. Cummings: University of California, San Francisco, 74 New Montgomery, Suite 600, San Francisco, CA 94105.

Drs. Cauley and Wolf: University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261.

Dr. Heaney: Creighton University, 2500 California Plaza, Omaha, NE 68178.

Dr. Harris: Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227.

Author Contributions: Conception and design: K.E. Ensrud, J.A. Cauley, S.R. Cummings.

Analysis and interpretation of the data: K.E. Ensrud, T. Duong, J.A. Cauley, R.L. Wolf, S.R. Cummings.

Drafting of the article: K.E. Ensrud, J.A. Cauley.

Critical revision of the article for important intellectual content: K.E. Ensrud, J.A. Cauley, R.L. Wolf, S.R. Cummings.

Final approval of the article: K.E. Ensrud, T. Duong, J.A. Cauley, R.P. Heaney, R.L. Wolf, E.L. Harris, S.R. Cummings.

Provision of study materials or patients: K.E. Ensrud, E.L. Harris.

Statistical expertise: T. Duong.

Obtaining of funding: K.E. Ensrud, S.R. Cummings.

Administrative, technical, or logistic support: K.E. Ensrud, R.P. Heaney.

Collection and assembly of data: K.E. Ensrud, T. Duong, R.P. Heaney, E.L. Harris.


Ann Intern Med. 2000;132(5):345-353. doi:10.7326/0003-4819-132-5-200003070-00003
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The fraction of calcium absorbed from the gut (fractional calcium absorption) varies widely from person to person, ranging from 10% to 70% (13). Cross-sectional studies in postmenopausal women have suggested that fractional calcium absorption increases with decreasing dietary calcium intake and decreases with advancing age (1, 4). It has been hypothesized that decreased ability to absorb calcium with age limits adaptation to low calcium intake and leads to secondary hyperparathyroidism, greater bone resorption, and increased risk for fracture (56). However, to our knowledge, the association between fractional calcium absorption and subsequent risk for fracture has never been studied.

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Figure.
Age-adjusted rates of hip fracture according to fractional calcium absorption and dietary calcium intake.

Striped bars represent fractional calcium absorption of 32.3% (median) or less; white bars represent fractional calcium absorption greater than 32.3%. Numbers in parentheses are 95% CIs for fracture rates.

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Summary for Patients

Calcium Absorption and the Risk for Hip Fracture in Older Women

The summary below is from the full report titled “Low Fractional Calcium Absorption Increases the Risk for Hip Fracture in Women with Low Calcium Intake.”. It is in the 7 March 2000 issue of Annals of Internal Medicine (volume 132, pages 345-353). The authors are K.E. Ensrud, T. Duong, J.A. Cauley, R.P. Heaney, R.L. Wolf, E. Harris, and S.R. Cummings, for the Study of Osteoporotic Fractures Research Group.

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