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Swaim RA, Barner JC, Brown CM. The relationship of calcium intake and exercise to osteoporosis health beliefs in postmenopausal women. Res Social Adm Pharm 2008; 4:153-63. [PMID: 18555968 DOI: 10.1016/j.sapharm.2007.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 03/23/2007] [Accepted: 03/24/2007] [Indexed: 10/21/2022]
Abstract
BACKGROUND Little is known about postmenopausal women's health beliefs and preventative behaviors regarding osteoporosis. Determining their beliefs and behaviors regarding osteoporosis can be helpful in developing effective interventions for osteoporosis prevention. OBJECTIVES To use the Health Belief Model to assess the associations between postmenopausal women's osteoporosis health beliefs and osteoporosis preventative behaviors. METHODS Using a self-administered survey, data were obtained from a convenience sample of 187 postmenopausal (> or =65 years of age) women, with no history of osteoporosis at a community pharmacy and senior nutrition sites in central Texas. The independent variables included health beliefs (susceptibility to osteoporosis, severity of osteoporosis, benefits and barriers of calcium intake, benefits and barriers of exercise, health motivation, self-efficacy of calcium intake and exercise) and modifying factors (demographics and risk factors). Calcium intake and exercise were the dependent variables. Multiple regression was used to assess the relationships between health beliefs and modifying factors with calcium intake and exercise. RESULTS The respondents' mean age was 75.4+/-6.5 years, and Mexican Americans comprised approximately 40% (39.6%) of the sample. Their reported calcium intake (mean+/-SD) was 1604.7+/-907mg/d and they engaged in 5 hours ([mean+/-SD]: 5.1+/-5.3) of weight-bearing exercise per week. Self-efficacy of calcium intake and self-efficacy of exercise had significant (P<.05) positive relationships with calcium intake behavior. In addition, self-efficacy of exercise was significantly (P<.05) and positively related to exercise behavior. CONCLUSIONS Self-efficacy was significantly associated with postmenopausal women's performance of osteoporosis preventative behaviors. Improving postmenopausal women's confidence in engaging in appropriate calcium intake and weight-bearing exercise behaviors may be beneficial to osteoporosis prevention.
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Affiliation(s)
- Rachelle A Swaim
- College of Pharmacy, Pharmacy Administration Division, The University of Texas at Austin, 2409 University Avenue, 1 University Sta A1930, Austin, TX 78712, USA
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54
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Abstract
Increased postmenopausal bone turnover leads to bone loss and fragility fracture risk. In the absence of osteoporosis, risk preventive measures, particularly those modifying nutritional lifestyle, are appropriate. We tested the hypothesis that milk supplementation affects bone turnover related to biochemical markers in a direction that, in the long term, may be expected to reduce postmenopausal bone loss. Thirty healthy postmenopausal women aged 59·3 (sd3·3) years were enrolled in a prospective crossover trial of 16 weeks. After a 4-week period of adaptation with diet providing 600 mg calcium plus 300 mg ingested as 250 ml semi-skimmed milk, participants were maintained during 6 weeks under the same 600 mg calcium diet and randomized to receive either 500 ml semi-skimmed milk, thus providing a total of 1200 mg calcium, or no milk supplement. In the next 6 weeks they were switched to the alternative regimen. At the end of the each period, i.e. after 4, 10 and 16 weeks, blood and urinary samples were collected. The changes in blood variables between the periods of 6 weeks without and with milk supplementation were: for parathyroid hormone, − 3·2 pg/ml (P = 0·0054); for crosslinked telopeptide of type I collagen, − 624 pg/ml (P < 0·0001); for propeptide of type I procollagen, − 5·5 ng/ml (P = 0·0092); for osteocalcin, − 2·8 ng/ml (P = 0·0014). In conclusion, a 6-week period of milk supplementation induced a decrease in several biochemical variables compatible with diminished bone turnover mediated by reduction in parathyroid hormone secretion. This nutritional approach to postmenopausal alteration in bone metabolism may be a valuable measure in the primary prevention of osteoporosis.
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Abstract
This review evaluates evidence from clinical trials that assessed the effect of dairy product or calcium intake, with or without concomitant energy restriction, on body weight and adiposity. Of 49 randomized trials assessing the effect of dairy products or calcium supplementation on body weight, 41 showed no effect, two demonstrated weight gain, one showed a lower rate of gain, and five showed weight loss. Four of 24 trials report differential fat loss. Consequently, the majority of the current evidence from clinical trials does not support the hypothesis that calcium or dairy consumption aids in weight or fat loss.
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Affiliation(s)
- Amy Joy Lanou
- University of North Carolina at Asheville, Department of Health and Wellness, Asheville, North Carolina 28804, USA.
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Nieves JW, Barrett-Connor E, Siris ES, Zion M, Barlas S, Chen YT. Calcium and vitamin D intake influence bone mass, but not short-term fracture risk, in Caucasian postmenopausal women from the National Osteoporosis Risk Assessment (NORA) study. Osteoporos Int 2008; 19:673-9. [PMID: 17999024 DOI: 10.1007/s00198-007-0501-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 09/27/2007] [Indexed: 12/31/2022]
Abstract
UNLABELLED The impact of calcium and vitamin D intake on bone density and one-year fracture risk was assessed in 76,507 postmenopausal Caucasian women. Adequate calcium with or without vitamin D significantly reduced the odds of osteoporosis but not the risk of fracture in these Caucasian women. INTRODUCTION Calcium and vitamin D intake may be important for bone health; however, studies have produced mixed results. METHODS The impact of calcium and vitamin D intake on bone mineral density (BMD) and one-year fracture incidence was assessed in 76,507 postmenopausal Caucasian women who completed a dietary questionnaire that included childhood, adult, and current consumption of dairy products. Current vitamin D intake was calculated from milk, fish, supplements and sunlight exposure. BMD was measured at the forearm, finger or heel. Approximately 3 years later, 36,209 participants returned a questionnaire about new fractures. The impact of calcium and vitamin D on risk of osteoporosis and fracture was evaluated by logistic regression adjusted for multiple covariates. RESULTS Higher lifetime calcium intake was associated with reduced odds of osteoporosis (peripheral BMD T-score < or =-2.5; OR = 0.80; 95% CI 0.72, 0.88), as was a higher current calcium (OR = 0.75; (0.68, 0.82)) or vitamin D intake (OR = 0.73; 95% CI 0.0.66, 0.81). Women reported 2,205 new osteoporosis-related fractures. The 3-year risk of any fracture combined or separately was not associated with intake of calcium or vitamin D. CONCLUSIONS Thus, higher calcium and vitamin D intakes significantly reduced the odds of osteoporosis but not the 3-year risk of fracture in these Caucasian women.
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Affiliation(s)
- J W Nieves
- Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY 10993, USA.
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Tang BMP, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 2007; 370:657-66. [PMID: 17720017 DOI: 10.1016/s0140-6736(07)61342-7] [Citation(s) in RCA: 788] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Whether calcium supplementation can reduce osteoporotic fractures is uncertain. We did a meta-analysis to include all the randomised trials in which calcium, or calcium in combination with vitamin D, was used to prevent fracture and osteoporotic bone loss. METHODS We identified 29 randomised trials (n=63 897) using electronic databases, supplemented by a hand-search of reference lists, review articles, and conference abstracts. All randomised trials that recruited people aged 50 years or older were eligible. The main outcomes were fractures of all types and percentage change of bone-mineral density from baseline. Data were pooled by use of a random-effect model. FINDINGS In trials that reported fracture as an outcome (17 trials, n=52 625), treatment was associated with a 12% risk reduction in fractures of all types (risk ratio 0.88, 95% CI 0.83-0.95; p=0.0004). In trials that reported bone-mineral density as an outcome (23 trials, n=41 419), the treatment was associated with a reduced rate of bone loss of 0.54% (0.35-0.73; p<0.0001) at the hip and 1.19% (0.76-1.61%; p<0.0001) in the spine. The fracture risk reduction was significantly greater (24%) in trials in which the compliance rate was high (p<0.0001). The treatment effect was better with calcium doses of 1200 mg or more than with doses less than 1200 mg (0.80 vs 0.94; p=0.006), and with vitamin D doses of 800 IU or more than with doses less than 800 IU (0.84 vs 0.87; p=0.03). INTERPRETATION Evidence supports the use of calcium, or calcium in combination with vitamin D supplementation, in the preventive treatment of osteoporosis in people aged 50 years or older. For best therapeutic effect, we recommend minimum doses of 1200 mg of calcium, and 800 IU of vitamin D (for combined calcium plus vitamin D supplementation).
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Affiliation(s)
- Benjamin M P Tang
- Centre for Complementary Medicine Research, University of Western Sydney, New South Wales, Australia.
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Shea B, Wells G, Cranney A, Zytaruk N, Robinson V, Griffith L, Hamel C, Ortiz Z, Peterson J, Adachi J, Tugwell P, Guyatt G. WITHDRAWN: Calcium supplementation on bone loss in postmenopausal women. Cochrane Database Syst Rev 2007; 2006:CD004526. [PMID: 17636765 PMCID: PMC10687496 DOI: 10.1002/14651858.cd004526.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although calcium is one the simplest and least expensive strategies for preventing osteoporotic fractures calcium supplementation is nevertheless not without controversy (Kanis 1989; Nordin 1990). The Food and Drug Administration in the US has permitted a bone health claim for calcium-rich foods, and the NIH in its Consensus Development Process approved a statement that high calcium intake reduces the risk of osteoporosis. OBJECTIVES To assess the effects of calcium on bone density and fractures in postmenopausal women. SEARCH STRATEGY We searched Cochrane Controlled Register, MEDLINE and EMBASE up to 2001, and examined citations of relevant articles and proceedings of international meetings. SELECTION CRITERIA Trials that randomized postmenopausal women to calcium supplementation or usual calcium intake in the diet and reported bone mineral density of the total body, vertebral spine, hip, or forearm or recorded the number of fractures, and followed patients for at least one year were considered for inclusion. DATA COLLECTION AND ANALYSIS Three independent reviewers assessed the methodologic quality and extracted data for each trial. For each bone density site (lumbar spine, total body, combined hip and combined forearm), we calculated the weighted mean difference in bone density between treatment and control groups using the percentage change from baseline. We constructed regression models in which the independent variables were year and dose, and the dependent variable was the effect size. This regression was used to determine the years across which pooling was appropriate. Heterogeneity was assessed. For each fracture analysis we calculated a risk ratio. MAIN RESULTS Fifteen trials, representing 1806 participants, were included. Calcium was more effective than placebo in reducing rates of bone loss after two or more years of treatment. The pooled difference in percentage change from baseline was 2.05% (95% CI 0.24 to 3.86) for total body bone density, 1.66% (95% CI 0.92 to 2.39) for the lumbar spine at 2 years, 1.60% (95% CI 0.78 to 2.41) for the hip, and 1.91% (95% CI 0.33 to 3.50) for the distal radius. The relative risk of fractures of the vertebrae was 0.79 (95% CI 0.54 to 1.09); the relative risk for non-vertebral fractures was 0.86 (95% CI 0.43 to 1.72). AUTHORS' CONCLUSIONS Calcium supplementation alone has a small positive effect on bone density. The data show a trend toward reduction in vertebral fractures, but it is unclear if calcium reduces the incidence of non vertebral fractures.
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Affiliation(s)
- B Shea
- University of Ottawa, Institute of Population Health, 1 Stewart St., Room 312, Ottawa, Onatrio, Canada K1N 6N5.
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Resch H, Walliser J, Phillips S, Wehren LE, Sen SS. Physician and patient perceptions on the use of vitamin D and calcium in osteoporosis treatment: a European and Latin American perspective. Curr Med Res Opin 2007; 23:1227-37. [PMID: 17559732 DOI: 10.1185/030079907x187964] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Although osteoporosis treatment guidelines include recommendations for calcium and vitamin D intake, routine use of adequate supplementation often is low. This study explored the attitudes of physicians and patients towards vitamin D and calcium and patient use of both supplements. METHODS A survey of randomly selected physicians in the United Kingdom, Mexico, and Austria, and the first seven eligible women with osteoporosis from each of their practices, was conducted. Physicians were asked to rate the importance of vitamin D and calcium in osteoporosis management on a scale of 1 to 10 (1 = not important at all, 10 = extremely important) and to estimate use of calcium and vitamin D supplements by their patients. Patients were asked about their own use of vitamin D and calcium, and their perceptions regarding these supplements. RESULTS Altogether 151 physicians (50 in Austria, 51 in the UK, and 50 in Mexico), and 910 osteoporosis patients (350 in Austria, 212 in UK, and 348 in Mexico) completed telephone surveys. Approximately, 86%, 28%, and 46% of physicians rated importance of vitamin D and calcium as being 9 or 10 in Austria, UK, and Mexico, respectively. Overall, 50% of patients reported taking calcium and vitamin D supplements (47% of these on a daily basis and 46% on a regular basis), and 19% of patients reported that they had no discussions with their physicians about calcium, while 39% reported no discussion about vitamin D. CONCLUSIONS Despite the recognition by physicians and patients that vitamin D and calcium are important for bone health, only a small proportion of patients regularly take supplements. This is the case even when vitamin D and calcium supplements are provided free with osteoporosis drug prescriptions, as occurs in Austria. However, these results rely on patient self-report of compliance which can lead to overestimation. In addition this study's participants may not be representative of other patient populations. This study provides additional evidence that compliance with treatment guidelines is suboptimal, and highlights the need for further study to explore the discrepancy between the highly perceived importance of vitamin D and calcium and the low use of both supplements, and to improve use among osteoporosis patients.
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Affiliation(s)
- H Resch
- Saint Vincent Hospital, Vienna, Austria
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60
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Bonnick S, Broy S, Kaiser F, Teutsch C, Rosenberg E, DeLucca P, Melton M. Treatment with alendronate plus calcium, alendronate alone, or calcium alone for postmenopausal low bone mineral density. Curr Med Res Opin 2007; 23:1341-9. [PMID: 17594775 DOI: 10.1185/030079907x188035] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Bisphosphonates such as alendronate are widely used for postmenopausal osteoporosis. Supplemental calcium is also generally recommended. This trial directly compares alendronate to supplemental calcium and examines the effect of calcium supplementation on alendronate treatment. METHODS This 2-year, randomized, double-blind, multicenter trial enrolled healthy, postmenopausal women with low bone mineral density (BMD). Patients with a dietary calcium intake > or = 800 mg/day received daily vitamin D 400 IU and alendronate 10 mg/calcium-placebo, alendronate 10 mg/elemental calcium 1000 mg, or alendronate-placebo/calcium 1000 mg (2:2:1). Endpoints included BMD, bone turnover markers (BTMs), and adverse events. RESULTS Randomized patients (N = 701) were an average of 20.4 years postmenopausal. After 24 months, increases in lumbar spine BMD differed significantly between patients receiving calcium alone (0.8%) and either alendronate alone (5.6%) or alendronate + calcium (6.0%) (p < 0.001). Significant differences were also seen at the trochanter and femoral neck (p < 0.001). BTMs were significantly lower with alendronate-containing treatments than calcium alone (p < 0.001). Addition of calcium supplementation to alendronate did not significantly increase BMD compared to alendronate alone (p = 0.29 to 0.97), but did result in a statistically significant, though small, additional reduction in urinary NTx. Adverse events were similar among treatment groups. Limitations include no assessment of vitamin D levels and a discontinuation rate of approximately 30%, although discontinuation rates were similar among treatment groups. CONCLUSIONS In postmenopausal women with a daily intake of > or =800 mg calcium and 400 IU vitamin D, 24-month treatment with alendronate 10 mg daily with or without calcium 1000 mg resulted in significantly greater increases in BMD and reduction of bone turnover than supplemental calcium alone. Addition of supplemental calcium to alendronate treatment had no effect on BMD and resulted in a small, though statistically significant, additional reduction in NTx.
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Affiliation(s)
- Sydney Bonnick
- Clinical Research Center of North Texas, Denton, TX 76210, USA.
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61
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Abstract
Calcium accounts for 1–2 % of adult human body weight. Over 99 % of total body Ca is found in the teeth and bones. Therefore, in addition to the obvious structural role of the skeleton, it also serves as a reservoir for Ca. Dietary Ca intake has an important impact on bone metabolism and bone health. Chronic Ca deficiency resulting from inadequate intake or poor intestinal absorption is one of several important causes of reduced bone mass and osteoporosis. It is vital, therefore, that adequate dietary Ca is consumed at all stages of life — in early life so that the genetically programmed peak bone mass can be reached and in later adulthood so that the skeletal mass can be maintained and age-related bone loss minimised. Unfortunately, there is wide variation in the estimates of daily Ca requirements made by different expert authorities. Furthermore, there is evidence that many individuals are not consuming these recommended levels. The consequence of this for bone health will be discussed in the present review. Besides the amount of Ca in the diet, the absorption of dietary Ca in foods is also a critical factor in determining the availability of Ca for bone development and maintenance. Thus, there is a need to identify food components and/or functional food ingredients that may positively influence Ca absorption in order to ensure that Ca bioavailability from foods can be optimised. This approach may be of particular value in individuals who fail to achieve the dietary recommended level of Ca.
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Coxam V. Inulin-type fructans and bone health: state of the art and perspectives in the management of osteoporosis. Br J Nutr 2007; 93 Suppl 1:S111-23. [PMID: 15877884 DOI: 10.1079/bjn20041341] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
If the primary role of diet is to provide sufficient nutrients to meet the metabolic requirements of an individual, there is an emerging rationale to support the hypothesis that, by modulating specific target functions in the body, it can help achieve optimal health. Regarding osteoporosis prevention, since Ca is most likely to be inadequate in terms of dietary intake, every strategy targeting an improvement in Ca absorption is very interesting. Actually, this process may be susceptible to manipulation by fermentable substrates. In this light, inulin-type fructans are very interesting, even if we need to gather more data targeting bone metabolism before health professionals can actively advocate their consumption to prevent senile osteoporosis. Besides targeting the prevention of postmenopausal osteoporosis, inulin-type fructans still remain a source for putative innovative dietary health intervention. Indeed, given in combination with isoflavones, they may have a potential for maintaining or improving the bone mass of human subjects, by modulating the bioavailability of phyto-oestrogens.
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Affiliation(s)
- Véronique Coxam
- Groupe Ostéoporose, INRA Theix, Saint-Genès Champanelle, France.
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63
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Abstract
Approximately 99% of body Ca is found in bone, where it serves a key structural role as a component of hydroxyapatite. Dietary requirements for Ca are determined by the needs for bone development and maintenance, which vary throughout the life stage, with greater needs during the periods of rapid growth in childhood and adolescence, during pregnancy and lactation, and in later life. There is considerable disagreement between expert groups on the daily Ca intake levels that should be recommended, reflecting the uncertainty in the data for establishing Ca requirements. Inadequate dietary Ca in early life impairs bone development, and Ca supplementation of the usual diet for periods of ≤3 years has been shown to enhance bone mineral status in children and adolescents. However, it is unclear whether this benefit is long term, leading to the optimisation of peak bone mass in early adulthood. In later years inadequate dietary Ca accelerates bone loss and may contribute to osteoporosis. Ca supplementation of the usual diet in post-menopausal women and older men has been shown to reduce the rate of loss of bone mineral density at a number of sites over periods of 1–2 years. However, the extent to which this outcome reduces fracture risk needs to be determined. Even allowing for disagreements on recommended intakes, evidence indicates that dietary Ca intake is inadequate for maintenance of bone health in a substantial proportion of some population groups, particularly adolescent girls and older women.
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Affiliation(s)
- Albert Flynn
- Department of Food and Nutritional Sciences, University College, Cork, Republic of Ireland.
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Ringe JD, van der Geest SAP, Möller G. Importance of calcium co-medication in bisphosphonate therapy of osteoporosis: an approach to improving correct intake and drug adherence. Drugs Aging 2007; 23:569-78. [PMID: 16930085 DOI: 10.2165/00002512-200623070-00003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE In all of the large, pivotal, multicentre trials of bisphosphonate therapy, patients have received added calcium in amounts ranging from 500 to 1000 mg/day above individual dietary intake. Accordingly, calcium supplements or calcium/vitamin D combinations are currently recommended as co-medication with anti-resorptive therapy in all recently published guidelines on the treatment of osteoporosis. However, the consistent use or effectiveness of calcium may be impaired by several factors in the individual patient, including low prescription rate or lack of advice to purchase calcium, reduced adherence because of the complexity of the regimen, and incorrect intake (e.g. taking calcium with bisphosphonates at the same time). Patients with osteoporosis who adhere to drug therapy experience a significantly lower fracture rate. Therefore, there is a need to improve correct intake of bisphosphonates together with calcium supplementation, which may enhance adherence. The dosage regimen could be simplified by providing the two compounds in an integrated pack. Such a pack, containing one tablet of risedronic acid and six calcium carbonate tablets (Actonel), Procter & Gamble Pharmaceuticals, Weiterstadt, Germany), has been developed to facilitate correct intake. In this study, the impact of this fixed-combination pack on patient understanding of dosing instructions and on preference was tested by comparing the fixed combination with separate risedronic acid and calcium packages. PATIENTS AND METHODS A new blister strip was developed containing one tablet of risedronic acid 35mg and six tablets of calcium carbonate 1250mg (500mg elemental calcium), representing 1 week of therapy; the control was the same medications in separate packaging. The study was conducted in a cohort of 164 postmenopausal women (mean age 69 years). Half of the participants were bisphosphonate users (n = 83). The combined understanding of five instructions - risedronic acid intake in the morning, only with water, without food, without other medication, and separate from calcium - was tested in a crossover design. Participants were also asked to state their preference for the combination packaging versus separate packs. RESULTS Understanding of the five instructions for the separate packaging was 70%. The combination pack significantly improved understanding of these instructions to 80% (p < 0.05). Eighty-three percent of participants preferred the combination pack over separate packs (p < 0.05). The most frequently given reasons for preferring the combination pack were prefer one pack over two packs, easy/convenient to use/practical/handy, easy to understand/less confusion, and easier to remember/less likely to forget. CONCLUSIONS The availability of a fixed-combination pack of risedronic acid 35 mg/week and calcium tablets can increase the likelihood that postmenopausal osteoporotic patients will receive both a bisphosphonate and calcium, which in turn is likely to enhance the correct intake of combination therapy.
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Affiliation(s)
- Johann D Ringe
- Medical Clinic 4, Klinikum Leverkusen, University of Cologne, Leverkusen, Germany.
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65
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Abstract
AbstractObjective:To review the evidence on diet and nutrition relating to osteoporosis and provide recommendations for preventing osteoporosis, in particular, osteopototic fracture.Approach:Firstly, to review the definition, diagnosis and epidemiology of osteoporosis, to discuss the difficulties in using bone mineral density to define osteoporosis risk in a world-wide context and to propose that fragility fracture should be considered as the disease endpoint. Secondly, to provide an overview of the scientific data, the strengths and weaknesses of the evidence and the conceptual difficulties in interpreting studies linking diet, nutrition and osteoporosis. The following were considered: calcium, vitamin D, phosphorus, magnesium, protein and fluorine. Other potential dietary influences on bone health were also discussed, including vitamins, trace elements, electrolytes, acid–base balance, phyto-oestrogens, vegetarianism and lactose intolerance.Conclusions:There is insufficient knowledge linking bone mineral status, growth rates or bone turnover in children and adolescents to long-term benefits in old age for these indices to be used as markers of osteoporotic disease risk. For adults, the evidence of a link between intakes of any dietary component and fracture risk is not sufficiently secure to make firm recommendations, with the exception of calcium and vitamin D. For other aspects of the diet, accumulating evidence suggests that current healthy-eating advice to decrease sodium intake, to increase potassium intake, and to consume more fresh fruits and vegetables is unlikely to be detrimental to bone health and may be beneficial.
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Affiliation(s)
- A Prentice
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK.
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66
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Sikon AL, Thacker HL, Carey J, Deal C, Licata AA. Secondary Osteoporosis: Are We Recognizing It? J Womens Health (Larchmt) 2006; 15:1174-83. [PMID: 17199458 DOI: 10.1089/jwh.2006.15.1174] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As a growing percentage of Americans will be reaching their elderly years in the next decade, the prevalence of osteoporosis and its effects will have an even greater impact on the healthcare system. Advancements in bone research and development of newer treatments have allowed for the establishment of more refined guidelines and a growing awareness of the need to prevent, screen, and diagnose osteoporosis. Thus, more women are now being screened with dual x-ray absorptiometry scans (DXA) than ever before. The importance of a true understanding of the test results obtained from such screening is paramount. In our institution, recommendations to consider a secondary evaluation are made by the DXA interpreters when the Z-score is low. Few, if any, studies have evaluated the rates of physician and patient adherence with specific recommendations provided on the bone density report. METHODS To assess compliance with such recommendations provided in DXA interpretations, we investigated the number of ordering providers who actually pursued these advisements. RESULTS We found that among providers ordering DXAs, primary care providers did not pursue recommendations to pursue a secondary workup as often as their subspecialty counterparts. We also found a significant amount of vitamin D deficiency/insufficiency and primary hyperparathyroidism in the population evaluated. CONCLUSIONS Primary care providers should be further educated on treatable secondary causes of osteoporosis as opposed to an often reflexive response of prescribing a pharmacological antiresportive agent without other consideration.
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Affiliation(s)
- Andrea L Sikon
- Women's Health Center, The Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA.
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Eagan MS, Lyle RM, Gunther CW, Peacock M, Teegarden D. Effect of 1-year dairy product intervention on fat mass in young women: 6-month follow-up. Obesity (Silver Spring) 2006; 14:2242-8. [PMID: 17189552 DOI: 10.1038/oby.2006.263] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Previous results from this laboratory suggest that a 1-year dairy intake intervention in young women does not alter fat mass. The objective of this study was to determine the impact of the 1-year dairy intervention 6 months after completion of the intervention. RESEARCH METHODS AND PROCEDURES Previously, normal-weight young women (n = 154) were randomized to one of three calcium intake groups: control (<800 mg/d), medium dairy (1000 to 1100 mg/d), or high dairy (1300 to 1400 mg/d) for a 1-year trial (n = 135 completed). In the current study, 51 women were assessed 6 months after completion of the intervention trial. Body compositions (body fat, lean mass) were measured using DXA. Self-report questionnaires were utilized to measure activity and dietary intake (kilocalories, calcium). RESULTS The high-dairy group (n = 19) maintained an elevated calcium intake (1027 +/- 380 mg/d) at 18 months compared with the control group (n = 18, 818 +/- 292; p = 0.02). Mean calcium intake over the 18 months predicted a negative change in fat mass (p = 0.04) when baseline BMI was controlled in regression analysis (model R(2) = 0.11). 25-Hydroxyvitamin D levels were correlated with fat mass at each time-point (baseline, r = -0.41, p = 0.003; 12 months, r = -0.42, p = 0.002; 18 months, r = -0.32, p = 0.02) but did not predict changes in fat mass. DISCUSSION Dietary calcium intake over 18 months predicted a negative change in body fat mass. Thus, increased dietary calcium intakes through dairy products may prevent fat mass accumulation in young, healthy, normal-weight women.
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Affiliation(s)
- Marianne S Eagan
- Department of Foods and Nutrition, Purdue University, 1264 Stone Hall, 700 West State Street, West Lafayette, IN 47907, USA
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Abstract
OBJECTIVE To update the evidence-based consensus opinion published by The North American Menopause Society (NAMS) in 2001 on the role of calcium in peri- and postmenopausal women. DESIGN NAMS followed the general principles established for evidence-based guidelines to create this document. A panel of clinicians and researchers acknowledged to be experts in the field of calcium and women's health was enlisted to review the previous position statement and data published since then, compile supporting statements, and make recommendations. Their advice was used to assist the NAMS Board of Trustees in publishing this position statement. RESULTS Adequate calcium intake (in the presence of adequate vitamin D status) has been shown to reduce bone loss in peri- and postmenopausal women and reduce fractures in postmenopausal women older than age 60 with low calcium intakes. Adequate calcium is considered a key component of any bone-protective therapeutic regimen. Calcium has also been associated with beneficial effects in several nonskeletal disorders, primarily hypertension, colorectal cancer, obesity, and nephrolithiasis, although the extent of those effects has not been fully elucidated. The calcium requirement rises at menopause. The target calcium intake for most postmenopausal women is 1,200 mg/day. Adequate vitamin D status, defined as 30 ng/mL or more of serum 25-hydroxyvitamin D (usually achieved with a daily oral intake of at least 400 to 600 IU), is required to achieve the nutritional benefits of calcium. The best source of calcium is food, and the best food source is dairy products. High-quality calcium supplements (taken in divided doses) are alternative sources for women unable to consume enough dietary calcium. There are no reported cases of calcium intoxication from food sources, and cases associated with supplements are rare (high intake levels of 2,150 mg/day have resulted in a 17% increase in renal calculi in one recent study, but not others). Because no accurate test to determine calcium deficiency exists, clinicians should focus instead on encouraging women to consume enough calcium to meet the recommended levels. CONCLUSIONS The most definitive role for calcium in peri- and postmenopausal women is in bone health, but, like most nutrients, calcium has beneficial effects in many body systems. Based on the available evidence, there is strong support for the importance of ensuring adequate calcium intake in all women, particularly those in peri- or postmenopause.
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Reid IR, Mason B, Horne A, Ames R, Reid HE, Bava U, Bolland MJ, Gamble GD. Randomized controlled trial of calcium in healthy older women. Am J Med 2006; 119:777-85. [PMID: 16945613 DOI: 10.1016/j.amjmed.2006.02.038] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Revised: 02/17/2006] [Accepted: 02/22/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE Calcium has been shown to have positive effects on bone mineral density in postmenopausal women. However, these effects are small, it is unknown whether they are sustained with long-term use, they have not been shown with intention-to-treat analyses, and the evidence for fracture prevention with calcium monotherapy is inconsistent. METHODS A randomized controlled trial of calcium (1 g/day as the citrate) in 1471 healthy postmenopausal women (aged 74+/-4 years) was performed to assess the effects on bone density and fracture incidence over 5 years. RESULTS Follow-up was complete in 90% of subjects, and average medication compliance was 55% to 58%. Calcium had a significant beneficial effect on bone density (intention-to-treat analysis), with between-groups differences at 5 years of 1.8% (spine), 1.6% (total hip), and 1.2% (total body). Effects were greater in a per-protocol analysis (5-year differences of 2.3%, 2.8%, and 1.8%, respectively). A total of 425 fractures occurred in 281 women. Hazard ratios, based on time to first fracture, were 0.90 (95% confidence interval [CI], 0.71-1.16) for any symptomatic fracture, 0.72 (95% CI, 0.44-1.18) for vertebral, 3.55 (95% CI, 1.31-9.63) for hip, and 0.65 (95% CI, 0.41-1.04) for forearm fracture. Per-protocol analysis found respective hazard ratios of 0.86 (95% CI, 0.64-1.17), 0.62 (95% CI, 0.33-1.16), 3.24 (95% CI, 0.65-16.1), and 0.45 (95% CI, 0.24-0.87). Height loss was reduced by calcium in the per-protocol population (P=.03). Serum alkaline phosphatase and procollagen type-I N-terminal propeptide were lower in the calcium group at 5 years, but constipation was more common. CONCLUSIONS Calcium results in a sustained reduction in bone loss and turnover, but its effect on fracture remains uncertain. Poor long-term compliance limits its effectiveness.
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Affiliation(s)
- Ian R Reid
- Department of Medicine, University of Auckland, Auckland, New Zealand.
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LAU EMC, SAMBROOK P, SEEMAN E, LEONG KH, LEUNG PC, DELMAS P. Guidelines for diagnosing, prevention and treatment of osteoporosis in Asia. ACTA ACUST UNITED AC 2006. [DOI: 10.1111/j.1479-8077.2006.00161.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Shiraishi A, Ito M, Hayakawa N, Kubota N, Kubodera N, Ogata E. Calcium supplementation does not reproduce the pharmacological efficacy of alfacalcidol for the treatment of osteoporosis in rats. Calcif Tissue Int 2006; 78:152-61. [PMID: 16525749 DOI: 10.1007/s00223-005-0014-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Accepted: 12/12/2005] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to assess whether a nutritional supply of calcium (Ca) could be substituted for alfacalcidol (ALF) administration in preventing bone loss due to estrogen deficiency. Female Wistar-Imamichi rats (8 months old) were ovariectomized (OVX) or sham-operated. OVX rats received ALF administration (0.025, 0.5, or 0.1 microg/kg, p.o., 5 times a week) with standard rodent chow [Ca 1.2%, phosphorus (P) 1.04%], a Ca-enriched diet containing 2%, 4%, or 6% Ca (Ca/P ratio of 2, 4, and 6, respectively), or a Ca/P-enriched diet (Ca/P ratio of 1.2). After 12 weeks of treatment, all rats were killed to harvest the spine, serum, and urine samples. Neither the ALF treatment nor the Ca supplement caused hypercalcemia. In the spine, ALF prevented decreases in bone mineral density (BMD) and compressive strength of lumbar spine induced by OVX. Micro-computed tomographic analysis confirmed that ALF significantly improved the trabecular bone pattern factor and the structure model index and suppressed bone destruction. In contrast, of particular interest, high-dose Ca administration did not have marked effects on bone fragility. Also, when both Ca and P were administered in high doses, BMD and mechanical strength decreased dose-dependently, urinary P excretion significantly increased, and serum parathyroid hormone level increased. Together, it is difficult to adjust the Ca supply through diet alone without disrupting the balance between serum Ca and P levels. Consequently, we conclude that ALF is beneficial for the treatment of osteoporosis, which is not achieved by the use of a Ca supplement.
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Affiliation(s)
- A Shiraishi
- Product Research Department, Chugai Pharmacological Co., 1-135 Komakado, Gotemba, Shizuoka 412-8513, Japan.
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72
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Abstract
BACKGROUND Older individuals with hip fractures almost always have osteoporosis. Such individuals are at increased risk of experiencing other osteoporotic fractures, including recurrent hip fractures. The management of such patients should include assessing bone mineral density and treating osteoporosis. OBJECTIVE The objective of this study was to investigate if elderly (> or =65 years) patients with hip fractures were assessed and treated for osteoporosis. METHODS A retrospective chart review was conducted of all elderly patients who underwent hip fracture surgery at a university teaching hospital during the calendar years 1997 to 1999. RESULTS A total of 95 subjects were identified (29% males and 71% females). Subjects' age ranged from 65 to 96 years with a mean (+/-standard deviation) 81 +/- 7 years. Femoral neck fractures were the most common (51%), followed by intertrochanteric (43%) and subtrochanteric fractures (3%). Two subjects (2%) had fractures at multiple sites. The most common cause of a hip fracture was a fall (87%). Other causes included motor vehicle accidents (6%) as well as other trauma (4%). One subject had a spontaneous hip fracture. A history of hip fractures was obtained in 8% of subjects. Osteoporosis was diagnosed in 17% of subjects before admission. On admission, 9% of subjects were receiving calcium, 3% were receiving vitamin D, none were receiving alendronate, and 1 subject was receiving calcitonin. Approximately 3% of female subjects were receiving estrogen on admission. On discharge, 11% of subjects were prescribed calcium, 6% were prescribed vitamin D, none were prescribed alendronate, and 2% were on calcitonin. None of the female subjects were discharged on estrogen. During hospitalization, 88% of subjects who were admitted to nonmedical services were seen by either a geriatric or a general internal medicine consult. Obtaining a medical and/or geriatric consult did not have an apparent effect on the frequency of treating osteoporosis in this high-risk group of subjects. CONCLUSION Older adults with hip fractures are not adequately treated for osteoporosis. This places them at increased risk of other osteoporotic fractures, including recurrent hip fractures.
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Affiliation(s)
- Hosam K Kamel
- Geriatric and Extended Care, St. Joseph's Mercy Health Center, 1635 Higdon Ferry, Suite H, Hot Springs, AR 71913, USA.
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Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, Bassford T, Beresford SAA, Black HR, Blanchette P, Bonds DE, Brunner RL, Brzyski RG, Caan B, Cauley JA, Chlebowski RT, Cummings SR, Granek I, Hays J, Heiss G, Hendrix SL, Howard BV, Hsia J, Hubbell FA, Johnson KC, Judd H, Kotchen JM, Kuller LH, Langer RD, Lasser NL, Limacher MC, Ludlam S, Manson JE, Margolis KL, McGowan J, Ockene JK, O'Sullivan MJ, Phillips L, Prentice RL, Sarto GE, Stefanick ML, Van Horn L, Wactawski-Wende J, Whitlock E, Anderson GL, Assaf AR, Barad D. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 2006; 354:669-83. [PMID: 16481635 DOI: 10.1056/nejmoa055218] [Citation(s) in RCA: 1109] [Impact Index Per Article: 61.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The efficacy of calcium with vitamin D supplementation for preventing hip and other fractures in healthy postmenopausal women remains equivocal. METHODS We recruited 36,282 postmenopausal women, 50 to 79 years of age, who were already enrolled in a Women's Health Initiative (WHI) clinical trial. We randomly assigned participants to receive 1000 mg of elemental [corrected] calcium as calcium carbonate with 400 IU of vitamin D3 daily or placebo. Fractures were ascertained for an average follow-up period of 7.0 years. Bone density was measured at three WHI centers. RESULTS Hip bone density was 1.06 percent higher in the calcium plus vitamin D group than in the placebo group (P<0.01). Intention-to-treat analysis indicated that participants receiving calcium plus vitamin D supplementation had a hazard ratio of 0.88 for hip fracture (95 percent confidence interval, 0.72 to 1.08), 0.90 for clinical spine fracture (0.74 to 1.10), and 0.96 for total fractures (0.91 to 1.02). The risk of renal calculi increased with calcium plus vitamin D (hazard ratio, 1.17; 95 percent confidence interval, 1.02 to 1.34). Censoring data from women when they ceased to adhere to the study medication reduced the hazard ratio for hip fracture to 0.71 (95 percent confidence interval, 0.52 to 0.97). Effects did not vary significantly according to prerandomization serum vitamin D levels. CONCLUSIONS Among healthy postmenopausal women, calcium with vitamin D supplementation resulted in a small but significant improvement in hip bone density, did not significantly reduce hip fracture, and increased the risk of kidney stones. (ClinicalTrials.gov number, NCT00000611.).
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Affiliation(s)
- Rebecca D Jackson
- Division of Endocrinology, Ohio State University, 485 McCampbell, 1581 Dodd Dr., Columbus, OH 43210, USA.
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Nakahara T, Nagai N, Tanaka M, Muranaga T, Kojima S, Nozoe SI, Naruo T. The effects of bone therapy on tibial bone loss in young women with anorexia nervosa. Int J Eat Disord 2006; 39:20-6. [PMID: 16231362 DOI: 10.1002/eat.20197] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Osteoporosis is recognized as a common medical complication of anorexia nervosa (AN). The purpose of the current study was to investigate the recovery mechanism of osteoporosis in AN and the effect of medical treatment on the skeletal system. METHOD We conducted a randomized placebo-controlled study of the effects of etidronate and calcium and vitamin D on bone loss in 41 outpatients with the restricting type of AN (AN-R). We measured the tibial speed of sound (SOS) before and after 3 months of treatment. RESULTS The bone mineral density (BMD) of the tibial SOS change in both the etidronate group and the calcium and vitamin D Group was significantly greater (p < .001) than in the control group. Urine-N-telopeptide cross-links of type I collagen (NTx) before and after treatment decreased significantly (p < .01) in the etidronate group. CONCLUSION These findings suggest that both etidronate and calcium and vitamin D are equally efficacious for reversing the degree of osteoporosis in patients with AN.
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Affiliation(s)
- Toshihiro Nakahara
- Department of Behavioral Medicine, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima-City, Japan.
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Casez P, Uebelhart B, Gaspoz JM, Ferrari S, Louis-Simonet M, Rizzoli R. Targeted education improves the very low recognition of vertebral fractures and osteoporosis management by general internists. Osteoporos Int 2006; 17:965-70. [PMID: 16758137 DOI: 10.1007/s00198-005-0064-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Accepted: 12/22/2005] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Vertebral fractures in older persons are strong predictors of subsequent fracture risk but remain largely under-recognized. To evaluate the impact of an educational intervention on the recognition of vertebral fractures and the prescription of anti-osteoporosis treatment among general internists, we conducted a prospective study in a service of general internal medicine of a large university teaching hospital in Geneva, Switzerland. During a 3.5-month observation period (phase 1), all lateral spinal or chest radiographs performed on consecutive inpatients over 60 years were reviewed by two independent investigators, and vertebral fractures were graded according to their severity. METHODS Results were compared with radiology reports and general internists' discharge summaries. During the following 2-month intervention period (phase 2), internists were actively educated about vertebral fracture identification by means of lectures, posters and flyers. Radiologists did not receive this educational strategy and served as controls. RESULTS Among 292 consecutive patients (54% men; range: 60-97 years) included in phase 1, 85 (29%) were identified by investigators as having at least one vertebral fracture; radiologists detected 29 (34%), and internists detected 19 (22%). During the intervention phase, 58 (34%) of 172 patients were identified with vertebral fractures by investigators; radiologists detected 13 patients (22%) whereas among internists the detection rate almost doubled (25/58 patients, 43%; p=0.008 compared to phase 1). The percentage of patients with vertebral fracture who benefitted from an osteoporosis medical management increased from 11% (phase 1) to 40% (phase 2, p<0.03). CONCLUSIONS Our findings confirm the large under-recognition of vertebral fractures, irrespective of their severity, and demonstrate that a simple educational strategy can significantly improve their detection on routine radiographs and, consequently, improve osteoporosis management.
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Affiliation(s)
- P Casez
- Service of Bone Diseases (WHO Collaborating Centre for Osteoporosis Prevention), Department of Rehabilitation and Geriatrics, Geneva University Hospitals, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
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76
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Shin CS. Pharmacological Therapy for Postmenopausal Osteoporosis. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2006. [DOI: 10.5124/jkma.2006.49.1.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine & Hospital, Korea.
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Abstract
Recent epidemiologic research suggests that dairy product intake or its components (calcium, vitamin D, and amount or source of protein) are associated with lower body weight or body fat. Clinical intervention trials designed to test this association during weight loss are promising, but still controversial. Few data are available on the effect of calcium or dairy products on prevention of weight gain in long-term trials. The mechanisms proposed to mediate the putative effect of dietary calcium are primarily the formation of fecal fatty acid complexes to reduce fat absorption and the regulation of energy metabolism, including lipolysis from adipocytes and fatty acid oxidation, through the calciotropic hormones, parathyroid hormone, and 1,25-dihydroxyvitamin D. Increased energy expenditure, increased satiety, or a shift from fat to lean mass must accompany these changes in lipid metabolism to achieve changes in fat mass; however, measurable changes in these other parameters either have not been tested or have not been noted uniformly. If dairy products or their components have an effect on altering fat mass, it is likely to be a small change that may have a substantial effect on the incidence of obesity over time.
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Affiliation(s)
- Dorothy Teegarden
- Interdepartmental Nutrition Program, Purdue University, West Lafayette, IN 47907, USA.
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Hamdy RC, Chesnut CH, Gass ML, Holick MF, Leib ES, Lewiecki ME, Maricic M, Watts NB. Review of Treatment Modalities for Postmenopausal Osteoporosis. South Med J 2005; 98:1000-14; quiz 1015-7, 1048. [PMID: 16295815 DOI: 10.1097/01.smj.0000184921.53062.bf] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This review summarizes and updates data presented at recent annual Southern Medical Association conferences on postmenopausal osteoporosis. As part of any osteoporosis treatment program, it is important to maintain adequate calcium and 25-hydroxyvitamin D levels either through diet or supplementation. Among the available pharmacologic therapies, the bisphosphonates alendronate and risedronate have demonstrated the most robust fracture risk reductions-approximately 40 to 50% reduction in vertebral fracture risk, 30 to 40% in nonvertebral fracture risk, and 40 to 60% in hip fracture risk. Ibandronate, a new bisphosphonate, has demonstrated efficacy in reducing vertebral fracture risk. Salmon calcitonin nasal spray and raloxifene demonstrated significant reductions in vertebral fracture risk in pivotal studies. Teriparatide significantly reduced vertebral and nonvertebral fracture risk. Drugs on the horizon include strontium ranelate, which has been shown to reduce vertebral and nonvertebral fracture risk, and zoledronic acid, an injectable bisphosphonate that increased bone density with once-yearly administration.
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Affiliation(s)
- Ronald C Hamdy
- East Tennessee State University, Johnson City, TN 37614, USA.
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Affiliation(s)
- M K Karlsson
- Department of Orthopaedic Surgery, Malmö University Hospital, SE-20502 Malmö, Sweden.
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Edwards BJ, Brooks ER, Langman CB. Osteoporosis screening of postmenopausal women in the primary care setting: a case-based approach. ACTA ACUST UNITED AC 2005; 1:70-85. [PMID: 16115586 DOI: 10.1016/s1550-8579(04)80013-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2004] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite the facts that approximately half of postmenopausal women will sustain an osteoporosis-related fracture and 15% will sustain a hip fracture in their lifetime, 75% of American women between the ages of 45 and 75 years have never discussed osteoporosis with their physician. OBJECTIVE This case-based review addresses screening for osteoporosis in the primary care setting. Topics include epidemiology, assessment of fracture risk, bone mineral density testing, primary prevention of osteoporosis, and thresholds for treatment. METHODS Relevant articles were identified through a search of MEDLINE (1980-2004) using the terms osteoporosis, fractures, randomized controlled trials (RCTs), and epidemiology, pathophysiology, diagnosis, and treatment of osteoporosis. Clinical guidelines on osteoporosis were also reviewed. CONCLUSIONS Osteoporosis is a prevalent disease in postmenopausal women. Osteoporosis-related fractures are a cause of major morbidity and mortality in older adults. Increased awareness of osteoporosis is necessary to stem the mounting number of complications.
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Affiliation(s)
- Beatrice J Edwards
- Bone Health and Osteoporosis Program, Division of Geriatric Medicine, Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
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Wolf RL, Cauley JA, Pettinger M, Jackson R, Lacroix A, Leboff MS, Lewis CE, Nevitt MC, Simon JA, Stone KL, Wactawski-Wende J. Lack of a relation between vitamin and mineral antioxidants and bone mineral density: results from the Women's Health Initiative. Am J Clin Nutr 2005; 82:581-8. [PMID: 16155271 DOI: 10.1093/ajcn.82.3.581] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antioxidant defenses are one possible mechanism for decreasing oxidative damage and its potentially negative effects on age-related bone mass. OBJECTIVE This study cross-sectionally examined whether higher dietary intakes, total intakes, and serum concentrations of antioxidants may be associated with higher bone mineral density (BMD). DESIGN Total hip (and subregions), spine, and total-body BMDs were measured in 11,068 women aged 50-79 y enrolled in the Women's Health Initiative Observational Study and Clinical Trial at 3 clinics. Antioxidant intakes from diet (vitamin A, retinol, beta-carotene, vitamin C, vitamin E, and selenium) were estimated by using a self-reported food-frequency questionnaire. Antioxidants from supplements were estimated with an interviewer-administered questionnaire. A random subset (n = 379) had serum concentrations of retinol, carotenoids, and tocopherols measured. RESULTS After adjustment for important BMD-related covariates, increasing intakes of antioxidants were not independently associated with BMD. A significant interaction effect was observed between intake of total vitamin C (lower three-fourths compared with highest one-fourth) and use of hormone therapy (HT) (P < 0.01). The beneficial effect of current HT use on femoral neck BMD appeared to be greater in women with higher concentrations of total vitamin C. This interaction was also significant for total-body (P < 0.045), spine (P = 0.03), and total-hip BMDs (P = 0.029). CONCLUSIONS Our results do not support independent associations between dietary intake, total intake, or serum concentrations of antioxidants and BMD in women participating in the Women's Health Initiative. The extent to which HT use may interact with vitamin C intake and BMD warrants further exploration.
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Affiliation(s)
- Randi L Wolf
- Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA.
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Wolf RL, Cauley JA, Pettinger M, Jackson R, Lacroix A, Leboff MS, Lewis CE, Nevitt MC, Simon JA, Stone KL, Wactawski-Wende J. Lack of a relation between vitamin and mineral antioxidants and bone mineral density: results from the Women’s Health Initiative. Am J Clin Nutr 2005. [DOI: 10.1093/ajcn/82.3.581] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Randi L Wolf
- From the Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY (RLW); the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (JAC); the Fred Hutchinson Cancer Research Center, Seattle, WA (MP and AL); The Ohio State University; Columbus, OH (RJ); the Department of Internal Medicine,
| | - Jane A Cauley
- From the Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY (RLW); the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (JAC); the Fred Hutchinson Cancer Research Center, Seattle, WA (MP and AL); The Ohio State University; Columbus, OH (RJ); the Department of Internal Medicine,
| | - Mary Pettinger
- From the Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY (RLW); the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (JAC); the Fred Hutchinson Cancer Research Center, Seattle, WA (MP and AL); The Ohio State University; Columbus, OH (RJ); the Department of Internal Medicine,
| | - Rebecca Jackson
- From the Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY (RLW); the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (JAC); the Fred Hutchinson Cancer Research Center, Seattle, WA (MP and AL); The Ohio State University; Columbus, OH (RJ); the Department of Internal Medicine,
| | - Andrea Lacroix
- From the Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY (RLW); the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (JAC); the Fred Hutchinson Cancer Research Center, Seattle, WA (MP and AL); The Ohio State University; Columbus, OH (RJ); the Department of Internal Medicine,
| | - Meryl S Leboff
- From the Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY (RLW); the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (JAC); the Fred Hutchinson Cancer Research Center, Seattle, WA (MP and AL); The Ohio State University; Columbus, OH (RJ); the Department of Internal Medicine,
| | - Cora E Lewis
- From the Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY (RLW); the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (JAC); the Fred Hutchinson Cancer Research Center, Seattle, WA (MP and AL); The Ohio State University; Columbus, OH (RJ); the Department of Internal Medicine,
| | - Michael C Nevitt
- From the Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY (RLW); the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (JAC); the Fred Hutchinson Cancer Research Center, Seattle, WA (MP and AL); The Ohio State University; Columbus, OH (RJ); the Department of Internal Medicine,
| | - Joel A Simon
- From the Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY (RLW); the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (JAC); the Fred Hutchinson Cancer Research Center, Seattle, WA (MP and AL); The Ohio State University; Columbus, OH (RJ); the Department of Internal Medicine,
| | - Katie L Stone
- From the Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY (RLW); the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (JAC); the Fred Hutchinson Cancer Research Center, Seattle, WA (MP and AL); The Ohio State University; Columbus, OH (RJ); the Department of Internal Medicine,
| | - Jean Wactawski-Wende
- From the Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY (RLW); the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (JAC); the Fred Hutchinson Cancer Research Center, Seattle, WA (MP and AL); The Ohio State University; Columbus, OH (RJ); the Department of Internal Medicine,
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Aloia JF, Talwar SA, Pollack S, Yeh J. A randomized controlled trial of vitamin D3 supplementation in African American women. ACTA ACUST UNITED AC 2005; 165:1618-23. [PMID: 16043680 PMCID: PMC1464166 DOI: 10.1001/archinte.165.14.1618] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND We conducted a randomized, placebo-controlled, double-blind trial to test the hypothesis that vitamin D(3) supplementation would prevent bone loss in calcium-replete, African American postmenopausal women. METHODS Two hundred eight healthy black postmenopausal women, 50 to 75 years of age, were assigned to receive either placebo or 20 microg/d (800 IU) of vitamin D(3). Calcium supplements were provided to ensure a total calcium intake of 1200 to 1500 mg/d. After 2 years, the vitamin D(3) dose was increased to 50 microg/d (2000 IU) in the active group, and the study continued for an additional year. Bone mineral density (BMD) was measured every 6 months. Markers of bone turnover, vitamin D metabolites, and parathyroid hormone (PTH) levels were measured in serum. RESULTS There were no significant differences in BMD between the active and control groups throughout the study. There was also no relationship between serum 25-hydroxyvitamin D levels attained and rates of bone loss. There was an increase in BMD of the total body, hip, and radius at 1 year in both groups. Over the 3 years, BMD declined at these sites by 0.26% to 0.55% per year. The BMD of the lumbar spine increased slightly in the placebo and active groups. There were no persistent changes in serum PTH levels or the markers of bone turnover, although there was a transient decline in PTH in both groups at 3 months. No significant adverse events were attributed to vitamin D supplementation. CONCLUSIONS There was no observed effect of vitamin D(3) supplementation on bone loss or bone turnover markers in calcium-replete, postmenopausal African American women. Further studies are needed to determine if these findings are applicable to women of other ethnic groups.
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Affiliation(s)
- John F Aloia
- Department of Medicine, Bone Mineral Research Center, Winthrop University Hospital, Mineola, NY 11501, USA.
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85
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Affiliation(s)
- Peter C Elwood
- Department of Epidemiology, Statistics and Public Health, Cardiff University. Llandough Hospital, Penarth CF64 2XW, UK.
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86
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Maxwell C, Viale PH. Cancer treatment-induced bone loss in patients with breast or prostate cancer. Oncol Nurs Forum 2005; 32:589-603. [PMID: 15897934 DOI: 10.1188/05.onf.589-603] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To review the prevalence, consequences, pathophysiology, diagnosis, and treatment of cancer treatment-induced bone loss (CTIBL) in patients with breast or prostate cancer. DATA SOURCES Published articles, abstracts, book chapters, electronic resources, and manufacturer information. DATA SYNTHESIS CTIBL is a long-term complication associated with cancer therapies that cause hypogonadism in patients with breast or prostate cancer. Early diagnosis and treatment of CTIBL is essential to prevent bone fractures. CTIBL treatment includes modification of lifestyles that increase the risk of developing bone loss and fractures and includes the use of bone loss therapies (e.g., bisphosphonates, selective estrogen receptor modifiers, calcitonin). CONCLUSIONS CTIBL is becoming more common as patients with breast or prostate cancer survive longer. Identifying and treating CTIBL early are important because once bone is lost, damaged bone becomes more difficult to repair; early diagnosis and treatment also may prevent fractures. IMPLICATIONS FOR NURSING Nurses must be knowledgeable about CTIBL to identify high-risk patients and educate patients and their families about CTIBL, bone loss therapies, and lifestyle modifications.
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Affiliation(s)
- Cathy Maxwell
- Oncology Hematology Group of South Florida, Miami, USA.
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87
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Abstract
There is evidence from both observational studies and clinical trials that calcium malnutrition and hypovitaminosis D are predisposing conditions for various common chronic diseases. In addition to skeletal disorders, calcium and vitamin D deficits increase the risk of malignancies, particularly of colon, breast and prostate gland, of chronic inflammatory and autoimmune diseases (e.g. insulin-dependent diabetes mellitus, inflammatory bowel disease, multiple sclerosis), as well as of metabolic disorders (metabolic syndrome, hypertension). The aim of the present review was to provide improved understanding of the molecular and cellular processes by which deficits in calcium and vitamin D cause specific changes in cell and organ functions and thereby increase the risk for chronic diseases of different aetiology. 1,25-Dihydroxyvitamin D(3) and extracellular Ca(++) are both key regulators of proliferation, differentiation and function at the cellular level. However, the efficiency of vitamin D receptor-mediated intracellular signalling is limited by the negative effects of hypovitaminosis D on extrarenal 25-hydroxyvitamin D-1alpha-hydroxylase activity and thus on the production of 1,25-dihydroxyvitamin D(3). Calcium malnutrition eventually causes a decrease in calcium concentration in extracellular fluid compartments, resulting in organ-specific modulation of calcium-sensing receptor activity. Hence, attenuation of signal transduction from the ligand-activated vitamin D receptor and calcium-sensing receptor seems to be the prime mechanism by which calcium and vitamin D insufficiencies cause perturbation of cellular functions in bone, kidney, intestine, mammary and prostate glands, endocrine pancreas, vascular endothelium, and, importantly, in the immune system. The wide range of diseases associated with deficits in calcium and vitamin D in combination with the high prevalence of these conditions represents a special challenge for preventive medicine.
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Affiliation(s)
- M Peterlik
- Department of Pathophysiology, Center for Physiology and Pathophysiology, University of Medicine Vienna, Vienna, Austria.
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88
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Abstract
Osteoporosis and low bone mass are currently estimated to be a major public health threat. Adequate nutrition plays a major role in the prevention and treatment of osteoporosis; the micronutrients of greatest importance are calcium and vitamin D. Calcium has been shown to have beneficial effects on bone mass at all ages, although the results are not always consistent. Higher doses than the current US recommendation (600 IU) of vitamin D in the elderly (age > or = 65 y) may actually be required for optimal bone health (800-1000 IU/d). The elderly can clearly benefit from increased vitamin D intakes; however, the potential importance of vitamin D in peak bone mass is just being investigated. Vitamin D has been related to falls, with supplementation reducing the number of falls. There are clear fracture benefits demonstrated in randomized clinical trials of calcium and vitamin D supplementation. The other micronutrient needs for optimizing bone health can be easily met by a healthy diet that is high in fruits and vegetables to ensure adequate intakes for magnesium, potassium, vitamin C, vitamin K, and other potentially important nutrients. Healthcare professionals need to be aware of the importance of adequate calcium and vitamin D intakes (easily monitored by serum 25(OH)D) for optimal bone health, as well as the prevention of falls and fractures. In addition, a healthy diet that includes 5 servings a day of fruits and vegetables should optimize the intake of micronutrients required for bone health.
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Affiliation(s)
- Jeri W Nieves
- Clinical Research and Regional Bone Centers, Helen Hayes Hospital, West Haverstraw, NY, USA
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89
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Abstract
Recent evidences from epidemiological and intervention trials suggest that a higher calcium intake is associated with a lower body weight and a reduction in total and central body fat. The potential role of calcium intake in the regulation of body adiposity has been explained by the intracellular calcium, which is able to promote adipocyte fat accumulation by exerting a coordinate regulation stimulating lipogenesis and suppressing lipolysis. Moreover, the intracellular calcium has been implicated on the etiopathogenesis of hypertension, insulin resistance and dyslipidemia, appearing as a potential common substrate in the metabolic syndrome. Dietary modulation of intracellular calcium through calciotropic hormones opens an exciting possibility to prevent and tackle obesity and its associated complications by increasing the calcium intake. However, available evidences are mostly indirect and further studies specifically designed for this purpose are needed.
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Affiliation(s)
- Pilar García-Lorda
- Unidad de Nutrición Humana, Facultad de Medicina y Ciencias de la Salud de Reus, Universitat Rovira i Virgili, Tarragona, España.
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Palacios S, Castelo-Branco C, Cifuentes I, von Helde S, Baró L, Tapia-Ruano C, Menéndez C, Rueda C. Changes in bone turnover markers after calcium-enriched milk supplementation in healthy postmenopausal women: a randomized, double-blind, prospective clinical trial. Menopause 2005; 12:63-8. [PMID: 15668602 DOI: 10.1097/00042192-200512010-00012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effect of calcium, phosphorus, lactose, and vitamin D fortified skimmed milk on biomarkers of bone turnover in healthy postmenopausal women. DESIGN The design was of a prospective, double-blind, randomized, 6 months study. Eighty postmenopausal women (aged 49-71 y) were allocated in two groups receiving 750 mL/day of a fortified skimmed milk containing 1,200 mg of calcium and 5.7 microg of vitamin D (group A) or 900 mg of calcium and 5.7 microg of vitamin D (group B). Ultrasound bone mass measurements and biochemical markers of bone formation, serum bone-specific alkaline phosphatase (AP), and carboxi-terminal propeptide of type I procollagen (PICP) and of bone resorption, urinary excretion of pyridinoline (Pyr), deoxypyridinoline (D-Pyr), and urinary type I collagen cross-linked N-telopeptide (NTx) were performed at baseline and after 10 weeks and 6 months of follow-up. RESULTS PICP levels showed a significant reduction during the study, but no differences were observed between groups (-18.47 +/- 11.4 group A vs -14.42 +/- 12.5 group B). Pyr levels decreased in group A (P < 0.001), whereas no changes were detected in group B. At the end of the study, a significant difference (P < 0.01) was detected between groups in Pyr (-23.66 +/- 5.7 group Avs 3.465 +/- 7.1 group B) and D-Pyr (-16.64 +/- 1.6 group Avs 2.955 +/- 2.1 group B). At the 6th month, serum 25OH vitamin D increased in group A and decreased in group B (P = 0.007). Additionally, no differences were observed between groups in bone mass and in the other bone markers. Body weight was unchanged for group A, whereas a significant increase was observed in group B. CONCLUSIONS The daily intake of 750 mL of enriched skimmed milk containing 1,200 mg of calcium appears to be a useful, safe, and acceptable measure to calcium supplementation in healthy elderly postmenopausal women.
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Schousboe JT, DeBold RC, Kuno LS, Weiss TW, Chen YT, Abbott TA. Education and Phone Follow-Up in Postmenopausal Women at Risk for Osteoporosis. ACTA ACUST UNITED AC 2005. [DOI: 10.2165/00115677-200513060-00004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Boonen S, McClung MR, Eastell R, El-Hajj Fuleihan G, Barton IP, Delmas P. Safety and efficacy of risedronate in reducing fracture risk in osteoporotic women aged 80 and older: implications for the use of antiresorptive agents in the old and oldest old. J Am Geriatr Soc 2004; 52:1832-9. [PMID: 15507059 DOI: 10.1111/j.1532-5415.2004.52506.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the efficacy of risedronate in reducing vertebral fracture risk in women aged 80 and older with osteoporosis. DESIGN Pooled analysis of data from three randomized, double-blind, controlled, 3-year-fracture-endpoint trials conducted from November 1993 to April 1998: Hip Intervention Program (HIP), Vertebral Efficacy with Risedronate Therapy-Multinational (VERT-MN), and VERT-North America (NA). SETTING Office-based practices, research centers, and osteoporosis clinics in Europe, North America, and Australia. PARTICIPANTS Osteoporotic (femoral neck bone mineral density T-score < -2.5 standard deviations or at least one prevalent vertebral fracture) women aged 80 and older. INTERVENTION Patients received placebo (n=688) or risedronate 5 mg/d (n=704) for up to 3 years. All patients received 1,000 mg/d calcium and, if baseline levels were low, up to 500 IU/d vitamin D. MEASUREMENTS Cumulative incidence of new vertebral fractures. RESULTS After 1 year, the risk of new vertebral fractures in the risedronate group was 81% lower than with placebo (95% confidence interval=60-91%; P<.001). The number of women who needed to be treated to prevent one new vertebral fracture after 1 year was 12. This early onset of efficacy was consistent across the clinical programs, and antifracture efficacy was confirmed over 3 years. Risedronate was well tolerated, with a safety profile comparable with that of placebo. CONCLUSION These findings provide the first evidence that, even in the very old, reducing bone resorption rate remains an effective treatment strategy for osteoporosis. Because each therapeutic agent used for the treatment of osteoporosis may have unique characteristics, the observations made in this study should not be assumed to apply to other bisphosphonates.
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Affiliation(s)
- Steven Boonen
- Leuven University Center for Metabolic Bone Diseases and Division of Geriatric Medicine, Katholieke Universiteit Leuven, Herestraat 49, B-3000 Leuven, Belgium
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Gold DT, Shipp KM, Pieper CF, Duncan PW, Martinez S, Lyles KW. Group treatment improves trunk strength and psychological status in older women with vertebral fractures: results of a randomized, clinical trial. J Am Geriatr Soc 2004; 52:1471-8. [PMID: 15341548 DOI: 10.1111/j.1532-5415.2004.52409.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess whether group exercise and coping classes reduce physical and psychological impairments and functional disability in older women with prevalent vertebral fractures (VFs). DESIGN Randomized, controlled trial (modified cross-over) with site as unit of assignment; testing at baseline and 3, 6, 9, and 12 months. SETTING Nine North Carolina retirement communities. PARTICIPANTS One hundred eighty-five postmenopausal Caucasian women (mean age 81), each with at least one VFs. INTERVENTION The intervention group had 6 months of exercise (3 meetings weekly, 45 minutes each) and coping classes (2 meetings weekly, 45 minutes each) in Phase 1, followed by 6 months of self-maintenance. The control group had 6 months of health education control intervention (1 meeting weekly, 45 minutes) in Phase 1, followed by the intervention described above. MEASUREMENTS Change in trunk extension strength, change in pain with activities, and change in psychological symptoms. RESULTS Between-group differences in the change in trunk extension strength (10.68 foot pounds, P<.001) and psychological symptoms (-0.08, P=.011) were significant for Phase 1. Changes in pain with activities did not differ between groups (-0.03, P=.64); there was no change in the pain endpoint. In Phase 2, controls showed significant changes in trunk strength (15.02 foot pounds, P<.001) and psychological symptoms (-0.11, P=.006) from baseline. Change in pain with activities was not significant (-0.03, P=.70). During self-maintenance, the intervention group did not worsen in psychological symptoms, but improved trunk extension strength was not maintained. CONCLUSION Weak trunk extension strength and psychological symptoms associated with VFs can be improved in older women using group treatment, and psychological improvements are retained for at least 6 months.
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Affiliation(s)
- Deborah T Gold
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Meier C, Woitge HW, Witte K, Lemmer B, Seibel MJ. Supplementation with oral vitamin D3 and calcium during winter prevents seasonal bone loss: a randomized controlled open-label prospective trial. J Bone Miner Res 2004; 19:1221-30. [PMID: 15231008 DOI: 10.1359/jbmr.040511] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2004] [Revised: 04/14/2004] [Accepted: 04/19/2004] [Indexed: 11/18/2022]
Abstract
UNLABELLED Bone metabolism follows a seasonal pattern with high bone turnover and bone loss during the winter. In a randomized, open-label 2-year sequential follow-up study of 55 healthy adults, we found that supplementation with oral vitamin D3 and calcium during winter abolished seasonal changes in calciotropic hormones and markers of bone turnover and led to an increase in BMD. Supplementation with oral vitamin D3 and calcium during the winter months seems to counteract the effects of seasonal changes in vitamin D and thus may be beneficial as a primary prevention strategy for age-related bone loss. INTRODUCTION Bone metabolism follows a seasonal pattern characterized by high bone turnover and bone loss during winter. We investigated whether wintertime supplementation with oral vitamin D3 and calcium had beneficial effects on the circannual changes in bone turnover and bone mass. MATERIALS AND METHODS This prospective study comprised an initial observation period of 12 months ("year 1"), followed by an intervention during parts of year 2. Fifty-five healthy subjects living in southwestern Germany (latitude, 49.5 degrees N) were randomized into two groups: 30 subjects were assigned to the treatment group and received oral cholecalciferol (500 IU/day) and calcium (500 mg/day) during the winter months of year 2 (October-April), while 25 subjects assigned to the control group obtained no supplements. Primary endpoints were changes in calciotropic hormones [serum 25(OH)D, 1,25(OH)2D, and parathyroid hormone], markers of bone formation (serum bone-specific alkaline phosphatase) and of bone resorption (urinary pyridinoline and deoxypyridinoline), and changes in lumbar spine and femoral neck BMD. RESULTS Forty-three subjects completed the study. During year 1, calciotropic hormones, markers of bone turnover, and BMD varied by season in both groups. During the winter months of year 1, bone turnover was significantly accelerated, and lumbar spine and femoral BMD declined by 0.3-0.9%. In year 2, seasonal changes in calciotropic hormones and markers of bone turnover were either reversed or abolished in the intervention group while unchanged in the control cohort. In the subjects receiving oral vitamin D3 and calcium, lumbar and femoral BMD increased significantly (lumbar spine: +0.8%, p = 0.04 versus year 1; femoral neck: +0.1%, p = 0.05 versus year 1), whereas controls continued to lose bone (intervention group versus control group: lumbar spine, p = 0.03; femoral neck, p = 0.05). CONCLUSIONS Supplementation with oral vitamin D3 and calcium during winter prevents seasonal changes in bone turnover and bone loss in healthy adults. It seems conceivable that annually recurring cycles of low vitamin D and mild secondary hyperparathyroidism during the winter months contributes, at least in part and over many years, to age-related bone loss. Supplementation with low-dose oral vitamin D3 and calcium during winter may be an efficient and inexpensive strategy for the primary prevention of bone loss in northern latitudes.
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Affiliation(s)
- Christian Meier
- Bone Research Program, ANZAC Research Institute, University Sydney, Concord, New South Wales, Australia
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Higano CS. Understanding treatments for bone loss and bone metastases in patients with prostate cancer: a practical review and guide for the clinician. Urol Clin North Am 2004; 31:331-52. [PMID: 15123412 DOI: 10.1016/j.ucl.2004.01.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Prostate cancer patients are at risk for developing bone loss and bone metastases. Clinicians prescribing ADT should appreciate the potential effects of ADT on BMD as well as the morbidity and mortality that can result from osteoporotic fractures. Measures to address the evaluation of patients and when to treat patients with significant bone loss have been discussed. Bisphosphonates effectively prevent loss of BMD in prostate cancer patients. Treatment of prostate cancer patients with established bone metastases with zoledronic acid should be considered strongly based on the results of the Saad study and other studies of patients with bone metastases with other malignancies. Zoledronic acid is approved by the US FDA for use in men with metastatic hormone-refractory prostate cancer and in the European Union for any patient with bone metastases, including prostate cancer patients,because of the beneficial impact of zoledronic acid on skeletal-related events. There is no validated method to determine which patients might benefit most from bisphosphonate therapy in this setting. Many questions about the use of bisphosphonate therapy in men with prostate cancer must be addressed, both in terms of the use in bone loss and bone metastases. These questions include: What is the optimal timing of therapy? Which bisphosphonate is best? What is the best dose and dose schedule? Do bisphosphonates effectively decrease skeletal fracture rates in patients with osteoporosis? How long should patients receive therapy? Are bisphosphonate "holidays" warranted? What are the long-term skeletal and renal toxicities? Is there a role for sequencing bisphosphonate therapy either before or after chemotherapy? Is bisphosphonate therapy synergistic with certain chemotherapy or other bone-targeted therapies? Which patients are the most likely to benefit from bisphosphonate therapy? What are clinically significant endpoints of bisphosphonate trials in patients with metastatic disease? Does inhibiting bone turnover also inhibit formation of bone metastases? Preliminary work in these areas has been completed, but more questions than answers are available. Given the rising costs of health care, it is imperative that these questions be addressed to best use the health care dollar while offering high-risk patients the best available therapy. At present, no data suggest that bisphosphonates should be used routinely to prevent BMD loss in men with normal BMD or to prevent the development of bone metastases in men with biochemical relapse. Continuing trials may give us guidance in the future.
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Affiliation(s)
- Celestia S Higano
- Department of Medicine and Department of Urology, University of Washington, 825 Eastlake Avenue East, Mail Stop G3-200, Seattle, WA 98109, USA.
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99
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Abstract
In postmenopausal women, the nonpharmacological prevention of osteoporotic fractures pursues the dual objective of minimizing bone loss and preventing falls. In women with a low fracture risk, optimizing the dietary intake of calcium is the main nutritional goal. Regular sustained physical activity should be encouraged. In older women, the high risk of proximal femoral fractures warrants a number of preventive measures, including calcium and vitamin D supplementation, correction of protein deficiency if needed, and minimization of the risk of falls. Hip protectors may be useful in institutionalized women at high risk for falls. These nonpharmacological measures should be part of a comprehensive customized management program used to complement standard pharmacological therapy.
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Affiliation(s)
- Xavier Deprez
- Rheumatology Department, Valenciennes Hospital, avenue Désandrouin, 59322 Valenciennes cedex, France.
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100
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Abstract
Any hope of a fountain of youth to stop people from getting older is a long way off, with science just beginning to understand the complex genetic, physical, and hormonal causes of aging. Clearly, modem research has demonstrated that the concept of a hormonal fountain of youth is predominantly mythology. The best evidence supporting use of hormonal replacement is vitamin D and estrogen replacement to prevent hip fractures. Other than that, treatment should be limited to hormone replacement in persons who have endocrine disease.
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Affiliation(s)
- Mohamad H Horani
- Division of Geriatric Medicine, Saint Louis University School of Medicine, MO 63104, USA
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