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Does dietary calcium have a protective effect on bone fractures in women? A meta-analysis of observational studies

  • Liangzhi Xu (a1), Patrick McElduff (a1), Catherine D'Este (a1) and John Attia (a1)
Abstract

It is generally accepted that supplemental Ca and/or vitamin D is effective in reducing the incidence of bone fractures; this is supported by numerous randomised controlled trials and meta-analyses. However, a question that has received much less attention is whether dietary Ca, i.e. Ca in physiological doses in normal food intake, also affects bone fracture risk. The present study aims to review the effect of dietary Ca on bone fractures at the hip, spine and radius in women >35 years old, and to compare these results with previous meta-analyses. MEDLINE (1966–1999) and reference lists in papers were searched for observational dietary Ca studies. Data were extracted in duplicate and separately. Heterogeneity and publication bias were tested. Observational studies failed to show any association between dietary Ca intake and risk of hip fracture (risk ratio 1·01, 95% CI 0·96, 1·07 for each increment of 300mg dietary Ca intake/d). There is a suggestion that either extremely low Ca intake may increase fracture risk, or that East Asian women may respond differently to increasing Ca intake.

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Corresponding author
*Corresponding author: Dr Liangzhi Xu, present address: Department of Obstetrics and Gynaecology, The Second West China Hospital, Sichuan University, Chengdu, China, fax +86 28 8555 9065, email liangzxu@mail.sc.cninfo.net
References
Hide All
M Angell (1989) Negative studies. New Engl J Med 321, 464466.

M Angell (1989) Negative studies. New Engl J Med 321, 464466.

G Block , CM Dresser , AM Hartman & MD Carroll (1985) Nutrient sources in the American diet: quantitative data from the NHANES II survey. I. Vitamins and minerals. Am J Epidemiol 122, 1326.

HH Chan , EM Lau , J Woo , F Lin , A Sham & PC Leung (1996) Dietary calcium intake, physical activity and the risk of vertebral fracture in Chinese. Osteoporos Int 6, 228232.

HH Chan , EM Lau , J Woo , F Lin , A Sham & PC Leung (1996) Dietary calcium intake, physical activity and the risk of vertebral fracture in Chinese. Osteoporos Int 6, 228232.

E Chrischilles , T Shireman & R Wallace (1994) Costs and health effects of osteoporotic fractures. Bone 15, 377386.

E Chrischilles , T Shireman & R Wallace (1994) Costs and health effects of osteoporotic fractures. Bone 15, 377386.

C Cooper , DJ Barker & C Wickham (1988) Physical activity, muscle strength, and calcium intake in fracture of the proximal femur in Britain. Br Med J 297, 14431446.

C Cooper , DJ Barker & C Wickham (1988) Physical activity, muscle strength, and calcium intake in fracture of the proximal femur in Britain. Br Med J 297, 14431446.

RG Cumming (1990) Calcium intake and bone mass: a quantitative review of the evidence. Calcif Tissue Int 47, 194201.

RG Cumming (1990) Calcium intake and bone mass: a quantitative review of the evidence. Calcif Tissue Int 47, 194201.

RG Cumming , SR Cummings , MC Nevitt , J Scott , KE Ensrud , TM Vogt & K Fox (1997) Calcium intake and fracture risk: results from the study of osteoporotic fractures. Am J Epidemiol 145, 926934.

RG Cumming , SR Cummings , MC Nevitt , J Scott , KE Ensrud , TM Vogt & K Fox (1997) Calcium intake and fracture risk: results from the study of osteoporotic fractures. Am J Epidemiol 145, 926934.

RG Cumming & RJ Klineberg (1994) Case–control study of risk factors for hip fractures in the elderly. Am J Epidemiol 139, 493503.

RG Cumming & MC Nevitt (1997) Calcium for prevention of osteoporotic fractures in postmenopausal women. J Bone Miner Res 12, 13211329.

RG Cumming & MC Nevitt (1997) Calcium for prevention of osteoporotic fractures in postmenopausal women. J Bone Miner Res 12, 13211329.

SR Cummings , MC Nevitt , WS Browner , K Stone , KM Fox , KE Ensrud , J Cauley , D Black & TM Vogt (1995) Risk factors for hip fracture in white women. New Engl J Med 332, 767773.

SR Cummings , MC Nevitt , WS Browner , K Stone , KM Fox , KE Ensrud , J Cauley , D Black & TM Vogt (1995) Risk factors for hip fracture in white women. New Engl J Med 332, 767773.

M Egger , G Davey Smith , M Schneider & C Minder (1997) Bias in meta-analysis detected by a simple, graphical test. Br Med J 315, 629634.

M Egger , G Davey Smith , M Schneider & C Minder (1997) Bias in meta-analysis detected by a simple, graphical test. Br Med J 315, 629634.

M Egger , S Ebrahim & GD Smith (2002) Where now for meta-analysis? Int J Epidemiol 31, 15.

M Egger , S Ebrahim & GD Smith (2002) Where now for meta-analysis? Int J Epidemiol 31, 15.

T Fujita & M Fukase (1992) Comparison of osteoporosis and calcium intake between Japan and the United States. Proc Soc Exp Biol Med 200, 149152.

T Fujita & M Fukase (1992) Comparison of osteoporosis and calcium intake between Japan and the United States. Proc Soc Exp Biol Med 200, 149152.

S Greenland & MP Longnecker (1992) Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol 135, 13011309.

G Gregoire , F Derderian & J Le Lorier (1995) Selecting the language of the publications included in a meta-analysis: is there a Tower of Babel bias? J Clin Epidemiol 48, 159163.

G Gregoire , F Derderian & J Le Lorier (1995) Selecting the language of the publications included in a meta-analysis: is there a Tower of Babel bias? J Clin Epidemiol 48, 159163.

SB Jaglal , N Kreiger & G Darlington (1993) Past and recent physical activity and risk of hip fracture. Am J Epidemiol 138, 107118.

O Johnell , B Gullberg , JA Kanis , (1995) Risk factors for hip fracture in European women: the MEDOS Study (Mediterranean Osteoporosis Study). J Bone Miner Res 10, 18021815.

O Johnell , B Gullberg , JA Kanis , (1995) Risk factors for hip fracture in European women: the MEDOS Study (Mediterranean Osteoporosis Study). J Bone Miner Res 10, 18021815.

N Kreiger , A Gross & G Hunter (1992) Dietary factors and fracture in postmenopausal women: a case–control study. Int J Epidemiol 21, 953958.

N Kreiger , A Gross & G Hunter (1992) Dietary factors and fracture in postmenopausal women: a case–control study. Int J Epidemiol 21, 953958.

V Krogh , JL Freudenheim , A D'Amicis , C Scaccini , S Sette , A Ferro-Luzzi & M Trevisan (1993) Food sources of nutrients of the diet of elderly Italians: II. Micronutrients. Int J Epidemiol 22, 869877.

V Krogh , JL Freudenheim , A D'Amicis , C Scaccini , S Sette , A Ferro-Luzzi & M Trevisan (1993) Food sources of nutrients of the diet of elderly Italians: II. Micronutrients. Int J Epidemiol 22, 869877.

E Lau , S Donnan , DJ Barker & C Cooper (1988) Physical activity and calcium intake in fracture of the proximal femur in Hong Kong. Br Med J 297, 14411443.

E Lau , S Donnan , DJ Barker & C Cooper (1988) Physical activity and calcium intake in fracture of the proximal femur in Hong Kong. Br Med J 297, 14411443.

AC Looker , TB Harris , JH Madans & CT Sempos (1993) Dietary calcium and hip fracture risk: the NHANES I Epidemiologic Follow-Up Study. Osteoporos Int 3, 177184.

L McAuley , B Pham , P Tugwell & D Moher (2000) Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses? Lancet 356, 12281231.

L McAuley , B Pham , P Tugwell & D Moher (2000) Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses? Lancet 356, 12281231.

HE Meyer , C Henriksen , JA Falch , JI Pedersen & A Tverdal (1995) Risk factors for hip fracture in a high incidence area: a case-control study from Oslo, Norway. Osteoporos Int 5, 239246.

HE Meyer , C Henriksen , JA Falch , JI Pedersen & A Tverdal (1995) Risk factors for hip fracture in a high incidence area: a case-control study from Oslo, Norway. Osteoporos Int 5, 239246.

HE Meyer , JI Pedersen , EB Loken & A Tverdal (1997) Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Am J Epidemiol 145, 117123.

HE Meyer , JI Pedersen , EB Loken & A Tverdal (1997) Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Am J Epidemiol 145, 117123.

K Michaelsson , L Holmberg , H Mallmin , S Sorensen , A Wolk , R Bergstrom & S Ljunghall (1995) Diet and hip fracture risk: a case-control study. Int J Epidemiol 24, 771782.

K Michaelsson , L Holmberg , H Mallmin , S Sorensen , A Wolk , R Bergstrom & S Ljunghall (1995) Diet and hip fracture risk: a case-control study. Int J Epidemiol 24, 771782.

D Moher , B Pham , T Klassen , KF Schulz , JA Berlin , AR Jadad & A Liverati (2000) What contributions do languages other than English make on the results of meta-analyses? J Clin Epidmiol 53, 964972.

D Moher , B Pham , T Klassen , KF Schulz , JA Berlin , AR Jadad & A Liverati (2000) What contributions do languages other than English make on the results of meta-analyses? J Clin Epidmiol 53, 964972.

JW Nieves , JA Grisso & JL Kelsey (1992) A case–control study of hip fracture: evaluation of selected dietary variables and teenage physical activity. Osteoporos Int 2, 122127.

JW Nieves , JA Grisso & JL Kelsey (1992) A case–control study of hip fracture: evaluation of selected dietary variables and teenage physical activity. Osteoporos Int 2, 122127.

A Paganini Hill , A Chao , RK Ross & BE Henderson (1991) Exercise and other factors in the prevention of hip fracture: the Leisure World study. Epidemiology 2, 1625.

A Paganini Hill , A Chao , RK Ross & BE Henderson (1991) Exercise and other factors in the prevention of hip fracture: the Leisure World study. Epidemiology 2, 1625.

KF Schulz , I Chalmers , RJ Hayes & DG Altman (1995) Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. J Am Med Assoc 273, 408412.

KF Schulz , I Chalmers , RJ Hayes & DG Altman (1995) Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. J Am Med Assoc 273, 408412.

ME Suarez-Almazor , E Belseck , J Homik , M Dorgan & C Ramos-Remus (2000) Identifying clinical trials in the medical literature with electronic databases: MEDLINE alone is not enough. Control Clin Trials 21, 476487.

ME Suarez-Almazor , E Belseck , J Homik , M Dorgan & C Ramos-Remus (2000) Identifying clinical trials in the medical literature with electronic databases: MEDLINE alone is not enough. Control Clin Trials 21, 476487.

A Tavani , E Negri & C La Vecchia (1995) Calcium, dairy products, and the risk of hip fracture in women in northern Italy. Epidemiology 6, 554557.

A Tavani , E Negri & C La Vecchia (1995) Calcium, dairy products, and the risk of hip fracture in women in northern Italy. Epidemiology 6, 554557.

CA Wickham , K Walsh , C Cooper , DJ Barker , BM Margetts , J Morris & SA Bruce (1989) Dietary calcium, physical activity, and risk of hip fracture: a prospective study. Br Med J 299, 889892.

RP Young , EM Lau , Z Birjandi , J Critchley & J Woo (1996) Interethnic differences in hip fracture rate and the vitamin D receptor polymorphism. Lancet 348, 688689.

RP Young , EM Lau , Z Birjandi , J Critchley & J Woo (1996) Interethnic differences in hip fracture rate and the vitamin D receptor polymorphism. Lancet 348, 688689.

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British Journal of Nutrition
  • ISSN: 0007-1145
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