Administration of a supplement containing both calcium and vitamin D is more effective than calcium alone to reduce secondary hyperparathyroidism in postmenopausal women with low 25(OH)vitamin D circulating levels
calcium; elderly; osteoporosis; parathyroid hormone; vitamin D
Abstract :
[en] Background and aims: Supplementation of postmenopausal women with calcium alone or calcium-vitamin D association was suggested to have positive effects on bone turnover and bone density, as well as to lower fracture incidence. The beneficial effect appears to be mediated by a reduction in parathyroid hormone secretion. Our aim was to compare the respective efficacy of calcium and calcium-vitamin D supplements in reducing serum parathyroid hormone levels in postmenopausal women with prevalent low 25(OH)vitamin D levels. Methods: One hundred consecutive ambulatory postmenopausal women with serum 25(OH)vitamin D levels below 18 ng/mL were included in a randomized, prospective, open label study. For a duration of 90 days, the women were randomly assigned to a daily supplementation of either one tablet of calcium gluconolactate and carbonate (500 mg calcium), or one powder-pack of an association of calcium carbonate (500 mg calcium), citric acid (2.175 gr) and cholecalciferol (200 IU). Changes observed during the 90 days of the study in circulating PTH levels were the primary endpoint, while changes in serum 25(OH)D levels were assessed as secondary endpoint. Results: A significant difference was observed between the calcium-vitamin D (CaD) and the calcium (Ca) only groups for changes occurring during the 90 days of the study in PTH (-14.5 +/- 40% and +2.5 +/- 46%) (p=0.009) and 25(OH)D (+67 +/- 77% and +18 +/- 55%) (p<0.001) circulating levels. PTH changes between baseline and day 90 were significant in the CaD group, but not in the Ca group. The odds ratio for a patient in group Ca to experience an absolute (<12 ng/mL) deficiency in circulating 25(OH)vitamin D levels, compared to a group CaD patient was statistically increased (OR: 3.22, 95% CI: 1.33-7.80). Conclusions: Our results support the recommendation of supplementing postmenopausal women with low circulating levels of 25(OH)vitamin D with a combination of calcium and vitamin D, rather than with calcium alone.
Disciplines :
Geriatrics Sociology & social sciences
Author, co-author :
Deroisy, Rita ; Centre Hospitalier Universitaire de Liège - CHU > Médecine de l'appareil locomoteur
Collette, Julien ; Centre Hospitalier Universitaire de Liège - CHU > Chimie médicale
Albert, Adelin ; Université de Liège - ULiège > Département des sciences de la santé publique > Informatique médicale et biostatistique
Jupsin, Isabelle ; Centre Hospitalier Universitaire de Liège - CHU > Médecine de l'appareil locomoteur
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie et santé publique
Language :
English
Title :
Administration of a supplement containing both calcium and vitamin D is more effective than calcium alone to reduce secondary hyperparathyroidism in postmenopausal women with low 25(OH)vitamin D circulating levels
van der Wielen R., Löwik M., van den Berg H., de Groot L., Haller J., Moreiras O., van Staveren W. (1995) Serum Vitamin D concentrations among elderly people in Europe. Lancet 346:207-210.
Reginster J.-Y., Deroisy R., Pirenne H., Frederick I., Dewe W., Albert A., Colette J., Zheng S., Gosset C. (1999) High prevalence of low femoral bone mineral density in elderly women living in nursing homes or community-dwelling: A plausible role of increased parathyroid hormone secretion. Osteoporos. Int 9:121-128.
Reginster J.-Y., Deroisy R., Sarlet N., Franchimont P. (1990) Relation between calcium intake during different periods of life and bone mineral content at the menopause., Christiansen C., Overgaard K. (Eds.), Osteoporosis 1990. Osteopress Publ., Copenhagen, Denmark; 400-401.
Quesada J.-M., Coopmans W., Ruiz B., Aljam P., Jans I., Bouillon R. (1992) Influence of Vitamin D on parathyroid function in the elderly. J. Clin. Endocrinol. Metab 75:494-501.
Chapuy M., Schott A., Garnero P., Hans D., Delmas P., Meunier P. (1996) Healthy elderly French women living at home have secondary hyperparathyroidism and high bone turnover in winter. J. Clin. Endocrinol. Metab , and the Epidos Study Group; 81:1129-1133.
Villareal D., Civitelli R., Chines A., Avioli L. (1991) Subclinical vitamin-D deficiency in postmenopausal women with low vertebral bone mass. J. Clin. Endocrinol. Metab 72:628-634.
Le Boff M., Kohlmeier L., Hurwitz S., Franklin J., Wright J., Glowacki J. (1999) Occult Vitamin D deficiency in postmenopausal US women with acute hip fracture. JAMA 281:1505-1511.
Chapuy M.-C., Chapuy P., Meunier P. (1987) Calcium and Vitamin D supplements: Effects on calcium metabolism in elderly people. Am. J. Clin. Nutr 46:324-328.
Deroisy R., Collette J., Chevallier T., Breuil V., Reginster J.-Y. (1998) Effects of two 1-year calcium and vitamin D3 treatments on bone remodeling markers and femoral bone density in elderly women. Curr. Ther. Res 59:850-862.
Dawson-Hughes B., Harris S., Krall E., Dallal G. (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N. Engl. J. Med 337:670-676.
Chapuy M., Arlot M., Duboeuf F., Brun J., Crouzet B., Amaud S., Delmas P., Meunier P. (1992) Vitamin D3 and calcium to prevent hip fractures in elderly women. N. Engl. J. Med 327:1637-1642.
Chapuy M., Arlot M., Delmas P., Meunier P. (1994) Effect of calcium and cholecalciferol treatment for three years on hip fractures in elderly women. BMJ 308:1081-1082.
Himmelstein S., Clemens T., Rubin A., Lindsay R. (1990) Vitamin D supplementation in elderly nursing home residents increases 25(OH)D but not 1,25(OH)2D. Am. J. Clin. Nutr 52:701-706.
Lips P., Graafmans W., Ooms M., Bezemer D., Bouter L. (1996) Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo-controlled clinical trial. Ann. Intern. Med 124:400-406.
Reid I., Ames R., Evans M., Gamble G., Sharpe S. (1995) Long-term effects of calcium supplementation on bone loss and fractures in postmenopausal women: A randomized controlled trial. Am. J. Med 98:331-335.
Holbrook T., Barrett-Connor E., Wingard D. (1988) Dietary calcium and risk of hip fracture: 14-year prospective population study. Lancet 5:1046-1049.
Cumming R., Cummings S., Nevitt M., Scott J., Ensrud K., Vogt T., Fox K. (1997) Calcium intake and fracture risk: Results from the Study of Osteoporotic Fractures. Am. J. Epidemiol 145:926-934.
Heaney R.P. (2000) Calcium dairy products and osteoporosis. J. Am. Coll. Nutr 19:83S-99S.
Reginster J.-Y., Frederick I., Deroisy R., Dewe W., Taquet A.-N., Albert A., Collette J., Pirenne H., Zheng S.X., Gosset C. (1998) Parathyroid hormone plasma concentrations in response to low 25-OH vitamin D circulating levels increase with age in elderly women. Osteoporos. Int 8:390-392.
Kanis J., Passmore R. (1989) Calcium supplementation of the diet-II. BMJ 298:205-208.
Nordin C., Heaney R. (1990) Calcium supplementation of the diet: Justified by present evidence. BMJ 300:1056-1060.
Nicar M., Pak C. (1985) Calcium bioavailability from calcium carbonate and calcium citrate. J. Clin. Endocrinol. Metab 61:391-393.
Reginster J.-Y., Denis D., Bartsch V., Deroisy R., Zegels B., Franchimont P. (1993) Acute biochemical variations induced by four different calcium salts in healthy male volunteers. Osteoporos. Int 3:271-275.
