Calcium And Vitamin D Supplementation Associated With Lower Risk Of Hip Fracture Women Receiving HRT

Calcium and vitamin D supplementation associated with lower risk of hip fracture among women receiving hormone replacement therapy

Calcium and vitamin D supplementation associated with lower risk of hip fracture among women receiving hormone replacement therapy

Friday, June 28, 2013. The results of a trial published in the February, 2014 issue of Menopause, the journal of The North American Menopause Society, add evidence to a bone-protective effect for supplementing with calcium and vitamin D among women receiving the hormone estrogen with or without progesterone. The findings are in conflict with a recently published US Preventive Services Task Force statement that there is insufficient evidence in favor of supplementing with the nutrients to lower fracture risk.

The trial included participants in the Women's Health Initiative, which recruited postmenopausal women between the ages of 50 and 79 years between 1993 and 1998. Among participants randomized to receive a placebo or hormone replacement therapy, 8,054 were assigned to receive 1,000 mg calcium and 400 mg vitamin D per day and 8,035 were assigned to a placebo.

Over an average of 7.2 years of follow-up, 214 hip fractures occurred. Women who received hormone therapy as well as calcium and vitamin D experienced a lower risk of hip fracture in comparison with those who received either treatment alone. Authors John A. Robbins, MD, MHS of the University of California Davis and his colleagues report that "The effect of hormone therapy on hip fracture prevention was stronger among women assigned to active calcium/vitamin D than among women assigned to placebo. Likewise, the effect of calcium/vitamin D was stronger among women assigned to active hormone therapy than among women assigned to placebo."

The combination of hormone therapy and calcium and vitamin D supplementation was determined to be associated with 11 hip fractures per 10,000 person-years in comparison with 22 fractures among those who received neither treatment. In subgroup analyses that included the subjects' personal calcium or vitamin D intake in addition to the amounts provided by the trial, the synergistic interaction of hormone therapy and these nutrients was consistent throughout all amounts of personal intake, and increased with higher intake levels.

"These results suggest that women taking postmenopausal estrogens should also take supplemental calcium/vitamin D," the authors write. "Because of the study design, we are unable to suggest a specific level of supplementation; benefit seems to increase with increasing total calcium/vitamin D intake."

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Is manganese the missing mineral in osteoporosis?

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A hypothesis submitted by researchers at the University of Castilla-La Mancha in Spain, published in the January, 2012 Frontiers of Bioscience Elite Edition, suggests that a lack of manganese rather than calcium could be the cause of osteoporosis, a disease characterized by progressive thinning of the bones that is common among older individuals, particularly women.

By studying deer antlers, Tomás Landete of the University's Research Institute of Hunting Resources (IREC) and his associates discovered an association between manganese depleted diets in 2005 and increased breakage. "Previous antler studies show that manganese is necessary for calcium absorption," commented Dr Landete. "Our hypothesis is that when the human body absorbs less manganese or when it is sent from the skeleton to other organs that require it, such as the brain, the calcium that is extracted at the same time is then not properly absorbed and is excreted in the urine. It is in this way that osteoporosis can slowly strike."

"Antlers grow by transferring 20% of the skeleton's calcium towards their structure," he added. "We therefore saw that it was not calcium deficiency that caused the weakening but rather the deficiency of manganese. The lack of manganese was almost as if the 'glue' that sticks calcium to antlers bones was missing."

The researchers suggest that osteoporosis caused by a lack of manganese could precede brain disorders including Alzheimer's and Parkinson's disease. A comparison of 45 osteoporosis patients and 68 subjects with osteoarthritis who underwent surgery between 2008 and 2009 found that 40 percent of those who had osteoporosis exhibited some type of cerebral dysfunction while none of those who had osteoarthritis showed signs of the condition.

"We are collecting human bones to confirm this," Dr Landete stated. "However, studies on rats in which Alzheimer's disease has been induced by aluminum intoxication show that as the severity of this disease increases, manganese levels in the bones decrease."

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