EFFECTS OF CALCIUM SUPPLEMENTATION ON THE RISK OF FRACTURE IN OLDER ADULTS

Li, Jianlei

doi:10.1590/1413-785220253306e284103

home Sumário navigate_before Anterior Atual Seguinte navigate_next

home Sumário

Review Article/Trauma • Acta Ortop Bras 33 (6) • 2025 • https://doi.org/10.1590/1413-785220253306e284103 linkcopy

EFFECTS OF CALCIUM SUPPLEMENTATION ON THE RISK OF FRACTURE IN OLDER ADULTS

EFEITOS DA SUPLEMENTAÇÃO DE CÁLCIO NO RISCO DE FRATURA EM ADULTOS IDOSOS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

To explore the effect of calcium supplementation on the risk of fractures at various sites in older adults based on randomized controlled trials (RCTs). PubMed, Embase, and the Cochrane Library were systematically searched for eligible RCTs from their inception until May 2023. The included trials investigated the effect of calcium supplementation on the risk of fracture in individuals aged 50 years or above, regardless of the use or nonuse of vitamin D. The primary and secondary outcome measures were total, vertebral, nonvertebral, and hip fractures. Twenty-three RCTs involving 70,837 individuals were enrolled. Calcium supplementation demonstrated a significant reduction in the risk of total (RR: 0.93; 95% CI: 0.88–0.99; P=0.019) and nonvertebral (RR: 0.93; 95% CI: 0.87–0.99; P=0.023) fractures. No significant differences were observed in vertebral (RR: 0.87; 95% CI: 0.75–1.01; P=0.074) and hip (RR: 0.90; 95% CI: 0.73–1.12; P=0.355) fractures between calcium and placebo or no treatment. Calcium dose influenced total fracture risk (P=0.008), while history of fracture (P=0.044), calcium dose (P=0.041), and follow-up duration (P=0.031) affected nonvertebral fracture risk. Follow-up duration impacted hip fracture risk (P=0.001). Calcium supplementation can significantly affect the risk of fracture, particularly nonvertebral fractures, in older adults. Level of Evidence I; Therapeutic Studies - Investigating the Results of Treatment.

Keywords:
Calcium; Fracture; Older Adults; Meta-Analysis

Study	Country	Sample size	Age (years)	Male (%)	Prior fracture	Vitamin D	Baseline 25 OHD	Intervention	Control	Follow-up	Jadad
Inkovaar²⁰	Finland	130 (88/42)	79.8	17.9/18.7	NA	(1000 IU/d)	NA	Calcium (1.2 g/d)	Placebo	9.0 months	3
Hansson²¹	Sweden	50 (25/25)	65.9	0.0	Yes	No	NA	Calcium (1.0 g/d)	Placebo	3.0 years	2
Chapuy²²	France	3,270 (1,634/1,636)	84.0	0.0	No	(800 IU/d)	NA	Calcium (1.2 g/d)	Placebo	1.5 years	4
Reid²³	New Zealand	122 (61/61)	58.0	0.0	No	No	37.5	Calcium (1.0 g/d)	Placebo	4.0 years	4
Recker²⁴	USA	191 (91/100)	73.5	0.0	Partial	No	25.5	Calcium (1.2 g/d)	Placebo	4.0 years	3
Dawson-Hughes²⁵	USA	389 (187/202)	71.1	46.0	NA	(700 IU/d)	29.6	Calcium (0.5 g/d)	Placebo	3.0 years	4
Riggs²⁶	USA	236 (119/117)	66.2	0.0	No	No	30.1	Calcium (1.6 g/d)	Placebo	4.0 years	2
Baron²⁷	USA	930 (464/466)	61.0	72.3	NA	No	NA	Calcium (1.2 g/d)	Placebo	4.0 years	5
Peacock²⁸	USA	253 (124/129)	73.8	28.4	Partial	No	25.0	Calcium (0.75 g/d)	Placebo	4.0 years	2
Chapuy²⁹	France	583 (393/190)	85.2	0.0	No	(800 IU/d)	8.9	Calcium (1.2 g/d)	Placebo	2.0 years	4
Avenell³⁰	UK	99 (64/35)	78.0	17.0	Yes	(800 IU/d)	NA	Calcium (1.0 g/d)	No treatment	3.8 years	3
Harwood³¹	UK	112 (75/37)	81.7	0.0	Yes	(800 IU/d)	11.9	Calcium (1.0 g/d)	No treatment	1.0 year	3
Porthouse³²	UK	3,314 (1,321/1,993)	76.8	0.0	Partial	(800 IU/d)	NA	Calcium (1.0 g/d)	No treatment	2.1 years	3
Grant³³	UK	3,949 (2,617/1,332)	77.3	15.3	Yes	(800 IU/d)	15.2	Calcium (1.0 g/d)	Placebo	2.0-5.2 years	5
Larsen³⁴	Denmark	7,073 (4,957/2,116)	74.0	39.8	No	(400 IU/d)	NA	Calcium (1.0 g/d)	No treatment	3.0 years	3
Jackson³⁵	USA	36,282 (18,176/18,106)	62.4	0.0	Partial	(400 IU/d)	18.9	Calcium (1.0 g/d)	Placebo	7.0 years	4
Prince³⁶	Australia	1,460 (730/730)	75.2	0.0	Partial	No	31.0	Calcium (0.48 g/d)	Placebo	5.0 years	4
Reid³⁷	New Zealand	1,471 (732/739)	74.3	0.0	Partial	No	20.7	Calcium (1.0 g/d)	Placebo	5.0 years	3
Bolton-Smith³⁸	UK	123 (62/61)	68.6	0.0	NA	(400 IU/d)	23.9	Calcium (1.0 g/d)	Placebo	2.0 years	3
Salovaara³⁹	Finland	3,195 (1,586/1,609)	67.3	0.0	Partial	(800 IU/d)	19.8	Calcium (1.0 g/d)	Placebo	3.0 years	3
Liu⁴⁰	China	98 (50/48)	62.1	0.0	No	(600 IU/d)	NA	Calcium (1.5 g/d)	Placebo	1.0 year	2
Xue⁴¹	China	312 (139/173)	63.6	0.0	Partial	(800 IU/d)	30.8	Calcium (0.6 g/d)	Placebo	1.0 year	3

Outcomes	Factors	Subgroup	RR and 95%CI	P value	I2 (%)	P value for I2	RRR between subgroups	P value between subgroups
Total fracture	Mean age	≥ 70.0	0.92 (0.86-0.99)	0.031	0.0	0.662	1.11 (0.83-1.49)	0.494
	Mean age	< 70.0	0.83 (0.62-1.10)	0.198	44.1	0.111	1.11 (0.83-1.49)	0.494
	Sex	Female	0.96 (0.91-1.01)	0.081	0.0	0.673	1.07 (0.93-1.22)	0.359
	Sex	Both	0.90 (0.79-1.02)	0.112	30.6	0.164	1.07 (0.93-1.22)	0.359
	Prior fracture	Yes	0.95 (0.90-0.99)	0.027	0.0	0.703	1.08 (0.81-1.44)	0.600
	Prior fracture	No	0.88 (0.66-1.16)	0.357	51.1	0.085	1.08 (0.81-1.44)	0.600
	Baseline 25 OHD	≥ 20.0	0.89 (0.76-1.04)	0.146	0.0	0.396	0.93 (0.79-1.09)	0.369
	Baseline 25 OHD	< 20.0	0.96 (0.91-1.01)	0.127	0.0	0.785	0.93 (0.79-1.09)	0.369
	Dose of calcium	≥ 1.2	0.29 (0.12-0.69)	0.005	0.0	0.918	0.31 (0.13-0.73)	0.008
	Dose of calcium	< 1.2	0.95 (0.91-0.99)	0.022	0.0	0.656	0.31 (0.13-0.73)	0.008
	Combined with vitamin D	Yes	0.96 (0.92-1.01)	0.117	0.0	0.820	1.16 (0.98-1.37)	0.089
	Combined with vitamin D	No	0.83 (0.71-0.98)	0.030	31.9	0.173	1.16 (0.98-1.37)	0.089
	Follow-up duration	≥ 3.0	0.95 (0.91-1.00)	0.041	0.0	0.491	1.20 (0.96-1.51)	0.110
	Follow-up duration	< 3.0	0.79 (0.63-0.98)	0.034	0.0	0.426	1.20 (0.96-1.51)	0.110
	Study quality	High	0.88 (0.78-1.00)	0.058	51.6	0.053	0.94 (0.80-1.10)	0.410
	Study quality	Low	0.94 (0.85-1.03)	0.171	0.0	0.820	0.94 (0.80-1.10)	0.410
Vertebral fracture	Mean age	≥ 70.0	0.83 (0.65-1.05)	0.121	0.0	0.833	0.92 (0.68-1.25)	0.602
	Mean age	< 70.0	0.90 (0.75-1.09)	0.291	0.0	0.946	0.92 (0.68-1.25)	0.602
	Sex	Female	0.88 (0.76-1.03)	0.112	0.0	0.975	1.35 (0.62-2.94)	0.443
	Sex	Both	0.65 (0.30-1.37)	0.254	0.0	0.688	1.35 (0.62-2.94)	0.443
	Prior fracture	Yes	0.87 (0.75-1.02)	0.083	0.0	0.935	1.07 (0.4-2.62)	0.875
	Prior fracture	No	0.81 (0.34-1.97)	0.646	0.0	0.583	1.07 (0.4-2.62)	0.875
	Baseline 25 OHD	≥ 20.0	0.82 (0.65-1.04)	0.109	0.0	0.881	0.90 (0.66-1.22)	0.505
	Baseline 25 OHD	< 20.0	0.91 (0.75-1.11)	0.352	0.0	0.613	0.90 (0.66-1.22)	0.505
	Dose of calcium	≥ 1.2	0.85 (0.58-1.25)	0.417	0.0	0.964	0.97 (0.64-1.47)	0.871
	Dose of calcium	< 1.2	0.88 (0.74-1.03)	0.111	0.0	0.918	0.97 (0.64-1.47)	0.871
	Combined with vitamin D	Yes	0.90 (0.74-1.09)	0.292	0.0	0.789	1.08 (0.80-1.47)	0.600
	Combined with vitamin D	No	0.83 (0.66-1.05)	0.127	0.0	0.916	1.08 (0.80-1.47)	0.600
	Follow-up duration	≥ 3.0	0.87 (0.75-1.01)	0.074	0.0	0.970	-	-
	Follow-up duration	< 3.0	-	-	-	-	-	-
	Study quality	High	0.93 (0.78-1.11)	0.433	0.0	0.768	1.22 (0.89-1.69)	0.217
	Study quality	Low	0.76 (0.58-0.99)	0.043	0.0	0.990	1.22 (0.89-1.69)	0.217
Non-vertebral fracture	Mean age	≥ 70.0	0.88 (0.80-0.97)	0.009	2.7	0.417	0.91 (0.81-1.01)	0.087
	Mean age	< 70.0	0.97 (0.92-1.03)	0.391	0.0	0.674	0.91 (0.81-1.01)	0.087
	Sex	Female	0.91 (0.84-1.00)	0.046	14.5	0.309	0.99 (0.84-1.17)	0.897
	Sex	Both	0.92 (0.80-1.06)	0.253	3.2	0.396	0.99 (0.84-1.17)	0.897
	Prior fracture	Yes	0.97 (0.92-1.02)	0.203	0.0	0.944	1.21 (1.01-1.46)	0.044
	Prior fracture	No	0.80 (0.67-0.96)	0.018	5.4	0.366	1.21 (1.01-1.46)	0.044
	Baseline 25 OHD	≥ 20.0	0.87 (0.71-1.05)	0.147	7.9	0.368	0.90 (0.73-1.10)	0.292
	Baseline 25 OHD	< 20.0	0.97 (0.92-1.02)	0.271	0.0	0.917	0.90 (0.73-1.10)	0.292
	Dose of calcium	≥ 1.2	0.80 (0.68-0.95)	0.009	0.0	0.380	0.83 (0.70-0.99)	0.041
	Dose of calcium	< 1.2	0.96 (0.91-1.01)	0.137	0.0	0.636	0.83 (0.70-0.99)	0.041
	Combined with vitamin D	Yes	0.89 (0.79-1.00)	0.052	35.0	0.138	0.96 (0.80-1.14)	0.630
	Combined with vitamin D	No	0.93 (0.81-1.06)	0.260	0.0	0.752	0.96 (0.80-1.14)	0.630
	Follow-up duration	≥ 3.0	0.96 (0.91-1.01)	0.144	0.0	0.614	1.22 (1.02-1.45)	0.031
	Follow-up duration	< 3.0	0.79 (0.67-0.94)	0.007	0.0	0.540	1.22 (1.02-1.45)	0.031
	Study quality	High	0.89 (0.79-0.99)	0.040	49.4	0.054	0.94 (0.76-1.16)	0.546
	Study quality	Low	0.95 (0.79-1.13)	0.551	0.0	0.960	0.94 (0.76-1.16)	0.546
Hip fracture	Mean age	≥ 70.0	0.92 (0.69-1.22)	0.559	49.7	0.025	1.03 (0.73-1.46)	0.851
	Mean age	< 70.0	0.89 (0.73-1.08)	0.236	0.0	0.490	1.03 (0.73-1.46)	0.851
	Sex	Female	0.90 (0.68-1.20)	0.481	44.8	0.070	0.98 (0.61-1.57)	0.928
	Sex	Both	0.92 (0.63-1.35)	0.682	36.8	0.148	0.98 (0.61-1.57)	0.928
	Prior fracture	Yes	1.02 (0.77-1.35)	0.886	46.8	0.043	1.44 (0.99-2.08)	0.056
	Prior fracture	No	0.71 (0.56-0.91)	0.007	0.0	0.618	1.44 (0.99-2.08)	0.056
	Baseline 25 OHD	≥ 20.0	1.76 (0.69-4.48)	0.237	31.9	0.221	1.85 (0.71-4.82)	0.206
	Baseline 25 OHD	< 20.0	0.95 (0.78-1.16)	0.612	16.4	0.308	1.85 (0.71-4.82)	0.206
	Dose of calcium	≥ 1.2	0.72 (0.56-0.92)	0.008	0.0	0.580	0.72 (0.50-1.04)	0.081
	Dose of calcium	< 1.2	1.00 (0.76-1.31)	0.984	40.4	0.065	0.72 (0.50-1.04)	0.081
	Combined with vitamin D	Yes	0.84 (0.73-0.97)	0.018	0.0	0.655	0.69 (0.36-1.33)	0.270
	Combined with vitamin D	No	1.21 (0.64-2.27)	0.554	65.8	0.007	0.69 (0.36-1.33)	0.270
	Follow-up duration	≥ 3.0	1.14 (0.89-1.47)	0.306	21.4	0.239	1.70 (1.23-2.36)	0.001
	Follow-up duration	< 3.0	0.67 (0.54-0.82)	< 0.001	0.0	0.808	1.70 (1.23-2.36)	0.001
	Study quality	High	0.85 (0.69-1.05)	0.139	42.0	0.078	0.62 (0.30-1.30)	0.204
	Study quality	Low	1.37 (0.68-2.79)	0.381	22.6	0.264	0.62 (0.30-1.30)	0.204

vertical_align_top show_chart

more_horiz close
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

ATHA EDITORA Rua: Machado Bittencourt, 190, 4º andar - Vila Mariana - São Paulo Capital - CEP 04044-000, Telefone: 55-11-5087-9502 - São Paulo - SP - Brazil
E-mail: actaortopedicabrasileira@uol.com.br

rss_feed Acompanhe os números deste periódico no seu leitor de RSS