Saturday, June 30, 2007

Don't give up on the calcium and D!

A number of my patients quit taking calcium and D in 2006 after getting the wrong impression from news reports out of the WHI that these supplements did not help preserve bone density.

As an editorial(1) accompanying the article points out, calcium and D are necessary to prevent bone loss, but not necessarily sufficient to do the job alone in women at risk for osteoporosis. As Dr. Joel Finkelstein points out:

Calcium with vitamin D supplementation is akin to the ante for a poker game: it is where everyone starts. If the clinical data suggest that the risk of fracture is significant, however, a woman probably needs something more.

Furthermore, Dr. Finkelstein and others have noted that the vitamin D dose used in this sub-study of the WHI was only 400 units, and other studies have suggested that doses of 700 units or more are needed to positively affect bones.

Here's the other part of the report that never made it into the popular media. Only 59% of study subjects actually stuck with the program and took the calcium and D as directed. If the data was analyzed for hip fracture protection in the compliant group alone, there was a 29% risk reduction.(2)

1. NEJMVolume 354:750-752 February 16, 2006 Number 7
2, NEJMVolume 354:669-683 February 16, 2006 Number 7

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