The potency of it meta-studies was their full characteristics
The common rate from BMD loss of more mature blog post-menopause women is mostly about 1% per year
We incorporated 59 randomised controlled products and examined the consequences regarding each other diet calcium supplements present and you may calcium for the BMD at five skeletal sites and at three time points. How big new opinion enabled an assessment of one’s outcomes into BMD of various resources of calcium supplements-losing weight supply or products-and the consequences inside crucial subgroups such as those discussed by dose out-of calcium supplements, entry to co-applied supplement D, and you can standard health-related characteristics. The outcome try in line with those individuals out-of an early on meta-research out of 15 randomised regulated examples out-of calcium, which stated an increase in BMD of 1.6-2.0% over 2 to 4 ages.72
An essential restriction would be the fact BMD is a surrogate for the newest clinical result of fracture. We undertook the comment, however, due to the fact a number of the subgroup analyses from the dataset out of examples which have crack because the an enthusiastic endpoint have limited power,10 and you will a comparison ranging from randomised regulated examples regarding weight reduction supplies out-of calcium supplements and calcium supplements with fracture given that endpoint are extremely hard due to the fact simply a couple short randomised controlled trials off dietary sourced elements of calcium supplements stated fracture studies.ten Other restrict is that from inside the 60% of your own meta-analyses, analytical heterogeneity between joingy hesap silme the studies are high (We 2 >50%). It appears large variability regarding results of provided products, although this was have a tendency to by the presence regarding a tiny amount of rural show. Subgroup analyses generally failed to dramatically eliminate otherwise explain the heterogeneity. I put haphazard effects meta-analyses that bring heterogeneity into consideration, as well as their efficiency should be translated because the reflecting the typical effect along the group of trials.
Ramifications from conclusions
Its lack of one communication that have standard losing weight calcium consumption or an amount-effect relation shows that expanding consumption courtesy dietary present or as a consequence of drugs cannot proper a diet deficit (in which case deeper outcomes might be observed in people with a decreased intakes or even the high amounts). An alternative chance is that broadening calcium consumption has a failing anti-resorptive feeling. Calcium supplements dump markers of bone formation and you can resorption from the throughout the 20%,62 65 73 and you will growing dairy intake along with minimizes bone turount.74 Suppression out of bone turount might lead to the tiny observed expands in the BMD.
Increases in BMD of about 1-2% over one to five years are unlikely to translate into clinically meaningful reductions in fractures. So the effect of increasing calcium intake is to prevent about one to two years of normal BMD loss, and if calcium intake is increased for more than one year it will slow down but not stop BMD loss. Epidemiological studies suggest that a decrease in BMD of one standard deviation is associated with an increase in the relative risk of fracture of about 1.5-2.0.75 A one standard deviation change in BMD is about equivalent to a 10% change in BMD. Based on these calculations, a 10% increase in BMD would be associated with a 33-50% reduction in risk of fracture. Therefore, the 1-2% increase in BMD observed with increased calcium intake would be predicted to produce a 5-10% reduction in risk of fracture. These estimates are consistent with findings from randomised controlled trials of other agents. The modest increases in BMD with increased calcium intake are smaller than observed with weak anti-resorptive agents such as etidronate76 and raloxifene.77 Etidronate, however, does not reduce vertebral or non-vertebral fractures, and raloxifene reduces vertebral but not non-vertebral fractures.78 In contrast, potent anti-resorptive agents such as alendronate, zoledronate, and denosumab increase BMD by 6-9% at the spine and 5-6% at the hip over three years.79 80 81 82 These changes are associated with reductions of 44-70% in vertebral fracture, 35-41% in hip fracture, and 15-25% in non-vertebral fractures.78 The magnitude of fracture reduction predicted by the small increases in BMD we observed with increased calcium intake are also consistent with the findings of our systematic review of calcium supplements and fracture.10 We observed small (<15%) inconsistent reductions in total and vertebral fracture overall but no reductions in fractures in the large randomised controlled trials at lowest risk of bias and no reductions in forearm or hip fractures.