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Long-term effects of nutrient intervention on markers of bone remodeling and calciotropic hormones in late-postmenopausal women^1,2,3,4

¹ From the University of California, Berkeley, School of Public Health, Department of Epidemiology (CJ, GB, and EG); the Aging Study Unit, Geriatrics Research, Education and Clinical Center, Veterans Affairs Medical Center, Palo Alto, CA (LH, GB, and RM); the Health Research and Studies Center, Los Altos, CA (GS); and the University of California, San Francisco, Medical Effectiveness Research Center (GG).

Background: Adequate intakes of calcium and vitamin D reduce bone loss and fracture risk in the elderly. Other nutrients also affect bone health, and adequate intakes may influence bone turnover and balance.

Objective: We compared the long-term effects on bone turnover markers and calciotropic hormones of a multinutrient supplement, a calcium and vitamin D supplement, and dietary instruction aimed at increasing calcium intake through foods.

Design: Ninety-nine healthy postmenopausal women participated in a 3-y, randomized trial, receiving either 1) supplemental calcium (1450 mg/d) and vitamin D [10 µg (400 IU)/d], 2) calcium, vitamin D, and other nutrients (multinutrient supplement), or 3) dietary instruction (dietary control group). Data are from 83 subjects who completed the trial.

Results: Increases over baseline in calcium intakes and serum 25-hydroxyvitamin D concentrations were sustained over 3 y in all treatment groups. Circulating parathyroid hormone concentrations were reduced at year 1 in all treatment groups but trended toward baseline thereafter. Bone turnover markers followed a similar pattern, and none of the changes in biochemical concentrations differed significantly between groups.

Conclusions: All 3 interventions offer long-term feasibility for increasing calcium intake and serum 25-hydroxyvitamin D concentrations. The dietary addition of micronutrients implicated in skeletal physiology confers no obvious bone-sparing effect in healthy postmenopausal women beyond that of calcium and vitamin D alone. The attenuation over time in suppression of parathyroid hormone and bone turnover might help explain why nutrient intervention tends to have less of a bone-sparing effect than do skeletally active medications such as estrogen or bisphosphonates.

Key Words: Postmenopausal women • calcium • vitamin D • trace minerals • bone turnover • parathyroid hormone • 25-hydroxyvitamin D • insulin-like growth factor I

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