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American Journal of Clinical Nutrition, Vol. 86, No. 1, 251-259, July 2007
© 2007 American Society for Nutrition

ORIGINAL RESEARCH COMMUNICATION

Bone mineral density and bone markers in patients with a recent low-energy fracture: effect of 1 y of treatment with calcium and vitamin D1,2,3

Mette F Hitz, Jens-Erik B Jensen and Peter C Eskildsen

1 From the Medical Department, Roskilde University Hospital Koge, Koge, Denmark (MFH and PCE), and the Calcium- and Bone-Metabolic Unit, Endocrine Department, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark (J-EBJ)

Background: Low-energy fractures of the hip, forearm, shoulder, and spine are known consequences of osteoporosis.

Objective: We evaluated the effect of 1 y of treatment with calcium and vitamin D on bone mineral density (BMD) and bone markers in patients with a recent low-energy fracture.

Design: In a double-blinded design, patients with fracture of the hip (lower-extremity fracture, or LEF) or upper extremity (UEF) were randomly assigned to receive 3000 mg calcium carbonate + 1400 IU cholecalciferol or placebo (200 IU cholecalciferol). BMD of the hip (HBMD) and lumbar spine (LBMD) were evaluated by dual-energy X-ray absorptiometry, and physical performance was assessed by the timed Up & Go test. Serum concentrations of 25-hydroxycholecalciferol, parathyroid hormone (PTH), telepeptide of type I collagen (ICTP), osteocalcin, and N-terminal propeptide of collagen type I were measured.

Results: A total of 122 patients were included (84% women; x ± SD age: 70 ± 11 y); 68% completed the study. In an intention-to-treat analysis, LBMD increased in the intervention group and decreased in the placebo group, and the difference between the groups was significant after 12 mo: 0.931 ± 0.211 compared with 0.848 ± 0.194 (P < 0.05). No significant change was shown for HBMD. The effect of treatment was more pronounced in patients aged <70 y. The intervention decreased bone turnover. PTH was significantly lower in the intervention group (P < 0.01) for the LEF patients. ICTP and change in LBMD were significantly related to physical performance.

Conclusions: A 1-y intervention with calcium and vitamin D reduced bone turnover, significantly increased BMD in patients younger than 70 y, and decreased bone loss in older patients. The effect of treatment was related to physical performance.

Key Words: Bone markers • bone mineral density • calcium • immobility • low-energy fracture • hip fracture • shoulder fracture • forearm fracture • vitamin D






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