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Kalsiuminsaanti ja luuntiheys menopaussin ohittaneilla naisilla

Näytönastekatsaukset
Christel Lamberg-Allardt
10.2.2014

Näytön aste: B

Riittävä kalsiuminsaanti ilmeisesti hidastaa luumassan vähenemistä menopaussin ohittaneilla naisilla.

Vuosien 2002–2012 välillä on julkaistu 4 systemaattista kirjallisuuskatsausta tai meta-analyysia «Cranney A, Horsley T, O'Donnell S ym. Effectivenes...»1, «Chung M, Balk EM, Brendel M ym. Vitamin D and calc...»2, «Shea B, Wells G, Cranney A ym. Meta-analyses of th...»3, «Waugh EJ, Lam MA, Hawker GA ym. Risk factors for l...»4 aiheesta kalsiumin saanti ja luunmineraalitiheys postmenopausaalisilla naisilla. Näitä on arvioitu systemaattisessa katsauksessa «Uusi-Rasi K, Kärkkäinen MU, Lamberg-Allardt CJ. Ca...»5. Alla oleva teksti perustuu siihen.

The meta-analysis of Shea et al. «Shea B, Wells G, Cranney A ym. Meta-analyses of th...»3 included 15 RCTs with Ca supplementations (N=1,806, out of them 953 were Ca supplemented). The pooled mean (95 % CI) difference in bone loss between the supplemented and placebo groups in percentage change from baseline was 1.66 % (0.92 - 2.39 %) for the lumbar spine (nine studies), 1.64 % (0.70 - 2.57%) for the hip (eight studies), and 1.91 % (0.33 - 3.50 %) for the distal radius (six studies) favoring Ca supplementation. They concluded that Ca supplementation alone had a small positive effect on bone density.

Chung et al. «Chung M, Balk EM, Brendel M ym. Vitamin D and calc...»2 included in their large review the Cranney et al. report «Cranney A, Horsley T, O'Donnell S ym. Effectivenes...»1 and did an update search of RCTs published after that. The review did not separate Ca trials from Ca in combination with vitamin D trials. The Cranney et al. report «Cranney A, Horsley T, O'Donnell S ym. Effectivenes...»1 concluded that overall, there is good evidence that combined vitamin D3 and Ca supplementation resulted in small increases in BMD of the spine, total body, femoral neck, and total hip. The update search of Chung et al. «Chung M, Balk EM, Brendel M ym. Vitamin D and calc...»2 did not find evidence to change this conclusion, although quantitative synthesis was limited due to variable treatment durations and BMD sites.

The SR (systematic review) by Waugh et al. «Waugh EJ, Lam MA, Hawker GA ym. Risk factors for l...»4 evaluated risk factors for low BMD among 40- to 60-year-old women. They found an inconsistent evidence of an association between the current Ca intake and BMD (four studies) and insufficient evidence of an association between the past Ca intake and BMD (one study). None of these studies were intervention studies, and Ca intake was self-reported. They concluded that evidence of an association between the current Ca intake and BMD was inconsistent and insufficient for past Ca intake and BMD.

Uus-Rasi et al. «Uusi-Rasi K, Kärkkäinen MU, Lamberg-Allardt CJ. Ca...»5 concluded: In postmenopausal women, a positive treatment effect on BMD was evident in most studies. Ca supplementation had a relatively small, but possibly meaningful, effect in reducing bone loss. Ca in combination with vitamin D3 supplementation resulted in small increases in BMD of the spine, femoral neck, and total hip. Based on included trials, it was less certain whether vitamin D3 supplementation alone has a significant effect on BMD.

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: hyvä

Kirjallisuutta

  1. Cranney A, Horsley T, O'Donnell S ym. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep) 2007:1-235 «PMID: 18088161»PubMed
  2. Chung M, Balk EM, Brendel M ym. Vitamin D and calcium: a systematic review of health outcomes. Evid Rep Technol Assess (Full Rep) 2009:1-420 «PMID: 20629479»PubMed
  3. Shea B, Wells G, Cranney A ym. Meta-analyses of therapies for postmenopausal osteoporosis. VII. Meta-analysis of calcium supplementation for the prevention of postmenopausal osteoporosis. Endocr Rev 2002;23:552-9 «PMID: 12202470»PubMed
  4. Waugh EJ, Lam MA, Hawker GA ym. Risk factors for low bone mass in healthy 40-60 year old women: a systematic review of the literature. Osteoporos Int 2009;20:1-21 «PMID: 18523710»PubMed
  5. Uusi-Rasi K, Kärkkäinen MU, Lamberg-Allardt CJ. Calcium intake in health maintenance - a systematic review. Food Nutr Res 2013;57 «PMID: 23687486»PubMed