BMJ  2006;333:775 (14 October), doi:10.1136/bmj.38950.561400.55 (published 15 September 2006)

Research

Effects of calcium supplementation on bone density in healthy children: meta-analysis of randomised controlled trials

Tania Winzenberg, musculoskeletal epidemiologist1, Kelly Shaw, specialist medical advisor2, Jayne Fryer, statistics fellow1, Graeme Jones, head, musculoskeletal unit1

1 Menzies Research Institute, Private Bag 23, Hobart, Tas 7001, Australia, 2 Department of Health and Human Services, Hobart, Tas 7000, Australia

Correspondence to: T Winzenberg tania.winzenberg{at}utas.edu.au

Abstract

Objectives To assess the effectiveness of calcium supplementation for improving bone mineral density in healthy children and to determine if any effect is modified by other factors and persists after supplementation stops.

Design Meta-analysis.

Data sources Electronic bibliographic databases, hand searching of conference proceedings, and contacting authors for unpublished data.

Review methods We included randomised placebo controlled trials of calcium supplementation in healthy children that lasted at least three months and had bone outcomes measured after at least six months of follow-up. Two reviewers independently extracted data and assessed quality. Meta-analyses predominantly used fixed effects models with outcomes given as standardised mean differences.

Results We included 19 studies involving 2859 children. Calcium supplementation had no effect on bone mineral density at the femoral neck or lumbar spine. There was a small effect on total body bone mineral content (standardised mean difference 0.14, 95% confidence interval 0.01 to 0.27) and upper limb bone mineral density (0.14, 0.04 to 0.24). This effect persisted after the end of supplementation only at the upper limb (0.14, 0.01 to 0.28). There was no evidence that sex, baseline calcium intake, pubertal stage, ethnicity, or level of physical activity modified the effect.

Conclusions The small effect of calcium supplementation on bone mineral density in the upper limb is unlikely to reduce the risk of fracture, either in childhood or later life, to a degree of major public health importance.


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Rapid Responses:

Read all Rapid Responses

To the Editor:
Robert P. Heaney, et al.
bmj.com, 26 Sep 2006 [Full text]
The Changing Face of Hypercalcaemia
Ali I Al-bahrani, et al.
bmj.com, 27 Sep 2006 [Full text]
In reply
Graeme Jones, et al.
bmj.com, 3 Oct 2006 [Full text]
Role of calcium supplementation is very limited in improving bone mineral density in all age groups
Jai B Sharma MD MRCOG, et al.
bmj.com, 13 Oct 2006 [Full text]
Adequate calcium intake plus high physical activity may be useful for bone health in children
Toshihiro Sugiyama
bmj.com, 14 Oct 2006 [Full text]
Take account of calcium excretion
Clare M Hamon
bmj.com, 14 Oct 2006 [Full text]
Effect size at the end of supplementation period in terms of g/cm2
Tanis R Fenton, et al.
bmj.com, 20 Apr 2007 [Full text]
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