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

doi:10.1136/bmj.38950.561400.55

BMJ, 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 ¹^*, Kelly Shaw ², Jayne Fryer ¹, Graeme Jones ¹

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

^* Correspondence to: tania.winzenberg{at}utas.edu.au.

Objectives To assess the effectiveness of calcium supplementationfor improving bone mineral density in healthy children and todetermine if any effect is modified by other factors and persistsafter supplementation stops.

Design Meta-analysis.

Data sourcesElectronic bibliographic databases, hand searching of conferenceproceedings, and contacting authors for unpublished data.

Reviewmethods We included randomised placebo controlled trials ofcalcium supplementation in healthy children that lasted at leastthree months and had bone outcomes measured after at least sixmonths of follow-up. Two reviewers independently extracted dataand assessed quality. Meta-analyses predominantly used fixedeffects models with outcomes given as standardised mean differences.

ResultsWe included 19 studies involving 2859 children. Calcium supplementationhad no effect on bone mineral density at the femoral neck orlumbar spine. There was a small effect on total body bone mineralcontent (standardised mean difference 0.14, 95% confidence interval0.01 to 0.27) and upper limb bone mineral density (0.14, 0.04to 0.24). This effect persisted after the end of supplementationonly at the upper limb (0.14, 0.01 to 0.28). There was no evidencethat sex, baseline calcium intake, pubertal stage, ethnicity,or level of physical activity modified the effect.

ConclusionsThe small effect of calcium supplementation on bone mineraldensity in the upper limb is unlikely to reduce the risk offracture, either in childhood or later life, to a degree ofmajor public health importance.

(Accepted 2 August 2006)

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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.
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In reply: Graeme Jones, et al.
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Role of calcium supplementation is very limited in improving bone mineral density in all age groups: Jai B Sharma MD MRCOG, et al.
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Adequate calcium intake plus high physical activity may be useful for bone health in children: Toshihiro Sugiyama
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Take account of calcium excretion: Clare M Hamon
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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]