Bischoff-Ferrari Heike A, Dawson-Hughes Bess, Baron John A, Burckhardt Peter, Li Ruifeng, Spiegelman Donna, Specker Bonny, Orav John E, Wong John B, Staehelin Hannes B, O'Reilly Eilis, Kiel Douglas P, Willett Walter C
Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
Am J Clin Nutr. 2007 Dec;86(6):1780-90. doi: 10.1093/ajcn/86.5.1780.
The role of total calcium intake in the prevention of hip fracture risk has not been well established.
The objective of the study was to assess the relation of calcium intake to the risk of hip fracture on the basis of meta-analyses of cohort studies and clinical trials.
In women (7 prospective cohort studies, 170,991 women, 2,954 hip fractures), there was no association between total calcium intake and hip fracture risk [pooled risk ratio (RR) per 300 mg total Ca/d = 1.01; 95% CI: 0.97, 1.05]. In men (5 prospective cohort studies, 68,606 men, 214 hip fractures), the pooled RR per 300 mg total Ca/d was 0.92 (95% CI: 0.82, 1.03). On the basis of 5 clinical trials (n = 5666 women, primarily postmenopausal, plus 1074 men) with 814 nonvertebral fractures, the pooled RR for nonvertebral fractures between calcium supplementation (800-1600 mg/d) and placebo was 0.92 (95% CI: 0.81, 1.05). On the basis of 4 clinical trials with separate results for hip fracture (6,504 subjects with 139 hip fractures), the pooled RR between calcium and placebo was 1.64 (95% CI:1.02, 2.64). Sensitivity analyses including 2 additional small trials with <100 participants or per-protocol results did not substantially alter results.
Pooled results from prospective cohort studies suggest that calcium intake is not significantly associated with hip fracture risk in women or men. Pooled results from randomized controlled trials show no reduction in hip fracture risk with calcium supplementation, and an increased risk is possible. For any nonvertebral fractures, there was a neutral effect in the randomized trials.
膳食总钙摄入量在预防髋部骨折风险中的作用尚未完全明确。
本研究旨在通过对队列研究和临床试验的荟萃分析，评估钙摄入量与髋部骨折风险之间的关系。
在女性中（7项前瞻性队列研究，共170,991名女性，2,954例髋部骨折），膳食总钙摄入量与髋部骨折风险之间无关联[每300mg总钙/天的合并风险比（RR）=1.01；95%置信区间（CI）：0.97，1.05]。在男性中（5项前瞻性队列研究，共68,606名男性，214例髋部骨折），每300mg总钙/天的合并RR为0.92（95%CI：0.82，1.03）。基于5项临床试验（n = 5666名女性，主要为绝经后女性，外加1074名男性），共814例非椎体骨折，补充钙剂（800 - 1600mg/天）与安慰剂相比，非椎体骨折的合并RR为0.92（95%CI：0.81，1.05）。基于4项分别报告髋部骨折结果的临床试验（6504名受试者，139例髋部骨折），钙剂与安慰剂之间的合并RR为1.64（95%CI：1.02，2.64）。敏感性分析纳入另外2项参与者少于100人的小型试验或按方案分析结果，未对结果产生实质性影响。
前瞻性队列研究的汇总结果表明，无论男性还是女性，钙摄入量与髋部骨折风险均无显著关联。随机对照试验的汇总结果显示，补充钙剂并未降低髋部骨折风险，甚至可能增加风险。对于任何非椎体骨折，随机试验显示为中性效应。
