Nieves J W, Komar L, Cosman F, Lindsay R
Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY 10993, USA.
Am J Clin Nutr. 1998 Jan;67(1):18-24. doi: 10.1093/ajcn/67.1.18.
We reviewed published clinical trials that measured bone mass of postmenopausal women from at least one skeletal site to evaluate whether calcium supplementation influenced the efficacy of estrogens and intranasal calcitonin on bone mass change. We compared results of the administration of oral estrogen or nasal calcitonin in conjuction with additional calcium intake either through diet or supplements compared with those of estrogen or calcitonin alone. Of the 31 published estrogen trials analyzed, 20 modified the diet or used a calcium supplement (total 1183 mg/d) and 11 did not (total 563 mg/d). The mean increase in bone mass of the lumbar spine when estrogen was given alone was 1.3%/y (n = 5) compared with 3.3%/y when estrogen was given in conjunction with calcium (n = 14; P = 0.01). The mean increase in bone mass of the femoral neck with estrogen alone (n = 3) was only 0.9%/y compared with 2.4%/y when calcium was given with estrogen (n = 6; P = 0.04). Similarly, forearm bone mass increased 0.4%/y with estrogen alone (n = 7) compared with 2.1%/y when estrogen was given with calcium (n = 12; P = 0.04). Similar results were found when weighted means were calculated. Of the seven published trials evaluating the effects of 200 IU nasal salmon calcitonin, six also used calcium supplements (total 1466 mg/d) whereas one used calcitonin alone (total 627 mg/d). Bone mass of the lumbar spine increased 2.1% with calcitonin plus calcium supplementation compared with -0.2%/y with calcitonin alone. These results suggest that a high calcium intake potentiates the positive effect of estrogen on bone mass at all skeletal sites and perhaps that of calcitonin on bone mass of the spine.
我们回顾了已发表的临床试验，这些试验测量了绝经后女性至少一个骨骼部位的骨量，以评估补钙是否会影响雌激素和鼻内降钙素对骨量变化的疗效。我们比较了口服雌激素或鼻内降钙素联合通过饮食或补充剂额外摄入钙与单独使用雌激素或降钙素的给药结果。在分析的31项已发表的雌激素试验中，20项改变了饮食或使用了钙补充剂（总计1183毫克/天），11项未使用（总计563毫克/天）。单独使用雌激素时，腰椎骨量的平均年增加率为1.3%（n = 5），而联合补钙时为3.3%（n = 14；P = 0.01）。单独使用雌激素时，股骨颈骨量的平均年增加率仅为0.9%（n = 3），联合补钙时为2.4%（n = 6；P = 0.04）。同样，单独使用雌激素时，前臂骨量的年增加率为0.4%（n = 7），联合补钙时为2.1%（n = 12；P = 0.04）。计算加权平均值时也发现了类似结果。在评估200 IU鼻内鲑鱼降钙素效果的7项已发表试验中，6项也使用了钙补充剂（总计1466毫克/天），而1项仅使用了降钙素（总计627毫克/天）。联合补钙时，降钙素使腰椎骨量增加了2.1%，而单独使用降钙素时为-0.2%/年。这些结果表明，高钙摄入可增强雌激素对所有骨骼部位骨量的积极作用，可能也增强降钙素对脊柱骨量的作用。
