Intervention Review

Calcium supplementation for improving bone mineral density in children

  1. Tania M Winzenberg1,*,
  2. Kelly A Shaw2,
  3. Jayne Fryer1,
  4. Graeme Jones1

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 14 APR 2010

Assessed as up-to-date: 21 FEB 2006

DOI: 10.1002/14651858.CD005119.pub2

Database Title

Additional Information

How to Cite

Winzenberg TM, Shaw KA, Fryer J, Jones G. Calcium supplementation for improving bone mineral density in children. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD005119. DOI: 10.1002/14651858.CD005119.pub2.

Author Information

  1. 1

    University of Tasmania, Menzies Research Institute, Hobart, TAS, Australia

  2. 2

    Public Health Unit, Menzies Research Institute, Hobart, Tasmania, Australia

*Tania M Winzenberg, Menzies Research Institute, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia. tania.winzenberg@utas.edu.au.

Publication History

  1. Publication Status: Edited (no change to conclusions), comment added to review
  2. Published Online: 14 APR 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Clinical trials have shown that calcium supplementation in children can increase bone mineral density (BMD) although this effect may not be maintained. There has been no quantitative systematic review of this intervention.

Objectives

·To determine the effectiveness of calcium supplementation for improving BMD in children.
·To determine if any effect varies by sex, pubertal stage, ethnicity or level of physical activity, and if any effect persists after supplementation is ceased.

Search methods

We searched CENTRAL, (Cochrane Central Register of Controlled Trials) (Issue 3, 2005), MEDLINE (1966 to 1 April 2005), EMBASE (1980 to 1 April 2005), CINAHL (1982 to 1 April 2005), AMED (1985 to 1 April 2005), MANTIS (1880 to 1 April 2005) ISI Web of Science (1945 to 1 April 2005), Food Science and Technology Abstracts (1969 to 1 April 2005) and Human Nutrition (1982 to 1 April 2005). Conference abstract books (Osteoporosis International, Journal of Bone and Mineral Research) were hand-searched.

Selection criteria

Randomised controlled trials of calcium supplementation (including by food sources) compared with placebo, with a treatment period of at least 3 months in children without co-existent medical conditions affecting bone metabolism. Outcomes had to include areal or volumetric BMD, bone mineral content (BMC), or in the case of studies using quantitative ultrasound, broadband ultrasound attenuation and ultrasonic speed of sound, measured after at least 6 months of follow-up.

Data collection and analysis

Two authors independently assessed trial quality and extracted data including adverse events. We contacted study authors for additional information.

Main results

The 19 trials included 2859 participants, of which 1367 were randomised to supplementation and 1426 to placebo. There was no heterogeneity in the results of the main effects analyses to suggest that the studies were not comparable. There was no effect of calcium supplementation on femoral neck or lumbar spine BMD. There was a small effect on total body BMC (standardised mean difference (SMD) +0.14, 95% CI+0.01, +0.27) and upper limb BMD (SMD +0.14, 95%CI +0.04, +0.24). Only the effect in the upper limb persisted after supplementation ceased (SMD+0.14, 95%CI+0.01, +0.28). This effect is approximately equivalent to a 1.7% greater increase in supplemented groups, which at best would reduce absolute fracture risk in children by 0.1-0.2%per annum. There was no evidence of effect modification by baseline calcium intake, sex, ethnicity, physical activity or pubertal stage. Adverse events were reported infrequently and were minor.

Authors' conclusions

While there is a small effect of calcium supplementation in the upper limb, the increase in BMD which results is unlikely to result in a clinically significant decrease in fracture risk. The results do not support the use of calcium supplementation in healthy children as a public health intervention. These results cannot be extrapolated to children with medical conditions affecting bone metabolism.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Calcium for improving bone mineral density in children

Do calcium supplements build stronger bones in children?

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

鈣質補充增進兒童骨質密度(BMD)

臨床研究顯示鈣質補充增進兒童骨質密度(BMD)，雖然其效果不一定持續。本處置未有量性的系統性回顧。

目標

評估鈣質補充增進兒童骨質密度之效果。研究有無性別，年紀、種族或運動的差異，及停止補充後是否效果持續。

搜尋策略

搜尋包括CENTRAL Cochrane Central Register of Controlled Trials) (Issue 3, 2005), MEDLINE (1966 to pril 2005), EMBASE (1980 to 1 April 2005), CINAHL (1982 to 1 April 2005), AMED (1985 to 1 April 2005), MANTIS (1880 to 1 April 2005) ISI Web of Science (194 o 1 April 2005), Food Science and Technology Abstracts (1969 to 1 April 2005 nd Human Nutrition (1982 to 1 April 2005)。同時手動搜尋Conference abstract books (Osteoporosis International, Journal of Bone and Mineral Research)。

選擇標準

隨機對照試驗比較鈣質補充(包括食物來源)或安慰劑至少使用3個月於無影響骨代謝疾病之兒童。結果評估為骨質密度(BMD)、骨質含量(BMC)或使用超音波之速率(speed of sound，SOS)及超音波寬頻之衰減率(broadband ultrasound attenuation，BUA)來測量骨質密度，至少追蹤6個月以上之測量。

資料收集與分析

兩位作者獨立進行資料摘錄包括不良事件，並對每篇試驗研究的品質進行評估。亦聯絡作者獲得更多資訊。

主要結論

19個研究包含2859例病患於分析中，其中1367位為治療組，1426位為安慰劑組。研究間結果無異質性。鈣質補充對股骨頸及腰椎骨質密度無顯著差異。鈣質補充對全身骨質含量(標準化平均差異+0.14, 95% 信賴區間CI+0.01 0.27)及上肢骨質密度(標準化平均差異 +0.14, 95% 信賴區間C 0.04, +0.24)有小的效果，只有上肢的效果在停藥後持續(標準化平均差異+0.14, 95% 信賴區間 CI+0.01, +0.28)。這效果約略增加1.7% ，最多每年絕對減少0.1 – 0.2% 骨折風險。研究顯示無基礎鈣攝取量、性別、青春期階段年齡、種族或運動上的差異，副作用少被報告且輕微。

作者結論

鈣質補充雖然對上肢骨質密度有小的效果，但這效果對減少骨折風險，無臨床顯著重要性。結果不建議在公共衛生的角度對健康兒童補充鈣質，但此結果不可引申到罹患影響疾病之兒童。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

鈣質補充增進兒童骨質密度：兒童服用鈣質補充真的會有較強壯的骨骼嗎? 19個研究包含2859位3到18歲兒童服用鈣片或安慰劑8.5個月到7年於分析中，各種鈣質補充量為300到1200毫克。研究發現鈣質補充對股骨頸及腰椎骨質密度無顯著差異。鈣質補充對全身及臂之骨質稍有增加，當停用後僅臂之骨質稍增加。研究亦顯示無性別，青春期階段年齡、種族或運動上的差異。結果顯示一般兒童不需補充鈣質。

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