COMMENTARY

Calcium + Vitamin D: Surprises From Long-term Follow-up

JoAnn E. Manson, MD, DrPH

Disclosures

December 11, 2013

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Hello. This is Dr. JoAnn Manson, Professor of Medicine at Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts. I want to talk about an update of the long-term follow-up of the calcium and vitamin D supplementation trial in the Women's Health Initiative.

A report by Jane Cauley and colleagues[1] was published last month in the Journal of Women's Health. I encourage you to take a look at the details of the study, because it includes interesting new findings. Today, I will touch on a few of the key points.

In this large trial, more than 36,000 postmenopausal women aged 50-79 years were randomly assigned to treatment with a combination of calcium carbonate at a dose of 1000 mg elemental calcium plus vitamin D3 400 IU daily, or placebo. Women received treatment for an average of 7 years. This follow-up took place an average of 5 years after intervention, for a total follow-up of about 12 years.

The overall outcomes for hip fracture in the intention-to-treat analysis were neutral; the trial showed no significant reduction in hip fracture among the active treatment group. However, the analyses that were limited to adherent women who were taking at least 80% of their study pills compared with the women who were taking at least 80% of their placebo pills showed a statistically significant 29% reduction in the risk for hip fracture.

In addition, with the follow-up now at 12 years, a significant 13% reduction in vertebral fracture emerged in the active treatment group, even in the intention- to-treat analyses. And already reported was the significant improvement in bone mineral density of the hip for those receiving active treatment vs placebo, as measured by DXA (dual-energy X-ray absorptiometry).

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