Dietary calcium and risk of fracture in osteoporosis

• this has no role as a sole treatment of osteoporosis unless there is inadequate dietary intake (1,2)
  
  
• evidence that an inadequate dietary intake of calcium is associated with increased fracture risk (3):
  • consumption of milk, yoghurt, and cheese, foods rich in calcium and protein, slows bone loss and improves insulin-like growth factor 1
  • Luliano et al conducted a prospective, two year, cluster randomised controlled trial to test the hypothesis that achieving recommended intakes of 1300 mg/day calcium and 1 g protein/kg body weight will reduce the risk of fragility fractures and falls when targeted to institutionalised older adults replete in vitamin D but with intakes below these levels
    • intervention was associated with risk reductions of 33% for all fractures (121 v 203; hazard ratio 0.67, 95% confidence interval 0.48 to 0.93; P=0.02), 46% for hip fractures (42 v 93; 0.54, 0.35 to 0.83; P=0.005), and 11% for falls (1879 v 2423; 0.89, 0.78 to 0.98; P=0.04)
    • risk reduction for hip fractures and falls achieved significance at five months (P=0.02) and three months (P=0.004), respectively
    • mortality was unchanged (900 v 1074; hazard ratio 1.01, 0.43 to 3.08)
  • study authors concluded that:
    • "..Although the risk of fracture attributable to undernutrition may be small in an individual, the large number of older adults in aged care confers a large fracture burden in the community; institutionalised people are the source of about 30% of all hip fractures...A high calcium and high protein nutritional intervention reduced the risk of falls and fractures. This intervention was tailored to the preferences of the residents and was successfully delivered through the food service using regular retail milk, yoghurt, and cheese incorporated into existing menus. In conclusion, this nutritional intervention has widespread implications as a public health measure for fracture prevention in the aged care setting and potentially in the wider community..."

Note that when combined with vitamin D, it is helpful as a treatment for osteoporosis (2)

Reference:

1. MeReC Bulletin (1999), 10 (7), 25-8.
2. Drug and Therapeutics Bulletin (2002), 40 (11), 83-6.
3. Luliano S, Poon S, Robbins J, Bui M, Wang X, De Groot L et al. Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial BMJ 2021; 375 :n2364 doi:10.1136/bmj.n2364