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Better bones: Will calcium and vitamin D help?

The confusion for women about whether or not to take supplements is at an all-time high. "Today" contributor Dr. Judith Reichman sheds some light.

For the past decade, women have been exhorted to cut down on fat consumption and to get their calcium and vitamin D, through nutrition, sunlight and supplements. Then, last month the promise that doing this every day, would keep the doctor away, appeared to be broken, when results from the Women’s Health Initiative (WHI), clinical trial were published in The Journal of the American Medical Association (JAMA), and the New England Journal of Medicine (NEJM.)  Medical contributor, Dr. Judith Reichman was invited to appear on "Today" to shed some light on how women should process this information and what the studies mean. Here's more on the subject:

The Women's Health Initiative study was the first federally funded study by the U.S. Government to look solely at women. It was initially designed to look at whether diets (low-fat diets, calcium and vitamin d supplements) had an effect on major diseases — primarily breast cancer, colorectal cancer and osteoporosis. Later heart disease was added to the study initiatives. Forty-eight thousand post-menopausal women (with the average age of 63) were tracked. (Fourteen thousand also participated in the hormone study that made news in 2002.)

In terms of the vitamin D/calcium component of the study, 36,000 women were followed for seven years. The control group was allowed to follow their regular diet and take whatever supplements they wanted (up to 1000 mg of calcium and 600 units of vitamin D) and the test group were given supplements that were chewable or pill form that contained 500 mg of calcium carbonate and 200 units of vitamin D. The supplements were to be taken twice a day.  (Calcium needs vitamin D to be absorbed into the body.) The study found as reported in recent headlines that "among healthy post-menopausal women, calcium and vitamin D supplementation resulted in a small but significant improvement, in hip bone density, did not significantly reduce hip fractures and increased the risk of kidney stones." This led some people to question whether they should continue taking their calcium pills. 

So what should women do?
First, you should read beyond the headline. Two issues should be considered when looking at the results. First, there wasn't that much of a difference between the control group and the test group since women were still allowed to take calcium/vitamin D supplements. And since the women weren't living in a bubble, as they read about the benefits of calcium/vitamin D they took supplements on their own. By the end of the study 69 percent were taking calcium supplements and 41 percent of the test group had stopped taking the calcium/vitamin D supplements. Also many of the women were given Fosomax, Actonel and Miacalcin — medications designed to help prevent/treat osteoporosis by diminishing bone lose.

Second, the average age of the WHI study was 63 — post-menopausal women. Since women begin to lose bone density starting at age 30 and even more after menopause, by 63 their bone density is already low. The belief is that for calcium/vitamin D supplements to be effective, women should start taking them before they reach menopause so they can stem the tide of bone loss. 

The study did seem to find that women over 60 did seem to have a reduced rate of hip fractures.

Since the study also found that renal/kidney stones were an issue for some women, women should consult their doctor to determine the best form the calcium/vitamin D supplement should be taken. Calcium Citrate has been shown to be less likely to cause stone formation than calcium carbonate. 

The bottom line: I recommend that my patients take 800 to 1000 units of vitamin D per day since other studies have shown that we need higher vitamin D levels as we get older, as well as calcium supplements. Also women should know that after menopause they may not be able to just rely on calcium and vitamin D to treat or prevent osteoporosis. Fosomax, Actonel Boniva and Misacalcin help stop bone loss. In a sense you need both if you find that you are losing bone density.

As women get older they should also consider getting a baseline bone density scan/test to determine if they are losing bone density at a fast or slow rate. Urine tests can also determine how active bone loss is. If you are losing bone density, you should consult your doctor to determine the best course of action, which could include the medicine listed above as well as weight bearing exercises which have been shown to help. The WHI Study did not look at the impact of exercise on bone density levels. 

Other studies on vitamin D
After reviewing 63 studies, researchers found that vitamin D may lower risk for certain cancers like breast, colon and ovarian. The federal government isn't telling people to take higher doses of vitamin D yet, but if you look at the connection between vitamin D and lab animals it may protect against cancer. The bottom line about this is that more studies need to be done.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.