Low fractional calcium absorption increases the risk for hip fracture in women with low calcium intake

Kristine E. Ensrud, Tu Duong, Jane A. Cauley, Robert P. Heaney, Randi L. Wolf, Emily Harris, Steven R. Cummings

Research output: Contribution to journalArticle

114 Citations (Scopus)

Abstract

Background: Decreased ability to absorb calcium with age limits adaptation to low calcium intake and is thought to lead to secondary hyperparathyroidism and increased risk for hip and other fractures. However, the associations between fractional calcium absorption, dietary calcium intake, and risk for fracture have never been studied. Objective: To determine whether low fractional calcium absorption in women with low calcium intake increases the risk for subsequent hip and other nonspine fractures. Design: Prospective cohort study. Setting: Four clinical centers in Baltimore County, Maryland; Portland, Oregon; Minneapolis, Minnesota; and the Monongahela Valley, Pennsylvania. Participants: 5452 nonblack women 69 years of age or older participating in the fourth examination of the Study of Osteoporotic Fractures. Measurements: Fractional calcium absorption was measured by using a 3-hour single isotope (45Ca) technique. Incident fractures were identified prospectively and were confirmed by radiographic report. Results: During an average of 4.8 years, 729 women (13%) experienced at least one nonspine fracture; 153 of these women had hip fractures. After adjustment for age, women with lower fractional calcium absorption were at increased risk for hip fracture (relative risk per 1-SD [7.7%] decrease in fractional calcium absorption, 1.24 [95% CI, 1.05 to 1.48]). Women with low fractional calcium absorption and low calcium intake were at greatest risk for subsequent hip fracture; among women whose dietary calcium intake was less than 400 mg/d, those who had fractional calcium absorption at or below the median value of 32.3% had a 2.5-fold (CI, 1.29-fold to 4.69-fold) increase in risk for hip fracture compared with those who had greater absorption efficiency. Fractional calcium absorption was not related to risk for other nonspine fractures (relative risk per 1-SD [7.7%] decrease in fractional calcium absorption, 1.05 [CI, 0.96 to 1.14]). Conclusions: In elderly women, low fractional calcium absorption in the setting of low calcium intake increases the risk for hip fracture. Our findings support the hypothesis of type II osteoporosis, which postulates that decreased calcium absorption is an important risk factor for hip fracture in older persons.

Original languageEnglish
Pages (from-to)345-353
Number of pages9
JournalAnnals of Internal Medicine
Volume132
Issue number5
StatePublished - Mar 7 2000
Externally publishedYes

Fingerprint

Hip Fractures
Calcium
Dietary Calcium
Baltimore
Secondary Hyperparathyroidism
Osteoporotic Fractures
Isotopes
Osteoporosis

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Ensrud, K. E., Duong, T., Cauley, J. A., Heaney, R. P., Wolf, R. L., Harris, E., & Cummings, S. R. (2000). Low fractional calcium absorption increases the risk for hip fracture in women with low calcium intake. Annals of Internal Medicine, 132(5), 345-353.

Low fractional calcium absorption increases the risk for hip fracture in women with low calcium intake. / Ensrud, Kristine E.; Duong, Tu; Cauley, Jane A.; Heaney, Robert P.; Wolf, Randi L.; Harris, Emily; Cummings, Steven R.

In: Annals of Internal Medicine, Vol. 132, No. 5, 07.03.2000, p. 345-353.

Research output: Contribution to journalArticle

Ensrud, KE, Duong, T, Cauley, JA, Heaney, RP, Wolf, RL, Harris, E & Cummings, SR 2000, 'Low fractional calcium absorption increases the risk for hip fracture in women with low calcium intake', Annals of Internal Medicine, vol. 132, no. 5, pp. 345-353.
Ensrud KE, Duong T, Cauley JA, Heaney RP, Wolf RL, Harris E et al. Low fractional calcium absorption increases the risk for hip fracture in women with low calcium intake. Annals of Internal Medicine. 2000 Mar 7;132(5):345-353.
Ensrud, Kristine E. ; Duong, Tu ; Cauley, Jane A. ; Heaney, Robert P. ; Wolf, Randi L. ; Harris, Emily ; Cummings, Steven R. / Low fractional calcium absorption increases the risk for hip fracture in women with low calcium intake. In: Annals of Internal Medicine. 2000 ; Vol. 132, No. 5. pp. 345-353.
@article{8b22ea01b59942938dbab017d0ed7085,
title = "Low fractional calcium absorption increases the risk for hip fracture in women with low calcium intake",
abstract = "Background: Decreased ability to absorb calcium with age limits adaptation to low calcium intake and is thought to lead to secondary hyperparathyroidism and increased risk for hip and other fractures. However, the associations between fractional calcium absorption, dietary calcium intake, and risk for fracture have never been studied. Objective: To determine whether low fractional calcium absorption in women with low calcium intake increases the risk for subsequent hip and other nonspine fractures. Design: Prospective cohort study. Setting: Four clinical centers in Baltimore County, Maryland; Portland, Oregon; Minneapolis, Minnesota; and the Monongahela Valley, Pennsylvania. Participants: 5452 nonblack women 69 years of age or older participating in the fourth examination of the Study of Osteoporotic Fractures. Measurements: Fractional calcium absorption was measured by using a 3-hour single isotope (45Ca) technique. Incident fractures were identified prospectively and were confirmed by radiographic report. Results: During an average of 4.8 years, 729 women (13{\%}) experienced at least one nonspine fracture; 153 of these women had hip fractures. After adjustment for age, women with lower fractional calcium absorption were at increased risk for hip fracture (relative risk per 1-SD [7.7{\%}] decrease in fractional calcium absorption, 1.24 [95{\%} CI, 1.05 to 1.48]). Women with low fractional calcium absorption and low calcium intake were at greatest risk for subsequent hip fracture; among women whose dietary calcium intake was less than 400 mg/d, those who had fractional calcium absorption at or below the median value of 32.3{\%} had a 2.5-fold (CI, 1.29-fold to 4.69-fold) increase in risk for hip fracture compared with those who had greater absorption efficiency. Fractional calcium absorption was not related to risk for other nonspine fractures (relative risk per 1-SD [7.7{\%}] decrease in fractional calcium absorption, 1.05 [CI, 0.96 to 1.14]). Conclusions: In elderly women, low fractional calcium absorption in the setting of low calcium intake increases the risk for hip fracture. Our findings support the hypothesis of type II osteoporosis, which postulates that decreased calcium absorption is an important risk factor for hip fracture in older persons.",
author = "Ensrud, {Kristine E.} and Tu Duong and Cauley, {Jane A.} and Heaney, {Robert P.} and Wolf, {Randi L.} and Emily Harris and Cummings, {Steven R.}",
year = "2000",
month = "3",
day = "7",
language = "English",
volume = "132",
pages = "345--353",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "5",

}

TY - JOUR

T1 - Low fractional calcium absorption increases the risk for hip fracture in women with low calcium intake

AU - Ensrud, Kristine E.

AU - Duong, Tu

AU - Cauley, Jane A.

AU - Heaney, Robert P.

AU - Wolf, Randi L.

AU - Harris, Emily

AU - Cummings, Steven R.

PY - 2000/3/7

Y1 - 2000/3/7

N2 - Background: Decreased ability to absorb calcium with age limits adaptation to low calcium intake and is thought to lead to secondary hyperparathyroidism and increased risk for hip and other fractures. However, the associations between fractional calcium absorption, dietary calcium intake, and risk for fracture have never been studied. Objective: To determine whether low fractional calcium absorption in women with low calcium intake increases the risk for subsequent hip and other nonspine fractures. Design: Prospective cohort study. Setting: Four clinical centers in Baltimore County, Maryland; Portland, Oregon; Minneapolis, Minnesota; and the Monongahela Valley, Pennsylvania. Participants: 5452 nonblack women 69 years of age or older participating in the fourth examination of the Study of Osteoporotic Fractures. Measurements: Fractional calcium absorption was measured by using a 3-hour single isotope (45Ca) technique. Incident fractures were identified prospectively and were confirmed by radiographic report. Results: During an average of 4.8 years, 729 women (13%) experienced at least one nonspine fracture; 153 of these women had hip fractures. After adjustment for age, women with lower fractional calcium absorption were at increased risk for hip fracture (relative risk per 1-SD [7.7%] decrease in fractional calcium absorption, 1.24 [95% CI, 1.05 to 1.48]). Women with low fractional calcium absorption and low calcium intake were at greatest risk for subsequent hip fracture; among women whose dietary calcium intake was less than 400 mg/d, those who had fractional calcium absorption at or below the median value of 32.3% had a 2.5-fold (CI, 1.29-fold to 4.69-fold) increase in risk for hip fracture compared with those who had greater absorption efficiency. Fractional calcium absorption was not related to risk for other nonspine fractures (relative risk per 1-SD [7.7%] decrease in fractional calcium absorption, 1.05 [CI, 0.96 to 1.14]). Conclusions: In elderly women, low fractional calcium absorption in the setting of low calcium intake increases the risk for hip fracture. Our findings support the hypothesis of type II osteoporosis, which postulates that decreased calcium absorption is an important risk factor for hip fracture in older persons.

AB - Background: Decreased ability to absorb calcium with age limits adaptation to low calcium intake and is thought to lead to secondary hyperparathyroidism and increased risk for hip and other fractures. However, the associations between fractional calcium absorption, dietary calcium intake, and risk for fracture have never been studied. Objective: To determine whether low fractional calcium absorption in women with low calcium intake increases the risk for subsequent hip and other nonspine fractures. Design: Prospective cohort study. Setting: Four clinical centers in Baltimore County, Maryland; Portland, Oregon; Minneapolis, Minnesota; and the Monongahela Valley, Pennsylvania. Participants: 5452 nonblack women 69 years of age or older participating in the fourth examination of the Study of Osteoporotic Fractures. Measurements: Fractional calcium absorption was measured by using a 3-hour single isotope (45Ca) technique. Incident fractures were identified prospectively and were confirmed by radiographic report. Results: During an average of 4.8 years, 729 women (13%) experienced at least one nonspine fracture; 153 of these women had hip fractures. After adjustment for age, women with lower fractional calcium absorption were at increased risk for hip fracture (relative risk per 1-SD [7.7%] decrease in fractional calcium absorption, 1.24 [95% CI, 1.05 to 1.48]). Women with low fractional calcium absorption and low calcium intake were at greatest risk for subsequent hip fracture; among women whose dietary calcium intake was less than 400 mg/d, those who had fractional calcium absorption at or below the median value of 32.3% had a 2.5-fold (CI, 1.29-fold to 4.69-fold) increase in risk for hip fracture compared with those who had greater absorption efficiency. Fractional calcium absorption was not related to risk for other nonspine fractures (relative risk per 1-SD [7.7%] decrease in fractional calcium absorption, 1.05 [CI, 0.96 to 1.14]). Conclusions: In elderly women, low fractional calcium absorption in the setting of low calcium intake increases the risk for hip fracture. Our findings support the hypothesis of type II osteoporosis, which postulates that decreased calcium absorption is an important risk factor for hip fracture in older persons.

UR - http://www.scopus.com/inward/record.url?scp=0034095006&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034095006&partnerID=8YFLogxK

M3 - Article

C2 - 10691584

AN - SCOPUS:0034095006

VL - 132

SP - 345

EP - 353

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 5

ER -