Jean-Luc Sebert

Effects on bone mineral density of calcium and vitamin D supplementation in elderly women with vitamin D deficiency.

OBJECTIVE Calcium and vitamin D deficiency is common in older individuals, particularly those who live in nursing homes, and increases the risk of osteoporosis and fractures. METHODS We conducted a randomized double-blind placebo-controlled study of combined supplementation with 500 mg of elemental calcium, as carbonate, and 400 IU of vitamin D bid for 12 months in women older than 65 years of age with vitamin D deficiency, defined as serum 25(OH)D concentrations </=12 ng/ml. RESULTS Mean patient age was 75 +/- 7 years, and median daily dietary intakes of calcium and vitamin D were 697 mg and 66.8 IU in the supplemented group (n = 95) and 671 mg and 61.8 IU in the placebo group (n = 97). The median serum 25(OH)D level was 7.0 ng/ml in both groups, and the medial intact parathyroid hormone (PTHi) levels were 49 and 48 pg/ml in the supplemented and placebo groups, respectively. The median increase in serum 25(OH)D was 22.0 ng/ml in the supplemented group and 4 ng/ml in the placebo group (P < 0.0001), and the median PTHi decrease was 17 and 5 pg/ml, respectively (P < 0.0001). The median bone mineral density increase was significantly greater in the supplemented group than in the placebo group: +2.98% vs. -0.21% at L2-L4 (P = 0.0009), +1.19% and -0.83% at the femoral neck (P = 0.015), +0.86% and -0.56% at the trochanter (P = 0.015), and +0.99% and +0.11% for the whole body (P = 0.01). Similarly, the median decrease in the main bone markers was significantly greater in the treated group than in the placebo group: -1.35 microg/l vs. +0.50 microg/l for bone alkaline phosphatase (P = 0.008), -16.6 nmol/mmol creatinine vs. -2.3 nmol/mmol creatinine for urinary type I amino-terminal telopeptide (P = 0.001), and -896 pmol/l vs. -201 pmol/l for serum type I carboxy-terminal telopeptide (P = 0.003). We found no significant differences between the two groups for serum calcium, although urinary calcium excretion changed more in the supplemented group than in the placebo group. In conclusion, bone mass in older women with vitamin D deficiency increases significantly at the lumbar spine, femur, trochanter, and whole body after calcium and vitamin D supplementation for 1 year, and concomitantly bone markers improved as vitamin D levels returned to normal.

Effect of sex and age on the ratio of cervical to trochanteric hip fracture. A meta-analysis of 16 reports on 36,451 cases.

We analyzed 15 published reports and our own data. In women, the ratio of cervical to trochanteric fractures (C/T) evolved in 3 periods. 1) Before the age of 50 years, the annual incidence of cervical fracture is close to that of trochanteric fracture. 2) Between 50 and 60 years, cervical fracture increases markedly, and the C/T ratio is well above unity at an age when the fracture incidence is still very low. 3) This imbalance progressively diminishes to reach unity in the very old, as the result of a progressive increase in trochanteric fractures. In men, cervical fractures are progressively more common with increasing age, and the C/T ratio exceeds unity after 70 years of age. In both genders, the incidence of cervical fracture is thus greater than that of trochanteric fracture during a limited period of time, in the perimenopausal period for women and in elderly men. Several hypotheses on the mechanics of falls and bone strength have been advanced, without any satisfactory explanation for the C/T sex and age changes.

Biological Effects of Supplementation with Vitamin D and Calcium in Postmenopausal Women with Low Bone Mass Receiving Alendronate

ObjectiveTo investigate the biological effects of supplementation with vitamin D and calcium versus supplementation with calcium alone during the first 3 months of treatment with alendronate in postmenopausal women with a risk of fracture and with vitamin D and calcium insufficiency.DesignRandomised, double-blind trial.SubjectsThe study randomised 48 osteopenic and osteoporotic women, mean age 70 ± 6 years and at least 5 years after menopause, who were living at home. Inclusion criteria were low bone mineral density (more than 1 SD below reference value), serum 25-hydroxy-vitamin D3 (25-OHD, calcifediol) <12 μg/L and dietary calcium intake <1 g/day.MethodsThe women were divided into two groups. The first group (n = 23) received alendronate 10mg once daily supplemented with calcium and vitamin D (elemental calcium 500mg, colecalciferol [vitamin D3] 400IU) twice daily for 3 months. The second group (n = 25) received the same dosage of alendronate and a placebo with calcium alone (500 mg/day). Blood, serum and urine samples were obtained for measurement of calcaemia, intact parathyroid hormone (i-PTH) and markers of bone remodelling such as the N- and C-terminal telopeptides of type I collagen (NTX and CTX).ResultsSupplementation with calcium and vitamin D caused a rapid increase of 25-OHD levels without changes in calcaemia or i-PTH levels. In the two groups, serum and urinary CTX and urinary NTX were dramatically and significantly decreased after as little as 15 days of treatment and remained decreased throughout the course of treatment. No significant difference between the two treatments was observed, but the combined treatment resulted in a more pronounced effect as assessed by the Hodge-Lehman test, particularly after 1 month for the bone resorption markers serum CTX (p = 0.064) and urinary NTX (p = 0.076).ConclusionSupplementation with calcium and vitamin D could be appropriate in elderly women with calcium and vitamin D insufficiencies being treated with alendronate in order to achieve rapid reduction of bone remodelling.

Effets sur la densité minérale osseuse d’une supplémentation vitamino-calcique chez la femme âgée présentant une insuffisance en vitamine D

Resume Objectifs. – L’insuffisance en vitamine D et en calcium est frequente chez les sujets âges, notamment institutionnalises et represente un facteur de risque d’osteoporose et donc de fractures. Methodes. – Nous avons evalue, a partir d’une etude randomisee en double aveugle contre placebo, les effets de l’administration d’une association de 500 mg de calcium elementaire, sous la forme de carbonate et de 400 UI de vitamine D3, deux fois par jour pendant 12 mois chez des femmes âgees de plus de 65 ans et presentant une insuffisance en vitamine D definie par des concentrations seriques en 25(OH)D ≤ 12 ng/ml. Resultats. – Les patientes incluses etaient âgees en moyenne de 75 ± 7 ans, leurs rations alimentaires journalieres medianes en calcium et en vitamine D dans les groupes placebo (n = 97) et supplementes (n = 95) etaient respectivement de 671 mg et 61,8 UI et de 697 mg et 66,8 UI. Les concentrations medianes de 25(OH)D etaient de 7,0 ng/ml dans les deux groupes, celles de la PTHi etaient respectivement de 48 et 49 pg/ml. L’augmentation mediane de la 25(OH)D est de 22,0 ng/ml vs 4 ng/ml (p