Abstract：
The effect of calcium supplementation on bone mineral accretion in people under 35 years old is inconclusive. To comprehensively summarize the evidence for the effect of calcium supplementation on bone mineral accretion in young populations (≤35 years).
This is a systematic review and meta-analysis. The Pubmed, Embase, ProQuest, CENTRAL, WHO Global Index Medicus, Clinical Trials.gov, WHO ICTRP, China National Knowledge Infrastructure (CNKI), and Wanfang Data databases were systematically searched from database inception to April 25, 2021. Randomized clinical trials assessing the effects of calcium supplementation on bone mineral density (BMD) or bone mineral content (BMC) in people under 35 years old.
This systematic review and meta-analysis identified 43 studies involving 7,382 subjects. Moderate certainty of evidence showed that calcium supplementation was associated with the accretion of BMD and BMC, especially on femoral neck (standardized mean difference [SMD] 0.627, 95% confidence interval [CI] 0.338-0.915; SMD 0.364, 95% CI 0.134-0.595; respectively) and total body (SMD 0.330, 95% CI 0.163-0.496; SMD 0.149, 95% CI 0.006-0.291), also with a slight improvement effect on lumbar spine BMC (SMD 0.163, 95% CI 0.008-0.317), no effects on total hip BMD and BMC and lumbar spine BMD were observed. Very interestingly, subgroup analyses suggested that the improvement of bone at femoral neck was more pronounced in the peripeak bone mass (PBM) population (20-35 years) than the pre-PBM population (<20 years).
Our findings provided novel insights and evidence in calcium supplementation, which showed that calcium supplementation significantly improves bone mass, implying that preventive calcium supplementation before or around achieving PBM may be a shift in the window of intervention for osteoporosis.
This work was supported by Wenzhou Medical University grant [89219029].
Osteoporosis and bone fractures are common problems among older people, particularly older women. These conditions cause disability and reduce quality of life. Progressive loss of bone mineral density is usually the culprit. So far, strategies to prevent bone weakening with age have produced disappointing results. For example, taking calcium supplements in later life only slightly reduces the risk of osteoporosis or fracture. New approaches are needed. Bone mass increases gradually early in life and peaks and plateaus around 20-35 years of age. After that period, bone mass slowly declines. Some scientists suspect that increasing calcium intake during this period of peak bone mass may reduce osteoporosis or fracture risk later in life. A meta-analysis by Liu, Le et al. shows that boosting calcium intake in young adulthood strengthens bones. The researchers analyzed data from 43 randomized controlled trials that enrolled 7,382 participants. About half the studies looked at the effects of taking calcium supplements and the other half analyzed the effects of a high calcium diet. Boosting calcium intake in people younger than age 35 improved bone mineral density throughout the body. It also increased bone mineral density at the femoral neck, where most hip fractures occur. Calcium supplementation produced larger effects in individuals between the ages of 20 and 35 than in people younger than 20. Both high calcium diets and calcium supplements with doses less than 1000 mg/d boosted bone strength. Higher dose calcium supplements did not provide any extra benefits. The analysis suggests people should pay more attention to bone health during early adulthood. Large randomized clinical trials are needed to confirm the long-term benefits of boosting calcium intake during early adulthood. But if the results are validated, taking calcium supplements, or eating more calcium-rich foods between the ages of 20 and 35 may help individuals build healthier bones and prevent fractures and osteoporosis later in life.
This is a systematic review and meta-analysis. The Pubmed, Embase, ProQuest, CENTRAL, WHO Global Index Medicus, Clinical Trials.gov, WHO ICTRP, China National Knowledge Infrastructure (CNKI), and Wanfang Data databases were systematically searched from database inception to April 25, 2021. Randomized clinical trials assessing the effects of calcium supplementation on bone mineral density (BMD) or bone mineral content (BMC) in people under 35 years old.
This systematic review and meta-analysis identified 43 studies involving 7,382 subjects. Moderate certainty of evidence showed that calcium supplementation was associated with the accretion of BMD and BMC, especially on femoral neck (standardized mean difference [SMD] 0.627, 95% confidence interval [CI] 0.338-0.915; SMD 0.364, 95% CI 0.134-0.595; respectively) and total body (SMD 0.330, 95% CI 0.163-0.496; SMD 0.149, 95% CI 0.006-0.291), also with a slight improvement effect on lumbar spine BMC (SMD 0.163, 95% CI 0.008-0.317), no effects on total hip BMD and BMC and lumbar spine BMD were observed. Very interestingly, subgroup analyses suggested that the improvement of bone at femoral neck was more pronounced in the peripeak bone mass (PBM) population (20-35 years) than the pre-PBM population (<20 years).
Our findings provided novel insights and evidence in calcium supplementation, which showed that calcium supplementation significantly improves bone mass, implying that preventive calcium supplementation before or around achieving PBM may be a shift in the window of intervention for osteoporosis.
This work was supported by Wenzhou Medical University grant [89219029].
Osteoporosis and bone fractures are common problems among older people, particularly older women. These conditions cause disability and reduce quality of life. Progressive loss of bone mineral density is usually the culprit. So far, strategies to prevent bone weakening with age have produced disappointing results. For example, taking calcium supplements in later life only slightly reduces the risk of osteoporosis or fracture. New approaches are needed. Bone mass increases gradually early in life and peaks and plateaus around 20-35 years of age. After that period, bone mass slowly declines. Some scientists suspect that increasing calcium intake during this period of peak bone mass may reduce osteoporosis or fracture risk later in life. A meta-analysis by Liu, Le et al. shows that boosting calcium intake in young adulthood strengthens bones. The researchers analyzed data from 43 randomized controlled trials that enrolled 7,382 participants. About half the studies looked at the effects of taking calcium supplements and the other half analyzed the effects of a high calcium diet. Boosting calcium intake in people younger than age 35 improved bone mineral density throughout the body. It also increased bone mineral density at the femoral neck, where most hip fractures occur. Calcium supplementation produced larger effects in individuals between the ages of 20 and 35 than in people younger than 20. Both high calcium diets and calcium supplements with doses less than 1000 mg/d boosted bone strength. Higher dose calcium supplements did not provide any extra benefits. The analysis suggests people should pay more attention to bone health during early adulthood. Large randomized clinical trials are needed to confirm the long-term benefits of boosting calcium intake during early adulthood. But if the results are validated, taking calcium supplements, or eating more calcium-rich foods between the ages of 20 and 35 may help individuals build healthier bones and prevent fractures and osteoporosis later in life.
摘要：
补钙对35岁以下人群骨矿物质增生的影响尚无定论。全面总结补钙对青年人群(≤35岁)骨矿物质增生影响的证据。
这是一项系统综述和荟萃分析。Pubmed,Embase,ProQuest,中部,世界卫生组织全球指数，临床试验.gov,世卫组织ICTRP，中国国家知识基础设施(CNKI),和万方数据数据库从数据库成立到2021年4月25日进行了系统搜索。评估钙补充剂对35岁以下人群的骨矿物质密度（BMD）或骨矿物质含量（BMC）的影响的随机临床试验。
这项系统评价和荟萃分析确定了43项研究，涉及7,382名受试者。证据的中度确定性表明，补钙与BMD和BMC的增加有关，尤其是股骨颈（标准化平均差[SMD]0.627，95％置信区间[CI]0.338-0.915；SMD0.364，95％CI0.134-0.595；分别）和全身（SMD0.330，95％CI0.163-0.496；SMD0.149，95％CI0.006-0.291），对腰椎BMC也有轻微的改善作用（SMD0.163，95%CI0.008-0.317），对髋部BMD、BMC和腰椎BMD无影响。非常有趣的是，亚组分析显示,与PBM前人群(<20岁)相比,围峰值骨量(PBM)人群(20~35岁)的股骨颈骨改善更为显著.
我们的发现为补钙提供了新的见解和证据，这表明补钙能显著改善骨量，这意味着在实现PBM之前或前后预防性补充钙可能是骨质疏松症干预窗口的转变。
这项工作得到温州医科大学资助[89219029]。
骨质疏松和骨折是老年人常见的问题，尤其是老年妇女。这些情况会导致残疾并降低生活质量。骨矿物质密度的进行性丢失通常是罪魁祸首。到目前为止,防止骨骼随着年龄的增长而减弱的策略产生了令人失望的结果。例如,在以后的生活中服用钙补充剂只会略微降低骨质疏松症或骨折的风险。需要新的方法。骨量在生命早期逐渐增加，在20-35岁左右达到高峰和高原。在那个时期之后,骨量缓慢下降。一些科学家怀疑，在峰值骨量期间增加钙的摄入量可能会降低以后生活中的骨质疏松症或骨折风险。刘的荟萃分析，Leetal.表明，在青年期增加钙的摄入量可以增强骨骼。研究人员分析了43项随机对照试验的数据，这些试验招募了7,382名参与者。大约一半的研究着眼于服用钙补充剂的影响，另一半分析了高钙饮食的影响。在35岁以下的人群中增加钙的摄入量可以改善整个身体的骨矿物质密度。它还增加了股骨颈的骨矿物质密度，大多数髋部骨折发生的地方。钙补充剂在20至35岁之间的个体中产生的影响大于20岁以下的人。高钙饮食和剂量小于1000mg/d的钙补充剂均可增强骨强度。较高剂量的钙补充剂没有提供任何额外的益处。分析表明，人们在成年早期应该更加关注骨骼健康。需要进行大型随机临床试验以确认在成年早期增加钙摄入量的长期益处。但是如果结果得到验证，服用钙补充剂，或者在20至35岁之间吃更多富含钙的食物可能有助于个体建立更健康的骨骼，并在以后的生活中预防骨折和骨质疏松症。
这是一项系统综述和荟萃分析。Pubmed,Embase,ProQuest,中部,世界卫生组织全球指数，临床试验.gov,世卫组织ICTRP，中国国家知识基础设施(CNKI),和万方数据数据库从数据库成立到2021年4月25日进行了系统搜索。评估钙补充剂对35岁以下人群的骨矿物质密度（BMD）或骨矿物质含量（BMC）的影响的随机临床试验。
这项系统评价和荟萃分析确定了43项研究，涉及7,382名受试者。证据的中度确定性表明，补钙与BMD和BMC的增加有关，尤其是股骨颈（标准化平均差[SMD]0.627，95％置信区间[CI]0.338-0.915；SMD0.364，95％CI0.134-0.595；分别）和全身（SMD0.330，95％CI0.163-0.496；SMD0.149，95％CI0.006-0.291），对腰椎BMC也有轻微的改善作用（SMD0.163，95%CI0.008-0.317），对髋部BMD、BMC和腰椎BMD无影响。非常有趣的是，亚组分析显示,与PBM前人群(<20岁)相比,围峰值骨量(PBM)人群(20~35岁)的股骨颈骨改善更为显著.
我们的发现为补钙提供了新的见解和证据，这表明补钙能显著改善骨量，这意味着在实现PBM之前或前后预防性补充钙可能是骨质疏松症干预窗口的转变。
这项工作得到温州医科大学资助[89219029]。
骨质疏松和骨折是老年人常见的问题，尤其是老年妇女。这些情况会导致残疾并降低生活质量。骨矿物质密度的进行性丢失通常是罪魁祸首。到目前为止,防止骨骼随着年龄的增长而减弱的策略产生了令人失望的结果。例如,在以后的生活中服用钙补充剂只会略微降低骨质疏松症或骨折的风险。需要新的方法。骨量在生命早期逐渐增加，在20-35岁左右达到高峰和高原。在那个时期之后,骨量缓慢下降。一些科学家怀疑，在峰值骨量期间增加钙的摄入量可能会降低以后生活中的骨质疏松症或骨折风险。刘的荟萃分析，Leetal.表明，在青年期增加钙的摄入量可以增强骨骼。研究人员分析了43项随机对照试验的数据，这些试验招募了7,382名参与者。大约一半的研究着眼于服用钙补充剂的影响，另一半分析了高钙饮食的影响。在35岁以下的人群中增加钙的摄入量可以改善整个身体的骨矿物质密度。它还增加了股骨颈的骨矿物质密度，大多数髋部骨折发生的地方。钙补充剂在20至35岁之间的个体中产生的影响大于20岁以下的人。高钙饮食和剂量小于1000mg/d的钙补充剂均可增强骨强度。较高剂量的钙补充剂没有提供任何额外的益处。分析表明，人们在成年早期应该更加关注骨骼健康。需要进行大型随机临床试验以确认在成年早期增加钙摄入量的长期益处。但是如果结果得到验证，服用钙补充剂，或者在20至35岁之间吃更多富含钙的食物可能有助于个体建立更健康的骨骼，并在以后的生活中预防骨折和骨质疏松症。
