July 3, 2013
Supplements Help Bone Health of Postmenopausal
Women on Hormones

Cleveland—Do vitamin D and calcium supplements improve bone health in postmenopausal women who use hormones?

An analysis from the influential Women's Health Initiative (WHI) trial suggests that they do. The report was published online by Menopause, the journal of The North American Menopause Society, but will not appear in the print version until February 2014.

Nearly 30,000 postmenopausal women are in the hormone trial, with about 8,000 taking supplemental calcium (1,000 mg/d) and vitamin D (400 mg/d), and another 8,000 using look-alike placebos. With the study groups coming from all segments of the WHI—those who took estrogen plus a progestogen (required for women with a uterus), those who took estrogen alone, and those who took the hormone look-alike placebos—researchers were able to look at how rates of hip fracture differed among women who took hormones and supplements, those who took hormones alone, and those who took neither.

They found a synergistic effect with the supplements and hormones: Women using both therapies had much greater protection against hip fractures than with either therapy alone. On the other hand, taking supplements alone wasn’t significantly better than taking no supplements and no hormones.

Hormone therapy appeared most beneficial in women who had a total calcium intake, including supplements and diet, greater than 1,200 mg/d. Benefit also was significant in women who had higher intakes of vitamin D. The individual effect of each one could not be determined, however, because the two supplements were administered together.

Overall, the research translated into 11 hip fractures per 10,000 women per year among the women who took both hormones and supplements compared with 18 per 10,000 women per year among those who took hormones only, 25 per 10,000 women per year among those who took supplements alone, and 22 among those who got neither therapy, according to the study.

While the research suggested that women using postmenopausal hormone therapy should also take supplemental calcium and vitamin D, according to the authors, a specific amount cannot be recommended because of the design of the study. They noted, however, that the benefits appeared to rise with increasing total intake of calcium and vitamin D, although adverse side effects, such as constipation from too much calcium, could set some limits.

The results of the study run counter to a recommendation earlier this year from the U.S. Preventive Services Task Force. That group stated there was no basis for recommending calcium and vitamin D supplements to prevent fractures. A large study such as this could influence any future recommendations, according to the report.

U.S. Pharmacist Social Connect