Download PDF
Horm Metab Res 2002; 34(1): 44-47
DOI: 10.1055/s-2002-19967
Original Clinical

© Georg Thieme Verlag Stuttgart · New York

Effects of Dose and Timing of Calcium Supplementation on Bone Resorption in Early Menopausal Women

F.  Scopacasa 1 , A.  G.  Need 1 , M.  Horowitz 2 , J.  M.  Wishart 2 , H.  A.  Morris 1 , B.  E.  C.  Nordin 1
  • 1 Division of Clinical Biochemistry, Institute of Medical and Veterinary Science, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  • 2 Department of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Further Information

Publication History

21 March 2001

30 August 2001

Publication Date:
14 August 2002 (online)

Also available at
    Permissions and Reprints

Abstract

Bone resorption follows a circadian rhythm that peaks at night, reflecting the circadian rhythm of serum parathyroid hormone. Our previous studies in early postmenopausal women have established that 1000 mg of calcium given at 9 p. m. reduced bone resorption markers overnight, but not during the day. In contrast, 1000 mg given as a divided dose (500 mg doses at 9 a. m. and 9 p. m. each) reduced bone resorption markers during the day, but not during the night. We have now evaluated the effect of 1500 mg of calcium given as a divided dose of 500 mg in the morning and 1000 mg in the evening on bone resorption. We studied 26 healthy women (median age 56 years) whose menopause was less than five years before. On two days, urine was collected from 9 a. m. to 9 p. m. (day collection), and from 9 p. m. to 9 a. m. (night collection); a further fasting (spot) urine sample was obtained at 9 a. m. at the end of the night collection. On the second day, 500 mg of calcium in the carbonate form was taken at 9 a. m. (at the start of the collection) and a further 1000 mg at 9 p. m. (at the start of the second night collection). Calcium supplementation decreased urinary deoxypyridinoline (DPyr/Cr) during the day (p = 0.08) and night (p < 0.05), as well as urinary pyridinoline (Pyr/Cr) both by day (p < 0.05) and night (p < 0.001). There were also decreases in urine hydroxyproline. We conclude that the acute administration of 500 mg of calcium in the morning and 1000 mg in the evening to early postmenopausal women suppresses bone resorption markers during both the day and night.

Key words

Calcium Supplementation - Bone Resorption - Postmenopausal

References

  • 1 Nordin B EC, Polley K J. Metabolic consequences of the menopause. A cross-sectional, longitudinal, and intervention study on 557 normal postmenopausal women.  Calcif Tissue Int. 1987;  41 S1
    PubMedGoogle Scholar
  • 2 Nordin B E, Need A G, Morris H A, Horowitz M. Biochemical variables in pre- and postmenopausal women: reconciling the calcium and estrogen hypotheses.  Osteoporos Int. 1999;  9 351-357
    CrossrefPubMedGoogle Scholar
  • 3 Heaney R P, Recker R R, Stegman M R, Moy A J. Calcium absorption in women: relationships to calcium intake, oestrogen status, and age.  J Bone Miner Res. 1989;  4 469-475
    PubMedGoogle Scholar
  • 4 Wishart J M, Scopacasa F, Horowitz M, Morris H A, Need A G, Clifton P M, Nordin B EC. Effect of perimenopause on calcium absorption: a longitudinal study.  Climacteric. 2000;  3 102-108
    PubMedGoogle Scholar
  • 5 Nordin B EC. Calcium and osteoporosis.  Nutrition. 1997;  13 664-686
    CrossrefPubMedGoogle Scholar
  • 6 Nilas L, Christiansen C, Rodbro P. Calcium supplementation and postmenopausal bone loss.  Br Med J. 1984;  289 1103-1106
    PubMedGoogle Scholar
  • 7 Riis B, Thomsen K, Christiansen C. Does calcium supplementation prevent postmenopausal bone loss?.  N Engl J Med. 1987;  316 173-177
    PubMedGoogle Scholar
  • 8 Dawson-Hughes M D, Dallal G E, Krall E A, Sadowski L, Sahyoun N, Tannenbaum S. A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women.  N Engl J Med. 1990;  323 878-883
    PubMedGoogle Scholar
  • 9 Elders P J, Lips P, Netelenbos J C. et al . Long-term effect of calcium supplementation on bone loss in perimenopausal women.  J Bone Miner Res. 1994;  9 963-970
    PubMedGoogle Scholar
  • 10 Prince R. The calcium controversy revisited: implications of new data.  Med J Aust. 1993;  159 404-407
    PubMedGoogle Scholar
  • 11 Reid I R, Schooler B A, Hannan S F, Ibbertson H K. The acute biochemical effects of four proprietary calcium preparations.  Aust N Z J Med. 1986;  16 193-197
    PubMedGoogle Scholar
  • 12 Heaney R P, Dowell M S, Barger-Lux M J. Absorption of calcium as the carbonate and citrate salts, with some observations on method.  Osteoporos Int. 1999;  9 19-23
    CrossrefPubMedGoogle Scholar
  • 13 Scopacasa F, Horowitz M, Wishart J M. et al . Calcium supplementation suppresses bone resorption in early postmenopausal women.  Calcif Tissue Int. 1998;  62 8-12
    CrossrefPubMedGoogle Scholar
  • 14 Scopacasa F, Need A G, Horowitz M, Wishart J M, Morris H A, Nordin B EC. Inhibition of bone resorption by divided dose calcium supplementation in early postmenopausal women.  Calcif Tissue Int. 2000;  67 440-442
    CrossrefPubMedGoogle Scholar
  • 15 Angus R M, Eisman J A. Osteoporosis: The role of calcium intake and supplementation.  Med J Aust. 1988;  148 630-633
    PubMedGoogle Scholar
  • 16 Morris H A, Chatterton B E, Ross P D, Durbridge T C. Diagnostic procedures. In: Nordin BEC, Need AG, Morris HA (eds) Metabolic bone and stone disease. Churchill Livingston 1993 3rd Edition: 339-379
    Google Scholar
  • 17 Fiore C E, Pennisi P, Ciffo F, Scebba C, Amico A, di Fazzio S. Immobilization-dependent bone collagen breakdown appears to increase with time: evidence for a lack of a new bone equilibrium in response to reduced load during prolonged bed rest.  Horm Metab Res. 1999;  31 31-36
    PubMedGoogle Scholar
  • 18 Kamel S, Brazier M, Desmet G, Picard C, Mennencier I, Sebert J. High performance liquid chromatography determination of 3-hydroxypyridinium derivatives as new markers of bone resorption.  J Chrom. 1992;  574 255-260
    PubMedGoogle Scholar
  • 19 Riggs B L, O'Fallon W M, Muhs J, O'Connor M K, Kumar R, Melton L. Long-term effects of calcium supplementation on serum parathyroid hormone level, bone turnover, and bone loss in elderly women.  J Bone Miner Res. 1998;  13 168-174
    PubMedGoogle Scholar
  • 20 McKane W R, Khosla S, Egan K S, Robins S P, Burritt M F, Riggs B L. The role of calcium intake in modulating age-related increases in parathyroid function and bone resorption.  J Clin Endocrinol Metab. 1996;  81 1699-1703
    CrossrefPubMedGoogle Scholar
  • 21 Blumsohn A, Herrington K, Hannon R A, Shao P, Eyre D R, Eastell R. The effect of calcium supplementation on the circadian rhythm of bone resorption.  J Endocrinol Metab. 1994;  79 730-735
    PubMedGoogle Scholar
  • 22 Horowitz M, Morris H M, Hartley T F. et al . The effect of an oral calcium load on plasma ionised calcium and parathyroid hormone concentrations in osteoporotic postmenopausal women.  Calcif Tissue Int. 1987;  40 133-136
    PubMedGoogle Scholar
  • 23 Ledger G, Burritt M, Kao P, O'Fallon W, Riggs B, Khosla S. Role of parathyroid hormone in mediating nocturnal and age-related increases in bone resorption.  J Clin Endocrinol Metab. 1995;  80 3304-3310
    CrossrefPubMedGoogle Scholar
  • 24 Schlemmer A, Hassager C, Pedersen B J, Christiansen C. Posture, age, menopause, and osteopenia do not influence the circadian variation in the urinary excretion of pyridinium crosslinks.  J Bone Miner Res. 1994;  9 1883-1888
    PubMedGoogle Scholar
  • 25 Heshmati H M, Riggs B L, Burritt M F, McAlister C A, Wollan P C, Khosla S. Effects of the circadian variation in serum cortisol on markers of bone turnover and calcium homeostasis in normal postmenopausal women.  J Clin Endocrinol Metab. 1998;  83 751-756
    CrossrefPubMedGoogle Scholar
  • 26 Patel S, Pazianas M, Tobias J, Chambers T, Fox S, Chow J. Early effects of hormone replacement therapy on bone.  Bone. 1999;  24 245-248
    CrossrefPubMedGoogle Scholar
  • 27 Horowitz M, Wishart J M, Need A G, Morris H A, Nordin B EC. Effects of norethisterone on bone related biochemical variables and forearm bone mineral in post-menopausal osteoporosis.  Clin Endocrinol Oxf. 1993;  39 649-655
    PubMedGoogle Scholar
  • 28 Ettinger B, Black D M, Mitlak B H. et al . Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomised clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) investigators.  JAMA. 1999;  282 637-645
    CrossrefPubMedGoogle Scholar
  • 29 Prestwood K M, Gunness M, Muchmore D B, Lu Y L, Raisz L G. A comparison of the effects of raloxifene and estrogen on bone in postmenopausal women.  J Clin Endocrinol Metab. 2000;  85 2197
    CrossrefPubMedGoogle Scholar
  • 30 Bettica P, Bevilaqua M, Vago T, Masino M, Cucinotta E, Norbiato G. Short-term variations in bone remodelling biochemical markers: cyclical etidronate and alendronate effects compared.  J Clin Endocrinol Metab. 1997;  82 3034-3039
    CrossrefPubMedGoogle Scholar
  • 31 Heaney R P, Weaver C M, Fitzsimmons M L. Influence of calcium load on absorption fraction.  J Bone Miner Res. 1990;  5 1135-1138
    PubMedGoogle Scholar

F. Scopacasa

Division of Clinical Biochemistry · Institute of Medical and Veterinary Science

PO Box 14 Rundle Mall · Adelaide 5000, South Australia · Australia

Phone: + 61 (8) 8222 3000

Fax: + 61 (8) 8222 3538

Email: franca.scopacasa@adelaide.edu.au