Dicalcium Malate Clinical Evidence

Osteoporosis International

Cussler, E.C., et al. Exercise frequency and calcium intake predict 4-year bone change in postmenopausal women.

2005 Dec; 16(12):212941.

Topic:

How does frequency of exercise and calcium intake affect bone mineral density in elderly women?

Background:

Calcium and exercise are both associated with bone health.

Study Type:

Human clinical intervention trial.

Study Design:

Randomized, crossover study. Subjects were divided into an exercising group and a control group. All subjects took calcium. At 1 year, the nonexercising group began to exercise. Researchers measured their bone mineral density (BMD) at the femur, hip, and spine and from these they calculated total-body BMD.

Subjects:

167 sedentary women

Dosage:

Varied by subject. Average total daily calcium intake from diet and supplements was 1,635 +/- 367 mg (supplemental calcium accounted for 711 +/- 174 mg per day) for 4 years.

Results:

Exercise frequency was significantly associated with improved bone mineral density in the femur, hip, spine, and total body. Calcium intake was also associated with better BMD.

Conclusion:

“The positive relationship of CI [calcium intake] to change in BMD among postmenopausal women not using HT [hormone therapy] has clinical implications in light of recent evidence of an increased health risk associated with HT.”

International Journal of Sports Medicine

Courtiex, D., et al. Cumulative effect of calcium supplementation and physical activity on bone accretion in premenarchal children: a double-blind randomised placebo-controlled trial.

2005 Jun; 26(5):3328.

Topic:

What is the effect of calcium supplementation and exercise on bone growth and bone mineral density in premenarchal girls (girls who have not yet had their first menstrual period)?

Background:

Previous research has shown that children with high calcium intake and high levels of physical activity have better bone health.

Study Type:

Human clinical intervention trial.

Study Design:

Double-blind, randomized, placebo-controlled. Subjects were divided into 4 groups that took milk powder or placebo and exercised or didn’t. Researchers measured their bone mineral density (BMD) at 6 sites at base line and at I year.

Subjects:

113 healthy premenarchal girls

Dosage:

800 mg/day for 1 year

Results:

BMD gains were significantly higher in the group that took calcium and exercised in all sites measured, and by 6.3% overall.

Conclusion:

“These data suggest that calcium supplementation increases the effect of physical exercise on bone mineral acquisition in the period preceding puberty, and that calcium supplementation without physical activity does not improve BMD acquisition during this period. Physical exercise that stimulated bone accretion needs high calcium intake to be completely effective.”

International Journal of Sports Nutrition and Exercise Metabolism

Winters-Stone, K.M., and Snow, C.M. One year of oral calcium supplementation maintains cortical bone density in young adult female runners.

2004 Feb; 14(1):717.

Topic:

Can calcium supplements improve bone density in young female athletes?

Background:

Bone loss occurs slowly over decades, so maintaining good bone health in young adulthood can help prevent frailty in old age.

Study Type:

Human clinical intervention trial.

Study Design:

Double-blind, randomized, placebo-controlled. Subjects took calcium or a placebo and researchers measured their bone mineral density in their hips, spines, and femurs.

Subjects:

23 women, all runners, with an average age 23.7 +/- 4.7 years

Dosage:

1,000 mg/day (two 500-mg chewable tablets, taken 812 hours apart) for 1 year 

Results:

Subjects who took calcium gained .1% of the bone in their femurs while subjects taking placebo lost 1.8%. Calcium did not affect other areas measured.

Conclusion:

“Calcium supplementation importantly minimized cortical bone loss in female endurance athletes in whom optimal skeletal development, during young adult years, is critical to ensure skeletal health in later life.”

Osteoporosis International

Going, S., et al. Effects of exercise on bone mineral density in calcium-replete postmenopausal women with and without hormone replacement therapy.

2003 Aug; 14(8):63743.

Topic:

Can calcium supplementation and exercise help prevent bone loss in elderly women?

Background:

The bone-protecting effects of calcium supplementation, exercise and hormone replacement therapy (HRT) have all been studied, but how do they interact when used together?

Study Type:

Human clinical intervention trial.

Study Design:

Subjects were randomized into exercising and nonexercising groups. In addition, some of the women were using HRT and others were not. All subjects took calcium supplements.

Subjects:

320 healthy, nonsmoking, postmenopausal women

Dosage:

800 mg/day for 1 year

Results:

The results demonstrate that regional BMD can be improved with aerobic, weight-bearing activity combined with weight lifting at clinically relevant sites in postmenopausal women. The response was significant at more sites in women who used HRT, suggesting a greater benefit with hormone replacement and exercise compared to HRT alone.

Conclusion:

"Women who took calcium, exercised, and used HRT significantly increased their bone mineral density (BMD) by 12% in the femur, hip, and spine. Those women who took calcium, exercised, and did not use HRT increased their BMD in the femur by 1%.  Those who took calcium and used HRT but did not exercise experienced only 'negligible' change in BMD."

 Journal of Bone and Mineral Research

Lau, E.M. et al. Milk supplementation of the diet of postmenopausal Chinese women on a low calcium intake retards bone loss.

2001 Sep; 16(9):17049.

Topic:

Can adding milk to the diet of elderly Chinese women reduce their risk of bone loss?

Background:

The traditional Chinese diet is low in calcium. Previous research has indicated that people who eat low-calcium diets are more prone to hip and vertebral fractures.

Study Type:

Human clinical intervention trial.

Study Design:

Subjects were assigned to treatment and control groups. Those in the treatment group took milk powder daily and researchers measured their height and bone mineral density (BMD) at the hip and spine. 

Subjects:

200 postmenopausal Chinese women, aged 5559

Dosage:

50 g of milk powder (containing 800 mg calcium)/day for 2 years

Results:

The supplementing group experienced less loss of height and less bone loss than the control group. Total bone loss for the treatment group was 0.32 +/- 0.16% and for the control group it was 1.2 +/- 0.19%.

Conclusion:

“We conclude that supplementing the diet of postmenopausal Chinese women with high calcium milk powder retards bone loss.”

American Journal of Therapeutics

Ruml, L.A., et al.  The effect of calcium citrate on bone density in the early and mid-postmenopausal period: a randomized placebo-controlled study.

1999 Nov; 6(6):30311.

Topic:

What effect does calcium supplementation have on bone density in the early and middle years of menopause?

Background:

Bone loss accelerates after menopause. Can supplementing with calcium shortly after menopause help prevent bone loss during this vulnerable period?

Study Type:

Human clinical intervention trial.

Study Design:

Placebo-controlled, randomized. Subjects took calcium and researchers measured their bone density in various sites and also analyzed their blood and urine.

Subjects:

63 postmenopausal women, 57 within 5 years of menopause

Dosage:

800 mg/day for 12 years

Results:

Bone density in the spine rose slightly, by 1.03%, in the treatment group and declined significantly, by 2.38%, in the control group. Bone density in the hip did not change significantly in either group.  In the radius, density decreased insignificantly, by 0.02% in the treatment group and significantly, by 1.79%, after 1 year and by 3.03% after 2 years, in the control group. Blood and urine tests indicated a suppression of parathyroid hormone, a hormone that causes calcium to leach from bone into the bloodstream, in subjects in the treatment group.

Conclusion:

“Thus, calcium citrate supplementation (400 mg of calcium twice daily) averted bone loss and stabilized bone density in the spine, femoral neck, and radial shaft in women relatively soon after menopause. This bone-sparing action was probably due to the inhibition of bone resorption from parathyroid suppression.”

 British Journal of Nutrition

Lee, W.T., et al. A randomized double-blind controlled calcium supplementation trial, and bone and height acquisition in children.

1995 Jul; 74(1):12539.

Topic:

How does calcium supplementation affect bone growth and height in children with low-calcium diets?

Background:

Asian children often drink little or no milk.  Would they benefit from calcium supplementation?

Study Type:

Human clinical intervention trial.

Study Design:

Randomized, double-blind, placebo-controlled. The children took calcium or a placebo, and researchers measured bone mass in their spines and hips and their blood calcium levels at 6-month intervals. 

Subjects:

84 7-year-old Hong Kong children with low dietary calcium intake (average 567 mg/day)

Dosage:

300 mg/day for 18 months

Results:

At the end of the study, the treatment group had significantly greater increases in bone mineral content (20.9% v. 16.34%) in their spines, significantly greater bone mass (11.16% v. 8.71%) in their spines, and moderately greater increase in bone mineral density in the radius (7.74% v. 6%).

Conclusion:

“The results confirm a positive effect of Ca on bone mass of the spine and radius but no effects on femoral-neck and height increase. A longer trial is warranted to confirm a positive Ca effect during childhood that may modify future peak bone mass.”

Osteoporosis International

Lau, E.M., et al. The effects of calcium supplementation and exercise on bone density in elderly Chinese women.

1992 Jul; 2(4):16873.

Topic:

Can calcium supplementation and exercise help maintain bone density in elderly women?

Background:

Calcium supplementation and exercise have both been shown to protect bone health. How do they work together?

Study Type:

Human clinical intervention trial.

Study Design:

Randomized, placebo-controlled. Subjects were assigned to 4 groups: calcium supplementation, weight-bearing exercise 4 times a week plus placebo, calcium plus exercise, and placebo only. Bone mineral density (BMD) was measured in three areas of the hip and one area of the spine. Parathyroid hormone and other markers of bone metabolism were also measured.

Subjects:

50 Chinese women, aged 6292

Dosage:

800 mg/day for 10 months

Results:

In the calcium group, BMD increased significantly in two areas of the hip, but remained unchanged in one hip area and in the spine. Exercise alone did not affect bone loss, but in the calcium plus exercise group, there was reduced loss in one area of the hip. Parathyroid hormone, which exacerbates bone loss, was lowered in both calcium groups.

Conclusion:

“Calcium supplementation in the form of calcium lactate gluconate was adequately absorbed in elderly Chinese women with a calcium intake of less than 300 mg per day. It was effective in reducing bone loss at the hip, and there may be interaction effects with exercise in maintaining bone density.”

 New England Journal of Medicine

Dawon-Hughes, B., et al. A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women.

1990 Sep 27;323(13):87883.

Topic:

Which older women are most in need of calcium supplementation?

Background:

Previous research has suggested women with low calcium intake are the most likely to benefit from calcium supplements.

Study Type:

Human clinical intervention trial.

Study Design:

Double-blind, randomized, placebo-controlled. Subject took calcium in one of two forms or a placebo. Researchers measured bone loss in the hip, spine, and radius.

Subjects:

301 healthy postmenopausal women, with calcium intake of either less than 400 mg/day or 400650 mg/day.

Dosage:

500 mg/day calcium citrate malate or calcium carbonate, for 2 years

Results:

In women who had undergone menopause recently (within 5 years), bone loss in the spine was not affected by supplementation. Among women who had been postmenopausal for at least 6 years and who took a placebo, bone loss was slowest among those who had higher dietary intake of calcium.  Among those with lower dietary calcium intake, calcium citrate malate significantly reduced bone loss in the hip, radius, and spine.  Calcium carbonate maintained bone density at the hip and radius but not at the spine. 

Conclusion:

“Healthy older postmenopausal women with a daily calcium intake of less than 400 mg can significantly reduce bone loss by increasing their calcium intake to 800 mg per day. At the dose we tested, supplementation with calcium citrate malate was more effective than supplementation with calcium carbonate.”

Mechanism of Action:

Calcium promotes bone health by maximizing bone mineral density during the peak period of bone accumulation in children, adolescents and younger adults, helping prevent frail bones later in life. In older adults, calcium reduces bone loss by ensuring the pace of bone resorption does not outstrip the pace of bone formation. Calcium may support bone density by suppressing parathyroid hormone, which speeds bone resorption.