Static and tetracycline-based bone histomorphometric data from 34 normal postmenopausal females.

Transilial bone biopsies were obtained from 34 healthy postmenopausal women following in vivo fluorochrome labeling. Stained and unstained undecalcified sections were evaluated using a Merz grid. Standard histomorphometric data from cancellous bone tissue were collected and the results were evaluated and presented as variables commonly used in bone histomorphometry. The normal ranges, medians, means, and standard deviations for the group of 34 are presented in tabular form for structural, surface, basic dynamic, and derived dynamic data. Similar data for individuals grouped by ages 45-54, 55-64, and 65-74 are also presented. Secular trends for the whole group are evaluated. The structural and surface data are not much different from previous reports of sudden-death accident victims, when methodologic differences are considered. The mineral apposition rate (MAR) was 0.53 +/- 0.08 micron/day, similar to previous reports in cancellous bone, but one-third less than in cortical bone. MAR showed a marked decline with age. In contrast, the extent of tetracycline-labeled surfaces varied widely without a secular trend. Double-label surface (dLS/BS) ranged from 0.5 to 8.0% and single-label surface (sLS/BS), from 0.5 to 10.5%. Mineralizing osteoid surface (MS/OS) varied from 2 to 64%. Using only double-label surface to represent mineralizing surface, volume-based bone formation rate (BFR/BV) ranged from 0.7 to 28%/yr, and the remodeling period (Rm.P) varied from 0.28 to 4.5 years. Calculations using other representations of mineralizing surface [double plus one-half single label (MS/BS"); all label (MS/BS')] are also presented. These bone histomorphometric data are important because: (1) they come from a cohort of living subjects that was recruited solely for the purpose of establishing normal bone histomorphometry; (2) they represent the age range of patients with postmenopausal osteoporosis; and (3) they markedly expand the bone histomorphometric database of healthy persons given in vivo fluorochrome labeling prior to transilial biopsy.

Correcting calcium nutritional deficiency prevents spine fractures in elderly women.

We tested the spine antifracture and bone sparing efficacy of 1.2 g/day of oral calcium as carbonate in two groups of elderly women, one with prevalent fractures (PF, n = 94) on entry and the other without (NPF, n = 103). It was a prospective randomized, double-blind, placebo-controlled trial in mostly rural communities in women over age 60 who were living independently and were consuming < 1 g/day of calcium. We obtained annual lateral spine radiographs and semiannual forearm bone density over 4.3 +/- 1.1 years and determined vertebral fractures by radiographic morphometry augmented by physician assessment. In the PF group, 15 of 53 subjects on calcium had incident fractures, compared with 21 of 41 on placebo (p = 0.023, chi2). Calcium did not reduce the rate of incident fractures in the NPF group. Those with a prevalent fracture on entry and not treated with calcium were 2.8 times more likely to experience an incident fracture than all others. Change in the forearm bone mass on placebo in the PF group was -1.24 +/- 2.41%/year compared with +0.31 +/- 1.80%/year on calcium (p < 0.001). In the NPF group, the difference was less: -0.39 +/- 2.08%/year versus 0.00 +/- 1.64%/year (p = 0.2). We conclude that in elderly postmenopausal women with spine fractures and selfselected calcium intakes of < 1 g/day, a calcium supplement of 1.2 g/day reduces the incidence of spine fractures and halts measurable bone loss.

Calcium intake and body weight.

Five clinical studies of calcium intake, designed with a primary skeletal end point, were reevaluated to explore associations between calcium intake and body weight. All subjects were women, clustered in three main age groups: 3rd, 5th, and 8th decades. Total sample size was 780. Four of the studies were observational; two were cross-sectional, in which body mass index was regressed against entry level calcium intake; and two were longitudinal, in which change in weight over time was regressed against calcium intake. One study was a double-blind, placebo-controlled, randomized trial of calcium supplementation, in which change in weight during the course of study was evaluated as a function of treatment status. Significant negative associations between calcium intake and weight were found for all three age groups, and the odds ratio for being overweight (body mass index, >26) was 2.25 for young women in the lower half of the calcium intakes of their respective study groups (P: < 0.02). Relative to placebo, the calcium-treated subjects in the controlled trial exhibited a significant weight loss across nearly 4 yr of observation. Estimates of the relationship indicate that a 1000-mg calcium intake difference is associated with an 8-kg difference in mean body weight and that calcium intake explains approximately 3% of the variance in body weight.

Variability of calcium absorption.

Variability in calcium absorption was estimated in three groups of normal subjects in whom Ca absorption was measured by standard isotopic-tracer methods at interstudy intervals ranging from 1 to 4 mo. Fifty absorption tests were performed in 22 subjects. Each was done in the morning after an overnight fast with an identical standard breakfast containing a Ca load of approximately 250 mg. Individual fractional absorption values were normalized to permit pooling of the data. The coefficient of variation (CVs) for absorption for the three groups ranged from 10.57 to 12.79% with the size of the CV increasing with interstudy duration. One other published study presenting replicate absorption values was analyzed in a similar fashion and was found to have a CV of absorption of 9.78%. From these data we estimate that when the standard double-isotope method is used to measure Ca absorption there is approximately 10% variability around any given absorption value within an individual human subject and that roughly two-thirds of this represents real biological variability in absorption.

Meal effects on calcium absorption.

The effect of coingestion of a meal on calcium absorption efficiency was investigated using Ca carbonate, milk, and a new Ca delivery system, CCM. Six experiments with 168 rats and two experiments with 46 normal young women showed that coingestion of a light meal of varied composition enhanced absorption efficiency from all three sources by 10-30% above levels achieved when the test load was ingested without other foods. The differences taken as a whole were highly statistically significant.

Wheat bran abolishes the inverse relationship between calcium load size and absorption fraction in women.

Fractional calcium absorption from varying intakes of calcium carbonate co-ingested with wheat bran, as well as alone, was measured in a randomized crossover study in healthy adult women. The calcium carbonate was intrinsically labeled with 45Ca. Absorption from the carbonate, ingested without bran, showed the expected inverse relationship to the logarithm of ingested load size (slope = -0.1199; not substantially different from the value previously reported for milk). At 0.5 mmol calcium load, fractional absorption averaged 0.769 +/- 0.134, whereas at 12.5 mmol load it averaged 0.378 +/- 0.069. In contrast, fractional absorption from calcium carbonate co-ingested with 40 g of a cereal product containing 16 g wheat bran, across a calcium load range from 0.5 to 15.5 mmol, was essentially constant (mean for all loads: 0.230 +/- 0.069). Thus, the calcium-binding capacity of the bran cereal altered the usual inverse relationship between calcium load and fractional absorption. In vitro calcium binding to the bran cereal was linear over a wide range of calcium levels. This suggests that binding of calcium to one or more components of the bran cereal is sufficient to explain the reduced absorption demonstrated in vivo.

Calcium absorption from a new calcium delivery system (CCM).

Absorption of calcium from a highly soluble form of calcium, a mixed calcium citrate-malate salt (CCM), was tested against calcium carbonate and milk in both rats and humans. The rat method estimated absorption from the 6-day retention of an oral tracer, and the human method employed the standard double-isotope procedure. CCM was given both as a dry powder and in an orange juice beverage. In two experiments in rats calcium from CCM was absorbed at least as well as, if not better than from calcium carbonate or milk. In two separate experiments in humans, calcium from CCM was absorbed significantly better than from calcium carbonate or milk. We conclude that CCM exhibits excellent bioavailability and that this formulation is a useful addition to the forms of calcium now available either for direct supplementation or for food fortification.

Bone gain in young adult women.

OBJECTIVE: To test whether bone mass increases in healthy nonpregnant white women during early adult life after cessation of linear growth; and to test whether various self-chosen levels of physical activity and nutrient intake or use of oral contraceptives influences this increase in bone mass. DESIGN: Longitudinal prospective study of up to 5 years of 156 healthy college-aged women full-time students attending professional schools in universities in the Omaha, Neb, area. SETTING: University medical center. PARTICIPANTS: A convenience sample of healthy women students from Omaha-area professional schools. Any candidate with an illness, condition, or medication (except oral contraceptives) thought to affect general health or bone mass was excluded. INTERVENTIONS: None. OUTCOME MEASURES: Clinical and family histories of disease, particularly osteoporosis; oral contraceptive use; bone mineral densities of the spine, forearm, and total body by dual- and single-photon absorptiometry; estimates of nutrient intake by repeated 7-day diet diaries; and measures of physical activity using a physical activity monitor. RESULTS: The median gain in bone mass for the third decade of life, expressed as a percentage per decade, was 4.8% for the forearm, 5.9% for lumbar bone mineral content, 6.8% for lumbar bone mineral density, and 12.5% for total body bone mass (P < .0001 in all cases). By both bivariate and multiple regression analysis the rate of gain in bone density of the spine was negatively correlated with age and positively correlated with calcium/protein intake ratio and physical activity (multiple r = .31; P = .004). Bivariate analysis showed that use of oral contraceptives was associated with greater gain in total body bone mass (r = .31, P = .01). The estimated age when mineral acquisition ceased ranged from 28.3 years to 29.5 years at the several study sites. CONCLUSIONS: Gain in bone mass occurs in healthy young women during the third decade of life. Physical activity and dietary calcium intake both exert a positive effect on this bone gain. Use of oral contraceptives exerts a further independent positive effect. Changes in life-style among college-aged women, involving relatively modest increases in physical activity and calcium intake, may significantly reduce the risk of osteoporosis late in life.