Positron emission tomography changes management and prognostic stratification in patients with oesophageal cancer: results of a multicentre prospective study.

OBJECTIVES: The aims of this study were (1) to determine the incremental information provided by (18)F-FDG positron emission tomography (PET) in staging patients with oesophageal cancer, and (2) to determine the impact of PET staging on post-PET clinical management of oesophageal cancer, and on prognosis. METHODS: In a multicentre, single-arm open study, patients with proved oesophageal cancer without definite distant metastases and regarded as suitable for potentially curative treatment were examined by PET. Clinicians were requested to supply a management plan before and another plan after being supplied with the PET scan results. Patients were followed for at least 1 year for outcome analysis. RESULTS: A total of 129 patients (104 men, mean age 67 y) were recruited. PET detected additional sites of disease in 53 patients (41%). Significant changes in management (high or medium impact) were observed in 38% of patients, primarily as a result of identifying additional sites of disease and/or confirming previously equivocal regional and distant metastases. Progression-free survival was significantly shorter in patients found to have additional lesions on PET (p < 0.05), but was not related to SUV(max). CONCLUSION: These findings demonstrate the significant impact of PET on the clinical management of patients with newly diagnosed oesophageal carcinoma, and on prognostic stratification of these patients.

Birth weight and gender determine expression of adipogenic, lipogenic and adipokine genes in perirenal adipose tissue in the young adult sheep.

Epidemiological studies have demonstrated that low birth weight is associated with an increased incidence of visceral obesity and metabolic disorders in later life. In the present study, we have determined the impact of birth weight and gender on gene expression in visceral adipose tissue (VAT) in the young adult sheep. Lambs (n=19, birth weight range 2.6-7.55 kg) were born at term and growth monitored for 22.4+/-0.2 weeks, when body composition was determined by Dual X-ray Absorptiometry (DXA) and samples of VAT and subcutaneous (SCAT) adipose tissue collected. Plasma samples were collected at post-mortem for the determination of free fatty acids (FFA), glucose and insulin concentrations. Peroxisome-Proliferator Activated Receptor-gamma (PPARgamma), glycerol-3-phosphate dehydrogenase (G3PDH), lipoprotein lipase (LPL), adiponectin and leptin mRNA expression was determined by qRT-PCR. Fractional growth rate in postnatal weeks 1-3 was inversely related to birth weight in both males and females (R2=0.22, P<0.05, n=19). PPARgamma mRNA expression in VAT, but not SCAT, was inversely related to birth weight (R2=0.60, P<0.01, n=18). In males, but not females, PPARgamma mRNA in VAT was directly related to G3PDH mRNA expression (R2=0.69, P<0.01, n=9). Plasma FFA concentrations were inversely related to birth weight in both males and females (R2=0.22, P<0.05, n=19). These findings demonstrate that low birth weight is associated with an increased expression of a key adipogenic factor in visceral adipose tissue in young adulthood. In males, this is associated with an increased expression of lipogenic genes, and this may contribute to the increased propensity for visceral obesity in low birth weight males compared to females.

Impact of indexing resting metabolic rate against fat-free mass determined by different body composition models.

OBJECTIVE: To examine the differences arising from indexing resting metabolic rate (RMR) against fat-free mass (FFM) determined using two-, three- and four-compartment body composition models. DESIGN: All RMR and body composition measurements were conducted on the same day for each subject following compliance with premeasurement protocols. SUBJECTS: Data were generated from measurements on 104 males (age 32.1+/-12.1 y (mean+/-s.d.); body mass 81.15+/-12.85 kg; height 179.5+/-6.5 cm; body fat 20.6+/-7.6%). INTERVENTIONS: Body density (BD), total body water (TBW) and bone mineral mass (BMM) were measured by hydrodensitometry, deuterium dilution and dual energy X-ray absorptiometry (DXA), respectively. These measures were used to determine two (hydrodensitometry: BD; hydrometry: TBW)-, three (BD and TBW)- and four- compartment (BD, TBW and BMM) FFM values. DXA also provided three compartment derived FFM values. RMR was measured using open circuit indirect calorimetry. RESULTS: Three (body fat group: lean, moderate, high) x five (body composition determination: hydrodensitometry, hydrometry, three-compartment, DXA, four-compartment) ANOVAs were conducted on FFM and RMR kJ.kg FFM(-1).d(-1). Within-group comparisons revealed that hydrodensitometry and DXA were associated with significant (P<0.001) overestimations and underestimations of FFM and RMR kJ.kg FFM(-1).d(-1), respectively, compared with four-compartment-derived criterion values. A significant interaction (P<0.001) resulted from DXA's greater deviations from criterion values in lean subjects. While hydrometric means were not significantly (P> or =0.68) different from criterion values intraindividual differences were large (FFM: -1.5 to 2.9 kg; RMR: -6.0 to 3.2 kJ.kg FFM(-1).d(-1)). CONCLUSION: The relationship between RMR kJ.kg FFM(-1).d(-1) and exercise status would best be investigated using three (BD, TBW)- or four (BD, TBW, BMM)-compartment body composition models to determine FFM. Other models either significantly underestimate indexed RMR (hydrodensitometry, DXA) or display large intraindividual differences (hydrometry) compared with four-compartment derived criterion values. SPONSORSHIP: Australian Research Council (small grants scheme).

Increased permeability of psoriatic skin to the protein, plasminogen activator inhibitor 2.

The penetration and permeation of the recombinant protein plasminogen activator inhibitor type 2 (PAI-2) in two formulations, one containing a penetration enhancer, into the psoriatic and uninvolved skin of eight patients with plaque-type psoriasis were investigated. Penetration and permeation of PAI-2 were measured by gamma counting and imaging following radiolabelling of a fraction of the applied PAI-2 with (123)I. The feasibility of topical delivery of drug to psoriatic plaques was confirmed by the finding that the permeability of psoriatic plaques to radiolabelled PAI-2 (P=0.007) and free (123)I (P=0.001) was approximately tenfold higher than the permeability of uninvolved skin. The addition of a penetration enhancer improved the permeation of PAI-2 into psoriatic plaques from an average of 35% to 46% (P=0.005). Occlusion decreased the permeation amount of PAI-2 from 46% to 15% due to losses on the occlusive dressing (P=0.001).

Body composition changes in female bodybuilders during preparation for competition.

OBJECTIVE: To determine anthropometric and body composition changes in female bodybuilders during preparation for competition. DESIGN: There was an attempt to match subjects in the control and experimental groups for height and percentage body fat (%BF) for the initial test of this longitudinal study. SUBJECTS: Five competitive bodybuilders (-X +/- s.d.: 35.3 +/- 5.7 y; 167.3 +/- 3.7 cm; 66.38 +/- 6.30 kg; 18.3 +/- 3.5 %BF) and five athletic females (-X +/- s.d.: 30.9 +/- 13.0 y; 166.9 +/- 3.9 cm; 55.94 +/- 3.59 kg; 19.1 +/- 3.3 %BF) were recruited from advertisements in a bodybuilding newsletter and placed on sports centre noticeboards. INTERVENTIONS: The following measurements were conducted 12 weeks, 6 weeks and 3-5 d before the bodybuilders' competitions: anthropometric profile, body density by underwater weighing, total body water via deuterium dilution and bone mineral mass from a dual-energy X-ray absorptiometry scan. A combination of the last three measurements enabled the %BF to the determined by a four compartment model. RESULTS: A significant (P < or = 0.001) 5.80 kg body mass loss by the bodybuilders as they prepared for competition was primarily due to a reduction in fat mass (FM; -4.42 kg; 76.2%) as opposed to fat-free mass (FFM; -1.38 kg; 23.8%). The decreases in body mass and FM over the final 6 weeks were greater than those over the first 6 weeks. Their %BF decreased (P < 0.001) from 18.3 to 12.7, whereas the values for the control group remained essentially unchanged at 19.1-19.6 %BF. These body composition changes by the bodybuilders were accompanied by a significant decline (P < 0.001) of 25.5 mm (76.3-50.8 mm) in the sum of eight skinfold thicknesses (triceps + subscapular + biceps + iliac crest + supraspinale + abdominal + front thigh + medial calf). CONCLUSIONS: Although the bodybuilders presented with low %BFs at the start of the experiment, they still significantly decreased their body mass during the 12 week preparation for competition and most of this loss was due to a reduction in FM as opposed to FFM.

A simple and inexpensive preparation of [(51)Cr]-MAA particles.

The feasibility of preparing [(51)Cr]-MAA was investigated using an MAA cold kit and commercially available sodium [(51)Cr]chromate solutions. Of different conditions tested, the best required an addition of a low level of sodium dithionite to achieve a radiolabeling efficiency of 44%. The product was purified by centrifugation to give [(51)Cr]-MAA with 99 +/- 1% radiochemical purity (RCP) comprised of >94% radioactive particles >10 microm, and resulted in a rat biodistribution with >80% in the lungs. [(51)Cr]-MAA is inexpensive, easily and conveniently prepared by this procedure.

Predicting the resting metabolic rate of young Australian males.

OBJECTIVES: The aims of this study were: (a) to generate regression equations for predicting the resting metabolic rate (RMR) of 18 to 30-y-old Australian males from age, height, mass and fat-free mass (FFM); and (b) cross-validate RMR prediction equations, which are frequently used in Australia, against our measured and predicted values. DESIGN: A power analysis demonstrated that 38 subjects would enable us to detect (alpha = 0.05, power = 0.80) statistically and physiologically significant differences of 8% between our predicted/measured RMRs and those predicted from the equations of other investigators. SUBJECTS: Thirty-eight males (chi +/- s.d.: 24.3+/-3.3y; 85.04+/-13.82 kg; 180.6+/-8.3 cm) were recruited from advertisements placed in a university newsletter and on community centre noticeboards. INTERVENTIONS: The following measurements were conducted: skinfold thicknesses, RMR using open circuit indirect calorimetry and FFM via a four-compartment (fat mass, total body water, bone mineral mass and residual) body composition model. RESULTS: A multiple regression equation using the easily measured predictors of mass, height and age correlated 0.841 with RMR and the SEE was 521 kJ/day. Inclusion of FFM as a predictor increased both the R and the precision of prediction, but there was virtually no difference between FFM via the four-compartment model (R = 0.893, SEE = 433 kJ/day) and that predicted from skinfold thicknesses (R = 0.886, SEE = 440 kJ/day). The regression equations of Harris & Benedict (1919) and Schofield (1985) all overestimated the mean RMR of our subjects by 518 - 600 kJ/day (P < 0.001) and these errors were relatively constant across the range of measured RMR. The equations of Hayter & Henry (1994) and Piers et al (1997) only produced physiologically significant errors at the lower end of our range of measurement. CONCLUSIONS: Equations need to be generated from a large database for the prediction of the RMR of 18 to 30-y-old Australian males and FFM estimated from the regression of the sum of skinfold thicknesses on FFM via the four compartment body composition model needs to be further explored as an expedient RMR predictor.

The relation between bone density, free androgen index, and estradiol in men 60 to 70 years old.

The cause of age-related bone loss in men is poorly understood. Previous studies of the relationship between bone density and serum androgens have yielded inconsistent results, perhaps partly because age is a determinant of both. Recent studies suggest that serum estrogen levels influence bone density in adult men. In order to determine whether bone mineral density (BMD) and bone turnover are associated with serum sex steroids, we investigated 37 normal men within a narrow age range (60-70 years). Bone mineral density at the forearm, hip, and spine, testosterone, sex hormone binding globulin (SHBG), free androgen index (FAI:T/SHBG), estradiol (E), free estradiol index (FEI:E/SHBG), and markers of bone formation (alkaline phosphatase, osteocalcin, procollagen type I C-terminal extension peptide) and bone resorption (hydroxyproline/creatinine [OHPr/Cr], deoxypyridinoline/creatinine [Dpd/Cr], pyridinoline/creatinine, collagen type I cross-linked telopeptide) were measured. Bone mineral density was positively related (r > 0.35, p < 0.05 at all sites) to log FAI, whereas there was no significant relationship between BMD and either serum total testosterone, serum E, or FEI. Bone density at the spine and hip were inversely related to both OHPr/Cr (r > -0.41, p < 0.05 for all sites) and Dpd/Cr (r > -0.36, p < 0.05 for all sites). OHPr/Cr (r = -0.41, p < 0.05) and Dpd/Cr (r = -0.41, p < 0.05) were both inversely related to log FAI. We conclude that BMD and bone turnover in adult men are related to plasma free androgens.

Familial and environmental influences on bone growth from 11-17 years.

The influences on bone growth of familial factors, nutrition and physical activity are described in a cohort of 108 children (56M, 52F). Distal forearm bone width, mineral content and volumetric density, anthropometry, pubertal status, nutritional intake and physical activity were measured at ages 11, 13, 15 and 17 y. Parental forearm bone status was also determined. Both mothers' and fathers' bone variables were significant predictors of the respective children's bone variables, but heritability estimates were greater between mothers and their children than between fathers and their children. By age 17 y boys had attained 101%, 85% and 89% of their fathers' height, bone mineral content and volumetric density, respectively; girls had attained 103%, 95% and 98% of their mothers' height, bone mineral content and volumetric density, respectively. There were no consistent associations among nutrient variables and bone status or rate of change in bone status. However, there was a significantly greater increase in bone mineral content and density from 11-17 y in those girls with consistently high calcium intake. There were no significant correlations between physical activity and bone values or rate of change of bone values. Age, gender, pubertal status, height, weight and parental bone values accounted for 80%, 71% and 49% of the variance of bone mineral content, bone width and volumetric density, respectively and 52%, 55% and 58% respectively of the variance of change in these variables. After age, gender, sexual maturity and body size, heritability accounts for the greatest variance in bone values through adolescence.

Resting metabolic rate, body composition and aerobic fitness comparisons between active and sedentary 54-71 year old males.

OBJECTIVE: To test the hypothesis that 55-70 y old male longterm exercisers (LE) have higher resting metabolic rates (RMR) than longterm nonexercisers (LNE). DESIGN: A power analysis demonstrated that this cross-sectional study required 12 subjects per group to detect a 10% RMR difference (kJ x kg FFM(-1) x d(-1)) between the LE and LNE (power = 0.8;alpha = 0.05). SUBJECTS: Twelve LE (X +/- s.d.; 63.5+/-3.4 y; 1.75+/-0.06 m; 69.01+/-8.24 kg; 20.4+/-4.9 %BF) and 12 LNE (63.6+/-5.6 y; 1.72+/-0.07 m; 79.44 12.4 kg; 29.6 4.4 %BF) were recruited from advertisements placed in a newspaper and on university and community noticeboards. INTERVENTIONS: Measurements were conducted for: RMR using the Douglas bag technique; body composition via a four compartment model which is based on determination of body density, total body water and bone mineral mass; and aerobic fitness using a submaximal work test on a cycle ergometer. RESULTS: The LE (93.00+/-7.16 kJ x kg(-1) x d(-1)) registered a significantly greater (P = 0.04) RMR than the LNE (84.70+/-11.23 kJ x kg(-1) x d(-1)) when energy expenditure was expressed relative to body mass, but this difference disappeared (P = 0.55) when the data were corrected for the non-zero intercept of the graph of RMR (MJ/d) against body mass. ANCOVA with FFM as the covariate also indicated that the RMR (MJ/d) difference between the groups was not statistically significant (P = 0.28). The adjusted means for the LE and LNE were 6.39 and 6.62 MJ/d, respectively. CONCLUSIONS: There are no RMR (MJ/d) differences between LE and LNE 54-71 y old males when statistical control is exerted for the effect of FFM and the higher value of the former group for RMR normalised to body mass disappears when this ratio is corrected for statistical bias.

In vivo real-time analysis of intraperitoneal radiolabeled tumor cell movement during laparoscopy.

PURPOSE: A porcine model has been developed to allow the real-time imaging of radiolabeled tumor cell movement throughout the peritoneal cavity, both at rest and during carbon dioxide insufflation. METHODS: Fifteen 30-kg domestic white female pigs were used. Under anesthesia, 15 to 20 million radiolabeled human colorectal tumor cells (LIM1215) were introduced into the peritoneal cavity under laparoscopic vision into the pelvis. Radiolabeled tumor cell movement was examined by using a 25-cm-diameter, low-energy mobile gamma camera with high resolution collimator. Tumor cell movement and distribution during two hours without insufflation was examined in four pigs. Then tumor cell movement and distribution during two hours with CO2 insufflation was examined in four pigs. In a further four pigs, tumor cells were then mixed with blood and injected into the peritoneal cavity and the effect of no insufflation vs. insufflation was noted. A further three pigs were examined with manipulation of the intra-abdominal contents after injection of LIM1215 cells into the peritoneal cavity. Venting insufflating CO2 was filtered for tumor cells. RESULTS: Widespread intraperitoneal distribution of tumor cells from the pelvis was identified both with CO2 insufflation of the peritoneal cavity and without insufflation. Tumor cells dispersed throughout the peritoneal cavity at a slower rate without carbon dioxide insufflation. There was a differential rate of tumor cell movement to the left upper quadrant and right upper quadrant with insufflation and without insufflation. Blood within the peritoneal cavity and an extended contact of the laparoscopic trocars with the peritoneal cavity in this setting increased contamination of the trocars and trocar sites with tumor cells. Tumor cells were identified on laparoscopic instruments in all experiments. No evidence of aerosolization of tumor cells was found. CONCLUSION: Tumor cells move throughout the peritoneal cavity both at rest and during CO2 insufflation. The pattern of tumor cell dispersion differs with CO2 insufflation. The presence of blood and extended contact of trocars with peritoneal contents are a major factor in trocar and trocar site tumor cell contamination.

Effect of 3 weeks of detraining on the resting metabolic rate and body composition of trained males.

OBJECTIVE: To examine the hypothesis that detraining decreases the resting metabolic rate (RMR) of long-term exercisers. DESIGN: Eight pairs of subjects were matched for age, mass and training volume. They were then randomly allocated to either a control group (continue normal training) or detraining group (stop normal training but continue activities of daily living). SETTING: Exercise Physiology Laboratory, The Flinders University of South Australia. SUBJECTS: Sixteen male subjects (age 23.1 +/- 4.7 y (s.d.); mass 73.73 +/- 8.9 kg; VO2max 60.2 +/- 6.3 ml. kg-1.min-1; height 180.3 +/- 5.0 cm; body fat 14.6 +/- 5.4%) were selected from a pool of respondents to our advertisements. INTERVENTIONS: Each pair of subjects was measured before and after a 3-week experimental period. RESULTS: Two (groups) x 3 (2-, 3-and 4-compartment body composition models) ANOVAs were conducted on the difference between the pre- and post-treatment scores for percentage body fat, fat-free mass (FFM) and relative RMR (kJ.kg FFM-1.h-1). No significant between-group differences were identified except for the detraining group's small decrease in FFM (0.7 kg, P = 0.05). The main effects for body composition model were all significant; but the overall differences between the multicompartment models and the 2-compartment one were less than their technical errors of measurement. No significant interaction (P = 0.51) resulted from a 2 x 2 ANOVA on the pre- and post-treatment absolute RMR data for the control (315.2 and 311.9 kJ/h) and detraining groups (325.4 and 325.5 kJ/h). CONCLUSIONS: 3-weeks detraining is not associated with a decrease in RMR (kJ/h, kJ.kg FFM-1.h-1) in trained males; hence, our data do not support a potentiation of the RMR via exercise training. The greater sensitivity of the multicompartment models to detect changes in body composition was of marginal value.

Bone growth from 11 to 17 years: relationship to growth, gender and changes with pubertal status including timing of menarche.

The tempo and change in bone growth during puberty in relation to physical growth is described in a cohort of 56 boys and 52 girls. Distal forearm bone width, mineral content and volumetric density, anthropometry and pubertal status were measured at ages 11, 13, 15 and 17 y, and bone age at 17 y. Bone width and mineral content increased independently with age for each pubertal stage. Volumetric density fell during early puberty and then increased rapidly. Maximal increase of all bone variables occurred earlier in girls than in boys and earliest for bone width, then mineral content, then density. In girls most change occurred in the 12 mo before and after menarche. The degree of tracking was similar to that for height. Bone growth followed physical growth but at a slower tempo. By age 17 y boys had attained 86% of the reference adult bone mineral content and volumetric density; girls had attained 93% of the reference adult bone mineral content and 94% of volumetric density. Those skeletally mature at 17 y had greater mineral content and volumetric density. To maximize peak bone mass, modifiable environmental factors should be optimized before the onset of puberty and be maintained throughout this period of rapid growth and beyond attainment of sexual maturity.

Segmental colonic transit after oral 67Ga-citrate in healthy subjects and those with chronic idiopathic constipation.

UNLABELLED: Measurement of segmental colonic transit is important in the assessment of patients with severe constipation. 111In-diethylenetriamine pentaacetic acid (DTPA) has been established as the tracer of choice for these studies, but it is expensive and not readily available. 67Ga-citrate is an inexpensive tracer and when given orally is not absorbed from the bowel. It was compared with 111In-DTPA in colonic transit studies in nonconstipated control subjects and then in patients with idiopathic constipation. METHODS: Studies were performed after oral administration of 3 MBq (81 microCi) 67Ga-citrate or 4 MBq (108 microCi) 111In-DTPA in solution. Serial abdominal images were performed up to 96 h postinjection, and computer data were generated from geometric mean images of segmental retention of tracer, mean activity profiles and a colonic tracer half-clearance time. RESULTS: There were no differences in segmental retention of either tracer or in mean activity profiles between control subjects and constipated patients. Results in constipated subjects were significantly different from those in controls. The mean half-clearance times of tracer for control subjects were 28.8 h for 67Ga-citrate and 29.9 h for 111In-DTPA in control subjects and 75.0 h for 67Ga-citrate and 70.8 h for 111In-DTPA in constipated patients. CONCLUSION: Oral 67Ga-citrate can be used as a safe alternative to 111In-DTPA for accurate measurement of segmental colonic transit.

Reliability of sentinel node status in predicting axillary lymph node involvement in breast cancer.

OBJECTIVES: To assess the reliability of determining sentinel node status in staging regional lymph nodes in breast cancer. DESIGN AND SETTING: Prospective validation study in a major public teaching hospital, comparing histological sentinel node status with that of remaining axillary nodes. PATIENTS: 117 women who underwent sentinel node biopsy and axillary dissection for primary breast cancer between 1995 and 1998. MAIN OUTCOME MEASURES: Intraoperative success rate in sentinel node identification; false negative rate; predictive value of negative sentinel node status; overall accuracy of sentinel node status. RESULTS: The sentinel node was identified at operation in 95 patients (81.2%). Tumour involvement of the sentinel node was demonstrated in 29 of 31 women (93.5%; 95% CI, 79%-99%). Sixty-four of the 66 women in whom the sentinel node was negative for tumour showed no further involvement of remaining axillary nodes (standard haematoxylin-eosin histological assessment), giving a predictive value of negative sentinel node status of 97% (95% CI, 89%-100%). The overall accuracy in 95 women in whom sentinel node status was compared with axillary node status was 97.9%. CONCLUSIONS: Histopathological examination of the sentinel node is an accurate method of assessing axillary lymph node status in primary breast cancer and is likely to be incorporated into future surgical management of women with primary breast cancer.

Comparisons of two-, three-, and four-compartment models of body composition analysis in men and women.

This study compared the traditional two-compartment (fat mass or FM; fat free mass or FFM) hydrodensitometric method of body composition measurement, which is based on body density, with three (FM, total body water or TBW, fat free dry mass)- and four (FM, TBW, bone mineral mass or BMM, residual)-compartment models in highly trained men (n = 12), sedentary men (n = 12), highly trained women (n = 12), and sedentary women (n = 12). The means and variances for the relative body fat (%BF) differences between the two- and three-compartment models [2.2 +/- 1.6 (SD) % BF; n = 48] were significantly greater (P

Nutrition, osteoporosis, and aging.

Loss of bone is an almost universal accompaniment of aging that proceeds at an average rate of 0.5-1% per annum from midlife onwards. There are at least four nutrients involved in this process: calcium, salt, protein, and vitamin D, at least in women. The pathogenesis of osteoporosis in men is more obscure. Calcium is a positive risk factor because calcium requirement rises at the menopause due to an increase in obligatory calcium loss and a small reduction in calcium absorption that persist to the end of life. A metaanalysis of 20 calcium trials shows that this process can generally be arrested by calcium supplementation, although there is some doubt about its effectiveness in the first few years after menopause. Salt is a negative risk factor because it increases obligatory calcium loss; every 100 mmol of sodium takes 1 mmol of calcium out of the body. Restricting salt intake lowers the rate of bone resorption in postmenopausal women. Protein is another negative risk factor; increasing animal protein intake from 40 to 80 g daily increases urine calcium by about 1 mmol/day. Low protein intakes in third world countries may partially protect against osteoporosis. Vitamin D (sometimes called a nutrient and sometimes a hormone) is important because age-related vitamin D deficiency leads to malabsorption of calcium, accelerated bone loss, and increased risk of hip fracture. Vitamin D supplementation has been shown to retard bone loss and reduce hip fracture incidence in elderly women.