Calcium and vitamin D intake and mortality: results from the Canadian Multicentre Osteoporosis Study (CaMos).

CONTEXT Calcium and vitamin D are recommended for bone health, but there are concerns about adverse risks. Some clinical studies suggest that calcium intake may be cardioprotective, whereas others report increased risk associated with calcium supplements. Both low and high serum levels of 25-hydroxyvitamin D have been associated with increased mortality. OBJECTIVE The purpose of this study was to determine the association between total calcium and vitamin D intake and mortality and heterogeneity by source of intake. DESIGN The Canadian Multicentre Osteoporosis Study cohort is a population-based longitudinal cohort with a 10-year follow-up (1995-2007). SETTING This study included randomly selected community-dwelling men and women. PARTICIPANTS A total of 9033 participants with nonmissing calcium and vitamin D intake data and follow-up were studied. EXPOSURE Total calcium intake (dairy, nondairy food, and supplements) and total vitamin D intake (milk, yogurt, and supplements) were recorded. OUTCOME The outcome variable was all-cause mortality. RESULTS There were 1160 deaths during the 10-year period. For women only, we found a possible benefit of higher total calcium intake, with a hazard ratio of 0.95 (95% confidence interval, 0.89-1.01) per 500-mg increase in daily calcium intake and no evidence of heterogeneity by source; use of calcium supplements was also associated with reduced mortality, with hazard ratio of 0.78 (95% confidence interval, 0.66-0.92) for users vs nonusers with statistically significant reductions remaining among those with doses up to 1000 mg/d. These associations were not modified by levels of concurrent vitamin D intake. No definitive associations were found among men. CONCLUSIONS Calcium supplements, up to 1000 mg/d, and increased dietary intake of calcium may be associated with reduced risk of mortality in women. We found no evidence of mortality benefit or harm associated with vitamin D intake.

[1]  V. Moyer.  Vitamin D and Calcium Supplementation to Prevent Fractures in Adults: U.S. Preventive Services Task Force Recommendation Statement , 2013, Annals of Internal Medicine.

[2]  H. Brenner,et al.  Serum 25-hydroxyvitamin D levels and overall mortality. A systematic review and meta-analysis of prospective cohort studies , 2013, Ageing Research Reviews.

[3]  A. Wolk,et al.  Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study , 2013, BMJ : British Medical Journal.

[4]  J. Manson,et al.  Health risks and benefits from calcium and vitamin D supplementation: Women's Health Initiative clinical trial and cohort study , 2012, Osteoporosis International.

[5]  G. Curhan,et al.  Calcium intake and risk of primary hyperparathyroidism in women: prospective cohort study , 2012, BMJ : British Medical Journal.

[6]  J. Richards,et al.  Temporal trends and determinants of longitudinal change in 25‐hydroxyvitamin D and parathyroid hormone levels , 2012, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[7]  R. Kaaks,et al.  Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg) , 2012, Heart.

[8]  J. Manson,et al.  Vitamin D with calcium reduces mortality: patient level pooled analysis of 70,528 patients from eight major vitamin D trials. , 2012, The Journal of clinical endocrinology and metabolism.

[9]  J. Christensen,et al.  A reverse J-shaped association of all-cause mortality with serum 25-hydroxyvitamin D in general practice: the CopD study. , 2012, The Journal of clinical endocrinology and metabolism.

[10]  D. Jacobs,et al.  Dietary supplements and mortality rate in older women: the Iowa Women's Health Study. , 2011, Archives of internal medicine.

[11]  I. Reid,et al.  Calcium and vitamin D supplements and health outcomes: a reanalysis of the Women's Health Initiative (WHI) limited-access data set. , 2011, The American journal of clinical nutrition.

[12]  L. Greene-Finestone,et al.  The vitamin D status of Canadians relative to the 2011 Dietary Reference Intakes: an examination in children and adults with and without supplement use. , 2011, The American journal of clinical nutrition.

[13]  K. Zhu,et al.  Calcium supplementation and the risks of atherosclerotic vascular disease in older women: Results of a 5‐year RCT and a 4.5‐year follow‐up , 2011, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[14]  Thuy-Tien L. Dam,et al.  Circulating 25‐Hydroxyvitamin D Levels and Frailty in Older Men: The Osteoporotic Fractures in Men Study , 2011, Journal of the American Geriatrics Society.

[15]  JoAnn E. Manson,et al.  The 2011 Report on Dietary Reference Intakes for Calcium and Vitamin D from the Institute of Medicine: What Clinicians Need to Know , 2010, The Journal of clinical endocrinology and metabolism.

[16]  S. Barr,et al.  Dietary patterns and incident low-trauma fractures in postmenopausal women and men aged ≥ 50 y: a population-based cohort study. , 2011, The American journal of clinical nutrition.

[17]  J. Richards,et al.  25-Hydroxyvitamin D in Canadian adults: biological, environmental, and behavioral correlates , 2011, Osteoporosis International.

[18]  I. Reid,et al.  Relationships between vascular calcification, calcium metabolism, bone density, and fractures , 2010, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[19]  S. Cummings,et al.  Circulating 25-hydroxyvitamin D levels and frailty status in older women. , 2010, The Journal of clinical endocrinology and metabolism.

[20]  David A Hanley,et al.  2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary , 2010, Canadian Medical Association Journal.

[21]  A. Avenell,et al.  Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis , 2010, BMJ : British Medical Journal.

[22]  Jennifer G. Robinson,et al.  Calcium/vitamin D supplementation and coronary artery calcification in the Women's Health Initiative , 2010, Menopause.

[23]  J. Aloia,et al.  The relative influence of calcium intake and vitamin D status on serum parathyroid hormone and bone turnover biomarkers in a double-blind, placebo-controlled parallel group, longitudinal factorial design. , 2010, The Journal of clinical endocrinology and metabolism.

[24]  J. Little,et al.  Vitamin D status of Canadians as measured in the 2007 to 2009 Canadian Health Measures Survey. , 2010, Health reports.

[25]  S. Barr,et al.  Dietary patterns in Canadian men and women ages 25 and older: relationship to demographics, body mass index, and bone mineral density , 2010, BMC musculoskeletal disorders.

[26]  Kevin Fiscella,et al.  Vitamin D, Race, and Cardiovascular Mortality: Findings From a National US Sample , 2010, The Annals of Family Medicine.

[27]  I. Reid,et al.  Effects of calcium supplementation on lipids, blood pressure, and body composition in healthy older men: a randomized controlled trial. , 2010, The American journal of clinical nutrition.

[28]  Lehana Thabane,et al.  Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study , 2009, Canadian Medical Association Journal.

[29]  M. Chonchol,et al.  25-Hydroxyvitamin D deficiency is independently associated with cardiovascular disease in the Third National Health and Nutrition Examination Survey. , 2009, Atherosclerosis.

[30]  R. Honkanen,et al.  Use of calcium supplements and the risk of coronary heart disease in 52-62-year-old women: The Kuopio Osteoporosis Risk Factor and Prevention Study. , 2009, Maturitas.

[31]  J. Manson,et al.  Calcium plus vitamin D supplementation and mortality in postmenopausal women: the Women's Health Initiative calcium-vitamin D randomized controlled trial. , 2009, The journals of gerontology. Series A, Biological sciences and medical sciences.

[32]  L. Joseph,et al.  Calcium and vitamin D intakes in an adult Canadian population. , 2009, Canadian journal of dietetic practice and research : a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en dietetique : une publication des Dietetistes du Canada.

[33]  B. Astor,et al.  25-hydroxyvitamin D levels and the risk of mortality in the general population. , 2008, Archives of internal medicine.

[34]  Stefan Pilz,et al.  Independent association of low serum 25-hydroxyvitamin d and 1,25-dihydroxyvitamin d levels with all-cause and cardiovascular mortality. , 2008, Archives of internal medicine.

[35]  Michael J. Pencina,et al.  Vitamin D Deficiency and Risk of Cardiovascular Disease , 2008, Circulation.

[36]  J. Yaphe,et al.  Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps. , 2008, The Cochrane database of systematic reviews.

[37]  P. Barber,et al.  Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial , 2008, BMJ : British Medical Journal.

[38]  J. Yaphe,et al.  Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps. , 2005, The Cochrane database of systematic reviews.

[39]  R. Cumming,et al.  Serum parathyroid hormone is associated with increased mortality independent of 25-hydroxy vitamin d status, bone mass, and renal function in the frail and very old: a cohort study. , 2004, The Journal of clinical endocrinology and metabolism.

[40]  Lawrence Joseph,et al.  Multiple Imputation to Account for Missing Data in a Survey: Estimating the Prevalence of Osteoporosis , 2002, Epidemiology.