Chapter 72 Chapter 72 Calcium in the Treatment of Osteoporosis Copyright © 2013 Elsevier Inc. All rights reserved.

FIGURE 72.1 The time course of fracture events (panel A) and the change in bone mineral density at the hip (Panel B) in a trial of calcium supplementation in 3270 healthy, elderly French women [6]. By 18 months of calcium supplementation, hip fracture risk had been reduced and the bone loss occurring in the placebo group had been stopped (and to some extent reversed). Source: redrawn from the data in the paper of Chapuy et al. [6]; Copyright Robert P. Heaney, Reproduced with permission. 2

Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 72.2 Time course of hip bone mineral density (BMD) in the treated and control groups of the trial by Chapuy et al. [6]. The solid lines represent the data to the end of study, and the dashed lines, their likely extension for a further 18 months. Source: Copyright Robert P. Heaney, Reproduced with permission. 3

Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 72.3 Time course of fracture events in the trial of Dawson-Hughes et al. [7]. The solid circles are for the controls and the open circles for the calcium-treated group. The dashed lines represent the trend lines for the two contrast groups. Source: redrawn from the original data; Copyright Robert P. Heaney, Reproduced with permission. 4

Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE h, overnight time course of serum Ca and parathyroid hormone (PTH) in untreated controls and in patients receiving alendronate [21]. Solid circles are for the untreated control group and the open circles for the alendronate-treated group. Source: Copyright Robert P. Heaney, Reproduced with permission. 5

Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 72.5 Bone mineral density (BMD) change in the calcium-treated and placebo groups (panel A) and by tertile of protein intake for the calcium-treated group (panel B) in the study of Dawson-Hughes et al. [28]. Source: Copyright Robert P. Heaney, Reproduced with permission. 6

Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 72.6 Slope of calcium balance on calcium intake derived from metabolic balance studies in 640 healthy women at mid-life [31]. Panel A is the slope for the entire group, irrespective of protein intake, and panel B shows the two slopes derived when the group is split at the median protein intake (62 g/day). Error bars are 1 standard error of the mean (SEM). Note that, for those with a protein intake below the median, the slope of calcium balance on calcium intake was not significantly different from zero. Source: Copyright Robert P. Heaney, Reproduced with permission. 7