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In this issue, the USPSTF recommendation statement and evidence review report insufficient evidence for or against testing for vitamin D deficiency. The editorialists urge practitioners to measure ...

In the elderly women in this study, low fractional calcium absorption in the setting of low calcium intake increased the risk for hip fracture. These findings support the hypothesis of type II oste...

In elderly women, continuous low-dose hormone replacement therapy with conjugated equine estrogen and oral medroxyprogesterone combined with adequate calcium and vitamin D provides a bone-sparing e...

Background: Hormone replacement therapy (HRT), the mainstay of osteoporosis prevention, is limited because of dose-related risks, side effects, and patient acceptance. The bone-sparing efficacy and tolerability of the lowest available doses of HRT have not been adequately studied in elderly women. Objective: To determine the bone-sparing effect of continuous low-dose HRT in elderly women. Design: Randomized, double-blind, placebo-controlled trial. Setting: University osteoporosis research and clinical center. Patients: 128 healthy white women (age > 65 years) with low bone mass recruited by word of mouth and by local advertisement. The principal eligibility criterion was spinal bone mineral density of 0.90 g/cm 2 or less. Intervention: Continuous therapy with conjugated equine estrogen, 0.3 mg/d, and medroxyprogesterone, 2.5 mg/d, or matching placebo. Sufficient calcium supplementation was given to bring all calcium intakes above 1000 mg/d in both groups; supplemental oral 25-hydroxyvitamin D was given to maintain serum 25-hydroxyvitamin D levels of at least 75 nmol/L in both groups. Measurements: Bone mineral density of the spine, hip, total body, and forearm; serum total alkaline phosphatase and serum osteocalcin levels at 6-month intervals; and 24-hour urine creatinine and hydroxyproline excretion at baseline, 12 months, and 42 months. Results: During 3.5 years of observation, spinal bone mineral density increased by 3.5% (P < 0.001) in an intention-to-treat analysis and by 5.2% among patients with greater than 90% adherence to therapy. Significant increases were seen in total-body and forearm bone density (P < 0.01). Symptoms related to HRT (breast tenderness, spotting, pelvic discomfort, and mood changes) were mild and short-lived. Conclusions: Continuous low-dose HRT with conjugated equine estrogen and oral medroxyprogesterone combined with adequate calcium and vitamin D provides a bone-sparing effect that is similar or superior to that provided by other, higher-dose HRT regimens in elderly women. This combination is well tolerated by most patients.

Sixty postmenopausal women were placed in three groups--control, sex hormone-treated, and CaCO3-treated--and followed for 2 years. Skeletal mass decreased by 1.18%/year in the control group, 0.15%/year in the hormone group, and 0.22%/year in the CaCO3 group by radiogrammetry; and 2.88%/year in the control group, 0.73%/year in the hormone group, and 1.83%/year in the CaCO3 group by photon absorptiometry. The treatment groups differed significantly from the control group except for photon absorptiometry in the CaCO3 group. Bone accretion and resorption decreased in the treatment groups as measured by calcium tracer kinetics, resorption more so than accretion. We conclude that [1] these techniques are sufficiently sensitive to detect age-related bone loss; [2] postmenopausal sex-hormone replacement measurably decreases age-related bone loss by suppressing bone turnover, resorption more than accretion; and [3] calcium supplements produce the same effect but at the dose we used were slightly less effective.

Measurements of true calcium absorption fraction in women were evaluated to see how closely calculations based on a single measurement of serum specific activity after administration of an oral calcium tracer might approximate the absorption value derived from the full, double-isotope absorption procedure. True absorption, body size, and miscible pool turnover could together explain better than 93% of the variance in serum calcium specific activity values 5 hours after a tracer-labeled test meal. Because measurement of pool turnover is not available routinely, it was dropped from the model, and a predictor equation was developed that allowed estimation of true absorption from the 5-hour serum specific activity value, height, and weight. These variables explained 90.8% of the variance in the 5-hour values and gave estimates of true absorption with a 95% confidence interval of +/- 0.055. This small range of uncertainty makes the procedure useful in estimating absorption efficiency for calcium therapy in routine clinical practice.

Excerpt To the editor: In October 1985, we described (1) a method for estimating true fractional calcium absorption, which requiredonly a single blood sample taken 5 hours after ingestion of an iso...