Skip to main content
NCBI home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1987 Mar 15;136(6):587–593.

Osteoporosis, calcium and physical activity.

A D Martin, C S Houston
PMCID: PMC1491904  PMID: 3545420

Abstract

Sales of calcium supplements have increased dramatically since 1983, as middle-aged women seek to prevent or treat bone loss due to osteoporosis. However, epidemiologic studies have failed to support the hypothesis that larger amounts of calcium are associated with increased bone density or a decreased incidence of fractures. The authors examine the evidence from controlled trials on the effects of calcium supplementation and physical activity on bone loss and find that weight-bearing activity, if undertaken early in life and on a regular basis, can increase the peak bone mass of early adulthood, delay the onset of bone loss and reduce the rate of loss. All of these factors will delay the onset of fractures. Carefully planned and supervised physical activity programs can also provide a safe, effective therapy for people who have osteoporosis.

Full text

PDF
587

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ABRAMSON A. S., DELAGI E. F. Influence of weight-bearing and muscle contraction on disuse osteoporosis. Arch Phys Med Rehabil. 1961 Mar;42:147–151. [PubMed] [Google Scholar]
  2. Albanese A. A., Edelson A. H., Lorenze E. J., Jr, Woodhull M. L., Wein E. H. Problems of bone health in elderly. Ten-year study. N Y State J Med. 1975 Feb;75(3):326–336. [PubMed] [Google Scholar]
  3. Aloia J. F., Cohn S. H., Ostuni J. A., Cane R., Ellis K. Prevention of involutional bone loss by exercise. Ann Intern Med. 1978 Sep;89(3):356–358. doi: 10.7326/0003-4819-89-3-356. [DOI] [PubMed] [Google Scholar]
  4. Andersson S. M., Nilsson B. E. Changes in bone mineral content following ligamentous knee injuries. Med Sci Sports. 1979 Winter;11(4):351–353. [PubMed] [Google Scholar]
  5. BOLLET A. J., ENGH G., PARSON W. EPIDEMIOLOGY OF OSTEOPOROSIS; SEX AND RACE INCIDENCE OF HIP FRACTURES. Arch Intern Med. 1965 Aug;116:191–194. doi: 10.1001/archinte.1965.03870020031009. [DOI] [PubMed] [Google Scholar]
  6. Banzer D. H., Schneider U., Risch W. D., Botsch H. Proceedings: Roentgen signs of vertebral demineralization and mineral content of peripheral cancellous bone. AJR Am J Roentgenol. 1976 Jun;126(6):1306–1308. doi: 10.2214/ajr.126.6.1306. [DOI] [PubMed] [Google Scholar]
  7. Bell R. R., Tzeng D. Y., Draper H. H. Long-term effects of calcium, phosphorus and forced exercise on the bones of mature mice. J Nutr. 1980 Jun;110(6):1161–1168. doi: 10.1093/jn/110.6.1161. [DOI] [PubMed] [Google Scholar]
  8. Borkan G. A., Norris A. H. Biological age in adulthood: comparison of active and inactive U.S. males. Hum Biol. 1980 Dec;52(4):787–802. [PubMed] [Google Scholar]
  9. Brewer V., Meyer B. M., Keele M. S., Upton S. J., Hagan R. D. Role of exercise in prevention of involutional bone loss. Med Sci Sports Exerc. 1983;15(6):445–449. [PubMed] [Google Scholar]
  10. Brighton C. T., Katz M. J., Goll S. R., Nichols C. E., 3rd, Pollack S. R. Prevention and treatment of sciatic denervation disuse osteoporosis in the rat tibia with capacitively coupled electrical stimulation. Bone. 1985;6(2):87–97. doi: 10.1016/8756-3282(85)90312-6. [DOI] [PubMed] [Google Scholar]
  11. Bringhurst F. R., Potts J. T., Jr Effects of vitamin D metabolites and analogs on bone collagen synthesis in vitro. Calcif Tissue Int. 1982 Jan;34(1):103–110. doi: 10.1007/BF02411216. [DOI] [PubMed] [Google Scholar]
  12. Burr D. B., Martin R. B., Martin P. A. Lower extremity loads stimulate bone formation in the vertebral column: implications for osteoporosis. Spine (Phila Pa 1976) 1983 Oct;8(7):681–686. doi: 10.1097/00007632-198310000-00001. [DOI] [PubMed] [Google Scholar]
  13. Chamay A., Tschantz P. Mechanical influences in bone remodeling. Experimental research on Wolff's law. J Biomech. 1972 Mar;5(2):173–180. doi: 10.1016/0021-9290(72)90053-x. [DOI] [PubMed] [Google Scholar]
  14. Christiansen C., Rødbro P. Serum vitamin D metabolites in younger and elderly postmenopausal women. Calcif Tissue Int. 1984 Jan;36(1):19–24. doi: 10.1007/BF02405289. [DOI] [PubMed] [Google Scholar]
  15. Cobey J. C., Cobey J. H., Conant L., Weil U. H., Greenwald W. F., Southwick W. O. Indicators of recovery from fractures of the hip. Clin Orthop Relat Res. 1976 Jun;(117):258–262. [PubMed] [Google Scholar]
  16. Cummings S. R., Kelsey J. L., Nevitt M. C., O'Dowd K. J. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev. 1985;7:178–208. doi: 10.1093/oxfordjournals.epirev.a036281. [DOI] [PubMed] [Google Scholar]
  17. Dalén N., Olsson K. E. Bone mineral content and physical activity. Acta Orthop Scand. 1974;45(2):170–174. doi: 10.3109/17453677408989136. [DOI] [PubMed] [Google Scholar]
  18. DeLuca H. F. The vitamin D system in the regulation of calcium and phosphorus metabolism. Nutr Rev. 1979 Jun;37(6):161–193. doi: 10.1111/j.1753-4887.1979.tb06660.x. [DOI] [PubMed] [Google Scholar]
  19. Dequeker J., Remans J., Franssen R., Waes J. Ageing patterns of trabecular and cortical bone and their relationship. Calcif Tissue Res. 1971;7(1):23–30. doi: 10.1007/BF02062590. [DOI] [PubMed] [Google Scholar]
  20. Ettinger B., Genant H. K., Cann C. E. Postmenopausal bone loss is prevented by treatment with low-dosage estrogen with calcium. Ann Intern Med. 1987 Jan;106(1):40–45. doi: 10.7326/0003-4819-106-1-40. [DOI] [PubMed] [Google Scholar]
  21. Francis R. M., Peacock M., Taylor G. A., Storer J. H., Nordin B. E. Calcium malabsorption in elderly women with vertebral fractures: evidence for resistance to the action of vitamin D metabolites on the bowel. Clin Sci (Lond) 1984 Jan;66(1):103–107. doi: 10.1042/cs0660103. [DOI] [PubMed] [Google Scholar]
  22. Gallagher J. C., Melton L. J., Riggs B. L., Bergstrath E. Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop Relat Res. 1980 Jul-Aug;(150):163–171. [PubMed] [Google Scholar]
  23. Goodship A. E., Lanyon L. E., McFie H. Functional adaptation of bone to increased stress. An experimental study. J Bone Joint Surg Am. 1979 Jun;61(4):539–546. [PubMed] [Google Scholar]
  24. Gordan G. S., Genant H. K. The aging skeleton. Clin Geriatr Med. 1985 Feb;1(1):95–118. [PubMed] [Google Scholar]
  25. Greaves J. P., Hollingsworth D. F. Trends in food consumption in the United Kingdom. World Rev Nutr Diet. 1966;6:34–89. doi: 10.1159/000391422. [DOI] [PubMed] [Google Scholar]
  26. Hansson T., Roos B., Nachemson A. The bone mineral content and ultimate compressive strength of lumbar vertebrae. Spine (Phila Pa 1976) 1980 Jan-Feb;5(1):46–55. doi: 10.1097/00007632-198001000-00009. [DOI] [PubMed] [Google Scholar]
  27. Horsman A., Gallagher J. C., Simpson M., Nordin B. E. Prospective trial of oestrogen and calcium in postmenopausal women. Br Med J. 1977 Sep 24;2(6090):789–792. doi: 10.1136/bmj.2.6090.789. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Houston C. S. The radiologist's opportunity to teach bone dynamics. J Can Assoc Radiol. 1978 Dec;29(4):232–238. [PubMed] [Google Scholar]
  29. Hurxthal L. M., Vose G. P. The relationship of dietary calcium intake to radiographic bone density in normal and osteoporotic persons. Calcif Tissue Res. 1969;4(3):245–256. doi: 10.1007/BF02279127. [DOI] [PubMed] [Google Scholar]
  30. Jensen G. F., Christiansen C., Transbøl I. Treatment of post menopausal osteoporosis. A controlled therapeutic trial comparing oestrogen/gestagen, 1,25-dihydroxy-vitamin D3 and calcium. Clin Endocrinol (Oxf) 1982 May;16(5):515–524. doi: 10.1111/j.1365-2265.1982.tb02769.x. [DOI] [PubMed] [Google Scholar]
  31. Johnell O., Nilsson B. E. Life-style and bone mineral mass in perimenopausal women. Calcif Tissue Int. 1984 Jul;36(4):354–356. doi: 10.1007/BF02405345. [DOI] [PubMed] [Google Scholar]
  32. Kiiskinen A., Heikkinen E. Physical training and connective tissues in young mice: biochemistry of long bones. J Appl Physiol Respir Environ Exerc Physiol. 1978 Jan;44(1):50–54. doi: 10.1152/jappl.1978.44.1.50. [DOI] [PubMed] [Google Scholar]
  33. Krølner B., Toft B., Pors Nielsen S., Tøndevold E. Physical exercise as prophylaxis against involutional vertebral bone loss: a controlled trial. Clin Sci (Lond) 1983 May;64(5):541–546. doi: 10.1042/cs0640541. [DOI] [PubMed] [Google Scholar]
  34. Lamke B., Sjöberg H. E., Sylvén M. Bone mineral content in women with Colles' fracture: effect of calcium supplementation. Acta Orthop Scand. 1978 Apr;49(2):143–146. doi: 10.3109/17453677809005740. [DOI] [PubMed] [Google Scholar]
  35. Lane N. E., Bloch D. A., Jones H. H., Marshall W. H., Jr, Wood P. D., Fries J. F. Long-distance running, bone density, and osteoarthritis. JAMA. 1986 Mar 7;255(9):1147–1151. [PubMed] [Google Scholar]
  36. Lewis A. F. Fracture of neck of the femur: changing incidence. Br Med J (Clin Res Ed) 1981 Nov 7;283(6301):1217–1220. doi: 10.1136/bmj.283.6301.1217. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Martin R. K., Albright J. P., Clarke W. R., Niffenegger J. A. Load-carrying effects on the adult beagle tibia. Med Sci Sports Exerc. 1981;13(5):343–349. doi: 10.1249/00005768-198105000-00014. [DOI] [PubMed] [Google Scholar]
  38. Marx J. L. Osteoporosis: new help for thinning bones. Science. 1980 Feb 8;207(4431):628–630. doi: 10.1126/science.7352275. [DOI] [PubMed] [Google Scholar]
  39. Matković V., Kostial K., Simonović I., Buzina R., Brodarec A., Nordin B. E. Bone status and fracture rates in two regions of Yugoslavia. Am J Clin Nutr. 1979 Mar;32(3):540–549. doi: 10.1093/ajcn/32.3.540. [DOI] [PubMed] [Google Scholar]
  40. Mazess R. B. On aging bone loss. Clin Orthop Relat Res. 1982 May;(165):239–252. [PubMed] [Google Scholar]
  41. Mazess R. B., Whedon G. D. Immobilization and bone. Calcif Tissue Int. 1983 May;35(3):265–267. doi: 10.1007/BF02405043. [DOI] [PubMed] [Google Scholar]
  42. Miller C. W. Survival and ambulation following hip fracture. J Bone Joint Surg Am. 1978 Oct;60(7):930–934. [PubMed] [Google Scholar]
  43. Montoye H. J., McCabe J. F., Metzner H. L., Garn S. M. Physical activity and bone density. Hum Biol. 1976 Sep;48(3):599–610. [PubMed] [Google Scholar]
  44. Nilas L., Christiansen C., Rødbro P. Calcium supplementation and postmenopausal bone loss. Br Med J (Clin Res Ed) 1984 Oct 27;289(6452):1103–1106. doi: 10.1136/bmj.289.6452.1103. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Nilsson B. E., Westlin N. E. Bone density in athletes. Clin Orthop Relat Res. 1971;77:179–182. [PubMed] [Google Scholar]
  46. Nordin B. E. Calcium deficiency and postmenopausal osteoporosis. Lancet. 1985 Sep 28;2(8457):720–720. doi: 10.1016/s0140-6736(85)92952-6. [DOI] [PubMed] [Google Scholar]
  47. Nordin B. E., Horsman A., Crilly R. G., Marshall D. H., Simpson M. Treatment of spinal osteoporosis in postmenopausal women. Br Med J. 1980 Feb 16;280(6212):451–454. doi: 10.1136/bmj.280.6212.451. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Paffenbarger R. S., Jr, Hyde R. T., Wing A. L., Hsieh C. C. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med. 1986 Mar 6;314(10):605–613. doi: 10.1056/NEJM198603063141003. [DOI] [PubMed] [Google Scholar]
  49. Parfitt A. M. Dietary risk factors for age-related bone loss and fractures. Lancet. 1983 Nov 19;2(8360):1181–1185. doi: 10.1016/s0140-6736(83)91226-6. [DOI] [PubMed] [Google Scholar]
  50. Raisz L. G., Kream B. E. Regulation of bone formation. N Engl J Med. 1983 Jul 7;309(1):29–35. doi: 10.1056/NEJM198307073090107. [DOI] [PubMed] [Google Scholar]
  51. Recker R. R., Heaney R. P. The effect of milk supplements on calcium metabolism, bone metabolism and calcium balance. Am J Clin Nutr. 1985 Feb;41(2):254–263. doi: 10.1093/ajcn/41.2.254. [DOI] [PubMed] [Google Scholar]
  52. Recker R. R., Saville P. D., Heaney R. P. Effect of estrogens and calcium carbonate on bone loss in postmenopausal women. Ann Intern Med. 1977 Dec;87(6):649–655. doi: 10.7326/0003-4819-87-6-649. [DOI] [PubMed] [Google Scholar]
  53. Riggs B. L., Melton L. J., 3rd Evidence for two distinct syndromes of involutional osteoporosis. Am J Med. 1983 Dec;75(6):899–901. doi: 10.1016/0002-9343(83)90860-4. [DOI] [PubMed] [Google Scholar]
  54. Riggs B. L., Seeman E., Hodgson S. F., Taves D. R., O'Fallon W. M. Effect of the fluoride/calcium regimen on vertebral fracture occurrence in postmenopausal osteoporosis. Comparison with conventional therapy. N Engl J Med. 1982 Feb 25;306(8):446–450. doi: 10.1056/NEJM198202253060802. [DOI] [PubMed] [Google Scholar]
  55. Riggs B. L., Wahner H. W., Dunn W. L., Mazess R. B., Offord K. P., Melton L. J., 3rd Differential changes in bone mineral density of the appendicular and axial skeleton with aging: relationship to spinal osteoporosis. J Clin Invest. 1981 Feb;67(2):328–335. doi: 10.1172/JCI110039. [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Rigotti N. A., Nussbaum S. R., Herzog D. B., Neer R. M. Osteoporosis in women with anorexia nervosa. N Engl J Med. 1984 Dec 20;311(25):1601–1606. doi: 10.1056/NEJM198412203112503. [DOI] [PubMed] [Google Scholar]
  57. Rubin C. T., Lanyon L. E. Regulation of bone mass by mechanical strain magnitude. Calcif Tissue Int. 1985 Jul;37(4):411–417. doi: 10.1007/BF02553711. [DOI] [PubMed] [Google Scholar]
  58. SMITH R. W., Jr, FRAME B. CONCURRENT AXIAL AND APPENDICULAR OSTEOPOROSIS: ITS RELATION TO CALCIUM CONSUMPTION. N Engl J Med. 1965 Jul 8;273:73–78. doi: 10.1056/NEJM196507082730203. [DOI] [PubMed] [Google Scholar]
  59. Saville P. D., Whyte M. P. Muscle and bone hypertrophy. Positive effect of running exercise in the rat. Clin Orthop Relat Res. 1969 Jul-Aug;65:81–88. [PubMed] [Google Scholar]
  60. Shapiro J. R., Moore W. T., Jorgensen H., Reid J., Epps C. H., Whedon D. Osteoporosis; evaluation of diagnosis and therapy. Arch Intern Med. 1975 Apr;135(4):563–567. doi: 10.1001/archinte.135.4.563. [DOI] [PubMed] [Google Scholar]
  61. Smith E. L., Jr, Reddan W., Smith P. E. Physical activity and calcium modalities for bone mineral increase in aged women. Med Sci Sports Exerc. 1981;13(1):60–64. [PubMed] [Google Scholar]
  62. Smith E. L., Jr, Smith P. E., Ensign C. J., Shea M. M. Bone involution decrease in exercising middle-aged women. Calcif Tissue Int. 1984;36 (Suppl 1):S129–S138. doi: 10.1007/BF02406146. [DOI] [PubMed] [Google Scholar]
  63. Sowers M. R., Wallace R. B., Lemke J. H. Correlates of mid-radius bone density among postmenopausal women: a community study. Am J Clin Nutr. 1985 May;41(5):1045–1053. doi: 10.1093/ajcn/41.5.1045. [DOI] [PubMed] [Google Scholar]
  64. Walker A. R. The human requirement of calcium: should low intakes be supplemented? Am J Clin Nutr. 1972 May;25(5):518–530. doi: 10.1093/ajcn/25.5.518. [DOI] [PubMed] [Google Scholar]
  65. Washburn R. A., Montoye H. J. The assessment of physical activity by questionnaire. Am J Epidemiol. 1986 Apr;123(4):563–576. doi: 10.1093/oxfordjournals.aje.a114277. [DOI] [PubMed] [Google Scholar]
  66. White M. K., Martin R. B., Yeater R. A., Butcher R. L., Radin E. L. The effects of exercise on the bones of postmenopausal women. Int Orthop. 1984;7(4):209–214. doi: 10.1007/BF00266829. [DOI] [PubMed] [Google Scholar]
  67. Williams J. A., Wagner J., Wasnich R., Heilbrun L. The effect of long-distance running upon appendicular bone mineral content. Med Sci Sports Exerc. 1984 Jun;16(3):223–227. [PubMed] [Google Scholar]
  68. Woo S. L., Kuei S. C., Amiel D., Gomez M. A., Hayes W. C., White F. C., Akeson W. H. The effect of prolonged physical training on the properties of long bone: a study of Wolff's Law. J Bone Joint Surg Am. 1981 Jun;63(5):780–787. [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES