Table 1:
Characteristics and findings of studies relating dietary calcium or vitamin D intake to bone health outcomes
| Authors, year (country) | Study Design | Study participants | Method of dietary assessment / intervention | Bone health outcome(s) | Relevant findings |
|---|---|---|---|---|---|
| Studies showing a beneficial association between calcium and/or vitamin D and bone health outcomes (n=2) | |||||
| Al-Qadreh, et al., 1996 (Greece) | Longitudinal open label interventional | T1D: 8M, 4F; age 12 ± 1.91 | Oral 1α-OHD3 0.05 μg/kg/d for 12 months | SPA: Radius aBMD | aBMD significantly increased over 12 months on treatment, p=0.02 |
| Weber, et al., 2017 (USA) | Cross-sectional observational | T1D: 20F; age 14.2 (range 9.1–16.5) | Ca intake by 3-day diet record, analyzed by NDSR | Estimated calcium retention using a dual-stable Ca isotope method | - Ca intake positively correlated with calcium retention (Spearman’s rho 0.49, p=0.03) |
| Studies showing no association between calcium and/or vitamin D and bone health outcomes (n=12) | |||||
| Maugeri, et al., 2002 (Italy) | Longitudinal intervention2 | T1D: 40F; age 76 ± 3 | Ca carbonate (1 gm/d) + vitamin D3 (800 IU/d) vs Ca + vitamin D3 + alendronate for 24 months | DXA: LS aBMD Z-scores | aBMD did not significantly change after 24 months of Ca carbonate + vitamin D3 alone |
| Heap, et al., 2003 (USA) | Cross-sectional observational |
T1D: 30M, age 14.6 ± 1.7; 25F, age 14.7 ± 1.9 Controls: 42M, age 14.5 ± 1.9; 53F, age 14.8 ± 1.5 |
Ca intake by questionnaire (unnamed) | DXA: TB, LS, hip aBMD pQCT: tibia |
- Ca intake did not differ significantly in T1D vs controls - Ca intake not significantly associated with DXA or pQCT outcomes |
| Moyer-Mileur et al., 2004 (USA) | Longitudinal observational |
T1D: 26M, age 14.9 ± 1.8; 16F, age 14.1 ± 1.8 Controls: 90M, age 15.0 ± 2.1; 109F, age 15.1 ± 1.0 |
Ca intake by questionnaire (unnamed) | DXA: TB, LS, hip aBMD pQCT: tibia |
- Ca intake did not differ significantly in T1D vs controls - Ca intake not significantly associated with changes in DXA or pQCT |
| Valerio, et al., 2004 (Italy) | Cross-sectional observational | T1D: 46 M, age 11.9 ± 4.1; 40F, age 11.8 ± 4.3 | Ca intake by FFQ (unnamed) | QUS: first phalynx speed of sound (SoS) Z-score | - Ca intake not significantly correlated with SOS |
| Janghorbani, et al., 2006 (USA) | Retrospective longitudinal |
T1D: 292F; age 54.7 ± 9.3 Controls: 101,343F, age (55.9 ± 9.4) |
Ca and Vitamin D intake by FFQ (unnamed) | Fracture | - Ca intake not significantly different in T1D vs controls - Ca intake did not alter association between T1D and increased fracture risk |
| Brandao, et al., 2007 (Brazil) | Cross-sectional observational |
T1D: 44 M/F; age 15.5 ± 2.4 Controls: 22 M/F; age 14.6 ± 2.8 |
Ca intake by questionnaire (unnamed) | DXA: LS BMC and aBMD Z-scores | - Ca intake not significantly different in T1D vs controls - Ca intake not significantly associated with BMC or aBMD |
| Heilman, et al., 2009 (Estonia) | Cross-sectional observational |
T1D: 19M, 11F; age 13.1 ± 3.6 Controls: 19M, 11F, age 13.2 ± 3.9 |
Ca intake by questionnaire (unnamed) | DXA: TB, LS BMC and aBMD3 | - Ca intake not significantly different in T1D and controls - aBMD did not differ significantly among those with low, moderate, or high Ca intake |
| Janner, et al., 2010 (Switzerland) | Cross-sectional observational | T1D: 129 M/F; age 11.6 (95% CI 11.012.3) | Ca intake by FFQ (unnamed) | Vitamin D status based on serum 25- OH vitamin D level | - Dietary Ca intake not significantly associated with vitamin D status |
| Maggio, et al., 2010 (Switzerland) | Cross-sectional observational |
T1D: 13M, 14F; age 10.5 ± 2.4 Controls: 16M, 16F; age 10.5 ± 2.5 |
Ca intake by FFQ (unnamed) | DXA: TB, LS, FN aBMD Z-scores | - Dietary Ca intake significantly lower in T1D vs controls (p=0.01) - Dietary Ca intake not significantly associated with aBMD Z-scores in T1D or controls |
| Simmons, et al., 2011 (USA) | Cross-sectional observational |
T1D - good control: 29M, 11 F; age 15.2 (IQR: 14.3–16.1) T1D - poor control: 11M, 16F; age 16.4 (IQR:15.1,17.8) |
Ca and vitamin D by 3-day diet record, analyzed by NDSR | DXA: TB and LS BMD Z-scores Serum markers of bone turnover | - Ca and vitamin D intake not significantly associated with glycemic control - Association between Ca/vitamin D intake and BMD not reported |
| Napoli, et al., 2013 (Italy) | Longitudinal randomized placebo controlled intervention |
T1D -placebo: 8M, 7F; age 22.0 ± 2.3 T1D-drug: 8M, 4F age 22.8 ± 2.1 |
Oral calcitriol 0.25 μg daily for 12 months | Serum markers of bone turnover (OCN, β-CTX) | - No effect of calcitriol intervention on 12-month change in OCN or β-CTX |
| Kujath, et al., 2015 (USA) | Cross-sectional observational |
T1D: 89F; age 27.9 ± 6.8 Controls: 76F age 28.4 ± 8.2 |
Ca intake by FFQ (unnamed) | DXA: Heel, forearm aBMD Serum markers of bone and mineral metabolism |
- Ca intake not significantly different between T1D vs controls - Ca intake not significantly associated with aBMD or any skeletal outcome in either group |
Abbreviations: 1α-OHD3, 1alpha-hydroxy vitamin D3; aBMD, areal bone mineral density; BMC, bone mineral content; β-CTX, beta cross-laps; F, female; FFQ, food frequency questionnaire; IQR, inter-quartile range; LS, lumbar spine; M, male; MET, metabolic equivalent time; NDSR, Nutrition Data System for Research program; OCN, osteocalcin; SPA, single photon absorptiometry; T1D, type 1 diabetes; TB, total body;
1
Age expressed in years, all such values
2
Not noted if subjects were randomized or blinded
3
Adjusted for age and height