Calcium supplementation for improving bone mineral density in children

Area of Science:

• Pediatrics
• Bone Metabolism
• Nutritional Science

Background:

• Previous studies suggest calcium supplementation increases bone mineral density (BMD) in children, but long-term maintenance is uncertain.
• A quantitative systematic review was lacking to assess the overall effectiveness of calcium supplementation in pediatric populations.

Purpose of the Study:

• To systematically review the effectiveness of calcium supplementation for enhancing BMD in children.
• To investigate if supplementation effects vary by sex, pubertal stage, ethnicity, or physical activity levels.
• To determine if any observed BMD benefits persist after cessation of calcium supplementation.

Main Methods:

• Conducted a systematic search of multiple databases (CENTRAL, MEDLINE, EMBASE, etc.) and hand-searched conference abstracts.
• Included randomized controlled trials (RCTs) of calcium supplementation versus placebo in healthy children for at least 3 months.
• Outcomes measured included bone mineral density (BMD), bone mineral content (BMC), or quantitative ultrasound parameters, with follow-up of at least 6 months.

Main Results:

• Nineteen trials with 2859 participants were analyzed; no heterogeneity was found in main effects.
• Calcium supplementation showed no significant effect on femoral neck or lumbar spine BMD.
• A small positive effect was observed on total body bone mineral content (BMC) and upper limb BMD, with the upper limb effect persisting post-supplementation.

Conclusions:

• The observed small increase in upper limb BMD from calcium supplementation is unlikely to lead to a clinically significant reduction in fracture risk.
• The evidence does not support the widespread use of calcium supplementation in healthy children as a public health strategy.
• Findings are not applicable to children with medical conditions affecting bone metabolism.