The Cochrane Abstract below is a su...

The Cochrane Abstract below is a summary of a review from the Cochrane Library. It is accompanied through an interpretation that will help clinicians enjoin evidence into practice. Cheryl A. Flynn MD M at hands a clinical scenario and question based forward the Cochrane Abstract, along with the evidence-based answer and a filled critique of the abstract.

This clinical ease conforms to AAFP criteria for evidence-based continuing medical education (EB CME) EB CME is clinical satisfaction presented with practice recommendations supported by the agency of evidence that has been systematically reviewed at an AAFP-approved source. The practice recommendations in this activity are available online at http://www.cochrane.org/ cochrane/revabstr/ab004526.htm.

Clinical Scenario

A 53-year-old woman who is undivided year postmenopausal comes in for a routine examination. She asks about taking supplemental calcium to impede osteoporosis.

Clinical Question

Should we attract favor to calcium supplementation for postmenopausal women?

Evidence-Based Answer

Calcium supplementation has a beneficial meaning on bone density and may diminish vertebral fractures. It has no clear weight on nonvertebral fractures, although the number of patients studied may be too small to predict this outcome

Practice Pointers

This was a well-conducted systematic review of calcium supplementation to increase bone density and bring to fracture risk in postmenopausal women Although not statistically significant, there was a stretch toward reduced vertebral fracture risk in postmenopausal women who take calcium. These data were consistent across trials. It is likely that the data did not reach statistical significance because of the small number of women registered in the studies (fewer than 600 total) and varying duration of follow-up (one to four years).

ends for secondary prevention of fractures also did not reach statistical significance. inferences for bone mineral density, an intermediate issue showed less bone loss in women taking calcium than in those who received placebo. The decrease in bone los was not statistically significant in women without osteoporosis, if it be not that it was statistically significant in women with osteoporosis.

Despite the limited data, calcium supplementation in postmenopausal women makes intellect The Institute for Clinical methods Improvement guideline on diagnosis and treatment of osteoporosis (2) approves 1,200 mg of calcium for day for healthy women across age 50 and 1,500 mg for day for women who have osteoporosis, use glucocorticoids, or are pregnant, nursing, or older than 65 Other options for bone los prevention include vitamin D estrogen bisphosphonates, and raloxifene. Bisphosphonates have the strongest evidence for prevention of fracture in women with osteoporosis. (2) The 2000 National Institutes of Health consensus meeting for consultation (3) also recommends calcium supplementation in women who do not achieve commited intake in their diet.

Based onward the best available evidence, calcium supplementation have the appearances like a worthwhile approach to bone health in postmenopausal women Although no definitive conclusions about dosage or formulation can be drawn from this meta-analysis, calcium carbonate at 1000 mg for day was the most usual dosage and is a reasonable choice.

REFERENCES

(1) Shea B Wells G Cranney A, Zytaruk N Robinson V Griffith L et al. Calcium supplementation upon bone loss in postmenopausal women Cochrane Database Syst Rev 2004:CD004526

(2) Institute for Clinical bodys Improvement. Diagnosis and treatment of osteoporosis. Accessed February 2004 at http://www.icsi. org/knowledge/detail.asp?catID=29&itemID=547.

(3) Osteoporosis prevention, diagnosis, and therapy. NIH Consen Statement 2000;17:1-45

RELATED ARTICLE: Cochrane abstract.

Background. Although calcium is the same of the simplest and least expensive strategies for preventing osteoporotic fractures, calcium supplementation is not without suit at law The U.S. Food and remedy Administration has permitted a bone health claim for calcium-rich feeds and a National Institutes of Health consensus statement notes that high calcium intake contracts the risk of osteoporosis.

Objectives. To assess the imports of calcium supplementation on bone density and fractures in postmenopausal women

Search Strategy. The authors (1) searched Cochrane Controll Register, MEDLINE, and EMBASE up to 2001 and examined citations of relevant articles and proceedings of international meetings.

Selection Criteria. Trials that randomized postmenopausal women to calcium supplementation or usual dietary calcium intake; followed patients for at least common year; and reported bone mineral density of the total corpse vertebral spine, hip, or forearm or recorded the number of fractures were considered for inclusion in the study

Data Collection and Analysis. Three independent reviewers assessed the methodologic quality and extracted data from each trial. For each bone-density site (i.e., lumbar spine, total material part combined hip, and combined forearm), the authors calculated the weighted mean difference (WMD) in bone density between treatment and curb groups using the percentage change from baseline. The authors builded regression models in which the independent variables were year and dosage, and the contingent variable was the effect size. This regression was used to determine the years across which pooling was appropriate. Heterogeneity was asssessed. The authors calculated a risk ratio for each fracture analysis.