Independent and Combined Effects of Calcium-Vitamin D3 and Exercise on Bone Structure and Strength in Older Men: An 18-Month Factorial Design Randomized Controlled Trial
The Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2010-2284
Submitted on September 28, 2010; Accepted on December 15, 2010
Sonja Kukuljan, Caryl A. Nowson, Kerrie M. Sanders, Geoff C. Nicholson, Markus J. Seibel, Jo Salmon, and Robin M. Daly rdaly at unimelb.edu.au.
School of Exercise and Nutrition Sciences (S.K., C.A.N., J.S., R.M.D.), Deakin University, Victoria 3125, Australia; Department of Clinical and Biomedical Sciences: Barwon Health (K.M.S., G.C.N.), University of Melbourne, Geelong Victoria 3220, Australia; Bone Research Program (M.J.S.), ANZAC Research Institute, University of Sydney, New South Wales 2006, Australia; and Department of Medicine (R.M.D.), University of Melbourne, Western Hospital, Melbourne 3011, Australia
Context: Exercise and calcium-vitamin D are independently recognized as important strategies to prevent osteoporosis, but their combined effects on bone strength and its determinants remain uncertain.
Objective: To assess whether calcium-vitamin D3 fortified milk could enhance the effects of exercise on bone strength, structure, and mineral density in middle-aged and older men.
Design, Setting, Participants: An 18-month factorial design randomized controlled trial in which 180 men aged 50–79 years were randomized to the following: exercise + fortified milk; exercise; fortified milk; or controls. Exercise consisted of progressive resistance training with weight-bearing impact activities performed 3 d/week. Men assigned to fortified milk consumed 400 ml/d of 1% fat milk containing 1000 mg/d calcium and 800 IU/d vitamin D3.
Main Outcome Measures: Changes in bone mineral density (BMD), bone structure, and strength at the lumbar spine (LS), proximal femur, mid-femur, and mid-tibia measured by dual energy x-ray absorptiometry and/or quantitative computed tomography.
Results: There were no exercise-by-fortified milk interactions at any skeletal site. Main effect analysis showed that exercise led to a 2.1% (95% confidence interval, 0.5–3.6) net gain in femoral neck section modulus, which was associated with an approximately 1.9% gain in areal BMD and cross-sectional area. Exercise also improved LS trabecular BMD net gain 2.2% (95% confidence interval, 0.2–4.1), but had no effect on mid-femur or mid-tibia BMD, structure, or strength. There were no main effects of the fortified milk at any skeletal site.
Conclusion: A community-based multi-component exercise program successfully improved LS and femoral neck BMD and strength in healthy older men, but providing additional calcium-vitamin D3 to these replete men did not enhance the osteogenic response.
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