Clinical practice guidelines of calcium for prevention of primary osteoporosis in adults_Chinese Journal of Evidence-Based Medicine

Authors：

 Chinese Pharmaceutical Society Evidence-based Pharmacy Specialised Committee

Corresponding author：

Chinese Pharmaceutical Society Evidence-based Pharmacy Specialised Committee, Email: zhanglingli@scu.edu.cn

Keywords：

Primary osteoporosis; Prevention; Calcium; Vitamin D; Clinical practice guidelines

DOI：

10.7507/1672-2531.202404072

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Primary osteoporosis is a common metabolic disease in China, causing immense disease and economic burden to patients, their families and the society. Prevention is an important strategy to reduce the disease burden of primary osteoporosis. Calcium, as a basic element for maintaining bone health, plays an important role in the prevention of primary osteoporosis. This guideline was initiated by the Chinese Pharmaceutical Society Evidence-based Pharmacy Specialised Committee. The standard methodology for the development of evidence-based clinical practice guidelines of the World Health Organization (WHO) was employed. A multidisciplinary guideline working group was formed. Delphi method was used to select and eventually identified 15 key clinical questions. Systematic evaluation was carried out on each of the key clinical question and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to formed 15 recommendations, providing guidance for standardizing the clinical practice of calcium supplementation in prevention of primary osteoporosis in adults in China.

Citation： Chinese Pharmaceutical Society Evidence-based Pharmacy Specialised Committee. Clinical practice guidelines of calcium for prevention of primary osteoporosis in adults. Chinese Journal of Evidence-Based Medicine, 2024, 24(10): 1117-1128. doi: 10.7507/1672-2531.202404072 Copy

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2.	中国骨质疏松症流行病学调查结果. 健康中国, 2018.
3.	Zhang C, Feng J, Wang S, et al. Incidence of and trends in hip fracture among adults in urban China: a nationwide retrospective cohort study. PLoS Med, 2020, 17(8): e1003180.
4.	中华医学会骨质疏松和骨矿盐疾病分会, 章振林. 原发性骨质疏松症诊疗指南(2022). 中国全科医学, 2023, 26(14): 1671-1691.
5.	中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊疗指南(2017). 中华内分泌代谢杂志, 2017, 33(10): 890-913.
6.	Scottish Intercollegiate Guidelines Network (SIGN). Management of osteoporosis and the prevention of fragility fractures. 2021.
7.	Grossman DC, Curry SJ, Owens DK, et al. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: US preventive services task force recommendation statement. JAMA, 2018, 319(15): 1592-1599.
8.	WHO. WHO handbook for guideline development. 2nd edition. Geneva: World Health Organization, 2014.
9.	Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol, 2011, 64(4): 383-394.
10.	Guyatt GH, Alonso-Coello P, Schünemann HJ, et al. Guideline panels should seldom make good practice statements: guidance from the GRADE working group. J Clin Epidemiol, 2016, 80: 3-7.
11.	Watts NB, Camacho PM, Lewiecki EM, et al. American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 update. Endocr Pract, 2021, 27(4): 379-380.
12.	张伋, 王惠君, 王志宏, 等. 中国9省区1991-2009年50岁以上中老年居民膳食钙摄入量及变化趋势分析. 中华流行病学杂志, 2012, 33(11): 1119-1122.
13.	夏维波, 章振林, 林华, 等. 维生素D及其类似物临床应用共识. 中华骨质疏松和骨矿盐疾病杂志, 2018, 11(1): 1-19.
14.	刘晓颖, 王佳贺. 老年维生素D缺乏合并骨质疏松症研究进展. 实用老年医学, 2020, 34(4): 320-322.
15.	张旭飞, 蒋志滨, 陈云志. 我国不同人群维生素D缺乏的流行病学研究进展. 湖北民族大学学报(医学版), 2023, 40(2): 75-79.
16.	Zaidi M. Skeletal remodeling in health and disease. Nat Med, 2007, 13(7): 791-801.
17.	邱敏丽, 谢雅, 王晓红, 等. 骨质疏松症患者实践指南. 中华内科杂志, 2020, 59(12): 953-959.
18.	Arden NK, Baker J, Hogg C, et al. The heritability of bone mineral density, ultrasound of the calcaneus and hip axis length: a study of postmenopausal twins. J Bone Miner Res, 1996, 11(4): 530-534.
19.	Ioannidis JP, Ng MY, Sham PC, et al. Meta-analysis of genome-wide scans provides evidence for sex- and site-specific regulation of bone mass. J Bone Miner Res, 2007, 22(2): 173-183.
20.	Ng MY, Sham PC, Paterson AD, et al. Effect of environmental factors and gender on the heritability of bone mineral density and bone size. Ann Hum Genet, 2006, 70(Pt 4): 428-438.
21.	Estrada K, Styrkarsdottir U, Evangelou E, et al. Genome-wide meta-analysis identifies 56 bone mineral density loci and reveals 14 loci associated with risk of fracture. Nat Genet, 2012, 44(5): 491-501.
22.	Giampietro PF, McCarty C, Mukesh B, et al. The role of cigarette smoking and statins in the development of postmenopausal osteoporosis: a pilot study utilizing the marshfield clinic personalized medicine cohort. Osteoporos Int, 2010, 21(3): 467-477.
23.	顾叶青, 夏阳, 张顺明, 等. 营养流行病学队列研究中的膳食营养调查方法及应用. 中华流行病学杂志, 2020, 41(7): 1145-1150.
24.	中国居民膳食营养素参考摄入量(2023版). 北京: 人民卫生出版社, 2023.
25.	中国营养学会健康管理分会. 维生素D营养状况评价及改善专家共识. 中华健康管理学杂志, 2023, 17(4): 245-252.
26.	Nayak S, Edwards DL, Saleh AA, et al. Systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for osteoporosis or low bone density. Osteoporos Int, 2015, 26(5): 1543-1554.
27.	何丽, 付萍, 张刚, 等. 不同钙摄入量对青年男性骨密度的影响. 中国健康教育, 2007, (6): 413-416.
28.	Reid IR, Ames R, Mason B, et al. Randomized controlled trial of calcium supplementation in healthy, nonosteoporotic, older men. Arch Intern Med, 2008, 168(20): 2276-2282.
29.	Méndez-Sánchez L, Clark P, Winzenberg TM, et al. Calcium and vitamin D for increasing bone mineral density in premenopausal women. Cochrane Database Syst Rev, 2023, (1): CD012664.
30.	Tai V, Leung W, Grey A, et al. Calcium intake and bone mineral density: systematic review and meta-analysis. BMJ, 2015, 29: 351: h4183.
31.	Dawson-Hughes B, Harris SS, Krall EA, et al. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med, 1997, 337(10): 670-676.
32.	Kemmler W, Shojaa M, Kohl M, et al. Effects of different types of exercise on bone mineral density in postmenopausal women: a systematic review and meta-analysis. Calcif Tissue Int, 2020, 107(5): 409-439.
33.	Lau EM, Woo J, Leung PC, et al. The effects of calcium supplementation and exercise on bone density in elderly Chinese women. Osteoporos Int, 1992, 2(4): 168-173.
34.	Kahwati LC, Weber RP, Pan H, et al. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: evidence report and systematic review for the US preventive services task force. JAMA, 2018, 319(15): 1600-1612.
35.	Reid IR, Mason B, Horne A, et al. Randomized controlled trial of calcium in healthy older women. Am J Med, 2006, 119(9): 777-785.
36.	Rajatanavin R, Chailurkit L, Saetung S, et al. The efficacy of calcium supplementation alone in elderly Thai women over a 2-year period: a randomized controlled trial. Osteoporos Int, 2013, 24(11): 2871-2877.
37.	Prince RL, Devine A, Dhaliwal SS, et al. Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Arch Intern Med, 2006, 166(8): 869-875.

1. Christiansen C. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Osteoporos Int, 1987, 295(1): 914-915.
2. 中国骨质疏松症流行病学调查结果. 健康中国, 2018.
3. Zhang C, Feng J, Wang S, et al. Incidence of and trends in hip fracture among adults in urban China: a nationwide retrospective cohort study. PLoS Med, 2020, 17(8): e1003180.
4. 中华医学会骨质疏松和骨矿盐疾病分会, 章振林. 原发性骨质疏松症诊疗指南(2022). 中国全科医学, 2023, 26(14): 1671-1691.
5. 中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊疗指南(2017). 中华内分泌代谢杂志, 2017, 33(10): 890-913.
6. Scottish Intercollegiate Guidelines Network (SIGN). Management of osteoporosis and the prevention of fragility fractures. 2021.
7. Grossman DC, Curry SJ, Owens DK, et al. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: US preventive services task force recommendation statement. JAMA, 2018, 319(15): 1592-1599.
8. WHO. WHO handbook for guideline development. 2nd edition. Geneva: World Health Organization, 2014.
9. Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol, 2011, 64(4): 383-394.
10. Guyatt GH, Alonso-Coello P, Schünemann HJ, et al. Guideline panels should seldom make good practice statements: guidance from the GRADE working group. J Clin Epidemiol, 2016, 80: 3-7.
11. Watts NB, Camacho PM, Lewiecki EM, et al. American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 update. Endocr Pract, 2021, 27(4): 379-380.
12. 张伋, 王惠君, 王志宏, 等. 中国9省区1991-2009年50岁以上中老年居民膳食钙摄入量及变化趋势分析. 中华流行病学杂志, 2012, 33(11): 1119-1122.
13. 夏维波, 章振林, 林华, 等. 维生素D及其类似物临床应用共识. 中华骨质疏松和骨矿盐疾病杂志, 2018, 11(1): 1-19.
14. 刘晓颖, 王佳贺. 老年维生素D缺乏合并骨质疏松症研究进展. 实用老年医学, 2020, 34(4): 320-322.
15. 张旭飞, 蒋志滨, 陈云志. 我国不同人群维生素D缺乏的流行病学研究进展. 湖北民族大学学报(医学版), 2023, 40(2): 75-79.
16. Zaidi M. Skeletal remodeling in health and disease. Nat Med, 2007, 13(7): 791-801.
17. 邱敏丽, 谢雅, 王晓红, 等. 骨质疏松症患者实践指南. 中华内科杂志, 2020, 59(12): 953-959.
18. Arden NK, Baker J, Hogg C, et al. The heritability of bone mineral density, ultrasound of the calcaneus and hip axis length: a study of postmenopausal twins. J Bone Miner Res, 1996, 11(4): 530-534.
19. Ioannidis JP, Ng MY, Sham PC, et al. Meta-analysis of genome-wide scans provides evidence for sex- and site-specific regulation of bone mass. J Bone Miner Res, 2007, 22(2): 173-183.
20. Ng MY, Sham PC, Paterson AD, et al. Effect of environmental factors and gender on the heritability of bone mineral density and bone size. Ann Hum Genet, 2006, 70(Pt 4): 428-438.
21. Estrada K, Styrkarsdottir U, Evangelou E, et al. Genome-wide meta-analysis identifies 56 bone mineral density loci and reveals 14 loci associated with risk of fracture. Nat Genet, 2012, 44(5): 491-501.
22. Giampietro PF, McCarty C, Mukesh B, et al. The role of cigarette smoking and statins in the development of postmenopausal osteoporosis: a pilot study utilizing the marshfield clinic personalized medicine cohort. Osteoporos Int, 2010, 21(3): 467-477.
23. 顾叶青, 夏阳, 张顺明, 等. 营养流行病学队列研究中的膳食营养调查方法及应用. 中华流行病学杂志, 2020, 41(7): 1145-1150.
24. 中国居民膳食营养素参考摄入量(2023版). 北京: 人民卫生出版社, 2023.
25. 中国营养学会健康管理分会. 维生素D营养状况评价及改善专家共识. 中华健康管理学杂志, 2023, 17(4): 245-252.
26. Nayak S, Edwards DL, Saleh AA, et al. Systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for osteoporosis or low bone density. Osteoporos Int, 2015, 26(5): 1543-1554.
27. 何丽, 付萍, 张刚, 等. 不同钙摄入量对青年男性骨密度的影响. 中国健康教育, 2007, (6): 413-416.
28. Reid IR, Ames R, Mason B, et al. Randomized controlled trial of calcium supplementation in healthy, nonosteoporotic, older men. Arch Intern Med, 2008, 168(20): 2276-2282.
29. Méndez-Sánchez L, Clark P, Winzenberg TM, et al. Calcium and vitamin D for increasing bone mineral density in premenopausal women. Cochrane Database Syst Rev, 2023, (1): CD012664.
30. Tai V, Leung W, Grey A, et al. Calcium intake and bone mineral density: systematic review and meta-analysis. BMJ, 2015, 29: 351: h4183.
31. Dawson-Hughes B, Harris SS, Krall EA, et al. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med, 1997, 337(10): 670-676.
32. Kemmler W, Shojaa M, Kohl M, et al. Effects of different types of exercise on bone mineral density in postmenopausal women: a systematic review and meta-analysis. Calcif Tissue Int, 2020, 107(5): 409-439.
33. Lau EM, Woo J, Leung PC, et al. The effects of calcium supplementation and exercise on bone density in elderly Chinese women. Osteoporos Int, 1992, 2(4): 168-173.
34. Kahwati LC, Weber RP, Pan H, et al. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: evidence report and systematic review for the US preventive services task force. JAMA, 2018, 319(15): 1600-1612.
35. Reid IR, Mason B, Horne A, et al. Randomized controlled trial of calcium in healthy older women. Am J Med, 2006, 119(9): 777-785.
36. Rajatanavin R, Chailurkit L, Saetung S, et al. The efficacy of calcium supplementation alone in elderly Thai women over a 2-year period: a randomized controlled trial. Osteoporos Int, 2013, 24(11): 2871-2877.
37. Prince RL, Devine A, Dhaliwal SS, et al. Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Arch Intern Med, 2006, 166(8): 869-875.

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