Calcium Plus Vitamin D Supplementation and Joint Symptoms in Postmenopausal Women in the Women's Health Initiative Randomized Trial

Rowan T. Chlebowski, Mary Pettinger, Karen Johnson, Robert Wallace, Catherine Womack, Yasmin Mossavar-Rahmani, Marcia Stefanick, Jean Wactawski-Wende, Laura Carbone, Bing Lu, Charles Eaton, Brian Walitt, Charles L. Kooperberg

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Low vitamin D intake and levels have been associated with increased joint symptoms in some observational studies but the findings are mixed and evidence from randomized trials sparse. Objective: To evaluate the influence of supplemental calcium and vitamin D on joint symptoms in the Women's Health Initiative randomized, placebo-controlled, clinical trial. Design: In post hoc analyses, the results of the Women's Health Initiative randomized clinical trial in which 36,282 postmenopausal women were randomized to receive calcium carbonate (1,000 mg as elemental calcium) with vitamin D-3 (400 IU) daily or placebo were examined in the 6% subgroup of 1,911 participants, oversampled for minorities, who had serial joint symptom assessment. Qualitative information on joint pain and joint swelling was collected by questionnaire before entry and 2 years after randomization. Logistic regression models were used to compare the occurrence and severity of joint symptoms across randomization groups. Results: At baseline, total calcium and vitamin D intakes from diet and supplements were similar in the two randomization groups. In addition, both joint pain (reported by 73%) and joint swelling (reported by 34%) were commonly reported and comparable in the supplement and placebo groups. Two years after randomization, no statistically significant differences between supplement and placebo groups were seen for joint pain frequency (74.6% compared with 75.1% [P=0.79] for supplement and placebo groups, respectively) or joint swelling frequency (34.6% compared with 32.4% [P=0.29], respectively) or in severity scores for either outcome. Subgroup analyses suggested study participants also using nonprotocol calcium supplements at study entry may have less joint pain with supplement group randomization (interaction P=0.02). Conclusions: Joint symptoms are relatively common in postmenopausal women. However, daily supplementation with 1,000 mg calcium carbonate and 400 IU vitamin D-3 in a randomized, placebo-controlled clinical trial setting did not reduce the self-reported frequency or severity of joint symptoms.

Original languageEnglish (US)
Pages (from-to)1302-1310
Number of pages9
JournalJournal of the Academy of Nutrition and Dietetics
Volume113
Issue number10
DOIs
StatePublished - Oct 1 2013

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women's health
Women's Health
vitamin D
Vitamin D
signs and symptoms (animals and humans)
placebos
Joints
Calcium
calcium
Random Allocation
pain
Placebos
Arthralgia
cholecalciferol
calcium carbonate
clinical trials
Randomized Controlled Trials
Calcium Carbonate
Cholecalciferol
randomized clinical trials

All Science Journal Classification (ASJC) codes

  • Food Science
  • Nutrition and Dietetics

Cite this

Calcium Plus Vitamin D Supplementation and Joint Symptoms in Postmenopausal Women in the Women's Health Initiative Randomized Trial. / Chlebowski, Rowan T.; Pettinger, Mary; Johnson, Karen; Wallace, Robert; Womack, Catherine; Mossavar-Rahmani, Yasmin; Stefanick, Marcia; Wactawski-Wende, Jean; Carbone, Laura; Lu, Bing; Eaton, Charles; Walitt, Brian; Kooperberg, Charles L.

In: Journal of the Academy of Nutrition and Dietetics, Vol. 113, No. 10, 01.10.2013, p. 1302-1310.

Research output: Contribution to journalArticle

Chlebowski, RT, Pettinger, M, Johnson, K, Wallace, R, Womack, C, Mossavar-Rahmani, Y, Stefanick, M, Wactawski-Wende, J, Carbone, L, Lu, B, Eaton, C, Walitt, B & Kooperberg, CL 2013, 'Calcium Plus Vitamin D Supplementation and Joint Symptoms in Postmenopausal Women in the Women's Health Initiative Randomized Trial', Journal of the Academy of Nutrition and Dietetics, vol. 113, no. 10, pp. 1302-1310. https://doi.org/10.1016/j.jand.2013.06.007
Chlebowski, Rowan T. ; Pettinger, Mary ; Johnson, Karen ; Wallace, Robert ; Womack, Catherine ; Mossavar-Rahmani, Yasmin ; Stefanick, Marcia ; Wactawski-Wende, Jean ; Carbone, Laura ; Lu, Bing ; Eaton, Charles ; Walitt, Brian ; Kooperberg, Charles L. / Calcium Plus Vitamin D Supplementation and Joint Symptoms in Postmenopausal Women in the Women's Health Initiative Randomized Trial. In: Journal of the Academy of Nutrition and Dietetics. 2013 ; Vol. 113, No. 10. pp. 1302-1310.
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abstract = "Background: Low vitamin D intake and levels have been associated with increased joint symptoms in some observational studies but the findings are mixed and evidence from randomized trials sparse. Objective: To evaluate the influence of supplemental calcium and vitamin D on joint symptoms in the Women's Health Initiative randomized, placebo-controlled, clinical trial. Design: In post hoc analyses, the results of the Women's Health Initiative randomized clinical trial in which 36,282 postmenopausal women were randomized to receive calcium carbonate (1,000 mg as elemental calcium) with vitamin D-3 (400 IU) daily or placebo were examined in the 6{\%} subgroup of 1,911 participants, oversampled for minorities, who had serial joint symptom assessment. Qualitative information on joint pain and joint swelling was collected by questionnaire before entry and 2 years after randomization. Logistic regression models were used to compare the occurrence and severity of joint symptoms across randomization groups. Results: At baseline, total calcium and vitamin D intakes from diet and supplements were similar in the two randomization groups. In addition, both joint pain (reported by 73{\%}) and joint swelling (reported by 34{\%}) were commonly reported and comparable in the supplement and placebo groups. Two years after randomization, no statistically significant differences between supplement and placebo groups were seen for joint pain frequency (74.6{\%} compared with 75.1{\%} [P=0.79] for supplement and placebo groups, respectively) or joint swelling frequency (34.6{\%} compared with 32.4{\%} [P=0.29], respectively) or in severity scores for either outcome. Subgroup analyses suggested study participants also using nonprotocol calcium supplements at study entry may have less joint pain with supplement group randomization (interaction P=0.02). Conclusions: Joint symptoms are relatively common in postmenopausal women. However, daily supplementation with 1,000 mg calcium carbonate and 400 IU vitamin D-3 in a randomized, placebo-controlled clinical trial setting did not reduce the self-reported frequency or severity of joint symptoms.",
author = "Chlebowski, {Rowan T.} and Mary Pettinger and Karen Johnson and Robert Wallace and Catherine Womack and Yasmin Mossavar-Rahmani and Marcia Stefanick and Jean Wactawski-Wende and Laura Carbone and Bing Lu and Charles Eaton and Brian Walitt and Kooperberg, {Charles L.}",
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AU - Pettinger, Mary

AU - Johnson, Karen

AU - Wallace, Robert

AU - Womack, Catherine

AU - Mossavar-Rahmani, Yasmin

AU - Stefanick, Marcia

AU - Wactawski-Wende, Jean

AU - Carbone, Laura

AU - Lu, Bing

AU - Eaton, Charles

AU - Walitt, Brian

AU - Kooperberg, Charles L.

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N2 - Background: Low vitamin D intake and levels have been associated with increased joint symptoms in some observational studies but the findings are mixed and evidence from randomized trials sparse. Objective: To evaluate the influence of supplemental calcium and vitamin D on joint symptoms in the Women's Health Initiative randomized, placebo-controlled, clinical trial. Design: In post hoc analyses, the results of the Women's Health Initiative randomized clinical trial in which 36,282 postmenopausal women were randomized to receive calcium carbonate (1,000 mg as elemental calcium) with vitamin D-3 (400 IU) daily or placebo were examined in the 6% subgroup of 1,911 participants, oversampled for minorities, who had serial joint symptom assessment. Qualitative information on joint pain and joint swelling was collected by questionnaire before entry and 2 years after randomization. Logistic regression models were used to compare the occurrence and severity of joint symptoms across randomization groups. Results: At baseline, total calcium and vitamin D intakes from diet and supplements were similar in the two randomization groups. In addition, both joint pain (reported by 73%) and joint swelling (reported by 34%) were commonly reported and comparable in the supplement and placebo groups. Two years after randomization, no statistically significant differences between supplement and placebo groups were seen for joint pain frequency (74.6% compared with 75.1% [P=0.79] for supplement and placebo groups, respectively) or joint swelling frequency (34.6% compared with 32.4% [P=0.29], respectively) or in severity scores for either outcome. Subgroup analyses suggested study participants also using nonprotocol calcium supplements at study entry may have less joint pain with supplement group randomization (interaction P=0.02). Conclusions: Joint symptoms are relatively common in postmenopausal women. However, daily supplementation with 1,000 mg calcium carbonate and 400 IU vitamin D-3 in a randomized, placebo-controlled clinical trial setting did not reduce the self-reported frequency or severity of joint symptoms.

AB - Background: Low vitamin D intake and levels have been associated with increased joint symptoms in some observational studies but the findings are mixed and evidence from randomized trials sparse. Objective: To evaluate the influence of supplemental calcium and vitamin D on joint symptoms in the Women's Health Initiative randomized, placebo-controlled, clinical trial. Design: In post hoc analyses, the results of the Women's Health Initiative randomized clinical trial in which 36,282 postmenopausal women were randomized to receive calcium carbonate (1,000 mg as elemental calcium) with vitamin D-3 (400 IU) daily or placebo were examined in the 6% subgroup of 1,911 participants, oversampled for minorities, who had serial joint symptom assessment. Qualitative information on joint pain and joint swelling was collected by questionnaire before entry and 2 years after randomization. Logistic regression models were used to compare the occurrence and severity of joint symptoms across randomization groups. Results: At baseline, total calcium and vitamin D intakes from diet and supplements were similar in the two randomization groups. In addition, both joint pain (reported by 73%) and joint swelling (reported by 34%) were commonly reported and comparable in the supplement and placebo groups. Two years after randomization, no statistically significant differences between supplement and placebo groups were seen for joint pain frequency (74.6% compared with 75.1% [P=0.79] for supplement and placebo groups, respectively) or joint swelling frequency (34.6% compared with 32.4% [P=0.29], respectively) or in severity scores for either outcome. Subgroup analyses suggested study participants also using nonprotocol calcium supplements at study entry may have less joint pain with supplement group randomization (interaction P=0.02). Conclusions: Joint symptoms are relatively common in postmenopausal women. However, daily supplementation with 1,000 mg calcium carbonate and 400 IU vitamin D-3 in a randomized, placebo-controlled clinical trial setting did not reduce the self-reported frequency or severity of joint symptoms.

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