Phosphate and carbonate salts of calcium support robust bone building in osteoporosis

Abstract

Background: Calcium is an essential cotherapy in osteoporosis treatment. The relative effectiveness of various calcium salts for this purpose is uncertain. Many older women with osteoporosis have phosphorus intakes of <70% of the Recommended Dietary Allowance.

Objective: Our objective was to test the hypothesis that calcium phosphate would better support anabolic bone building than would calcium carbonate.

Design: This study was a 12-mo, randomized, positive-comparator, 2-arm, single-blind clinical trial in 211 patients treated with teriparatide who consumed <1000 mg phosphorus/d. Participants were randomly assigned to receive, in addition to teriparatide and 1000 IU cholecalciferol, 1800 mg calcium/d as either tricalcium phosphate or calcium carbonate. The primary endpoints were changes in lumbar spine and total hip bone mineral densities (BMDs); secondary endpoints were changes in bone resorption biomarkers and serum and urine calcium and phosphorus concentrations.

Results: In the combined group, the lumbar spine BMD increased by 7.2%, and total hip BMD increased by 2.1% (P < 0.01 for both). However, there was no significant difference between calcium-treatment groups, and there were no significant between-group differences in serum calcium and phosphorus concentrations or in urine calcium concentrations. Bone resorption biomarkers increased in both groups, as expected with teriparatide, but the increases in the 2 calcium groups did not differ significantly.

Conclusions: Tricalcium phosphate and calcium carbonate appear to be approximately equally effective in supporting bone building with a potent anabolic agent; phosphate salt may be preferable in patients with restricted phosphorus intakes. This trial was registered at clinicaltrials.gov as NCT00074711.

Figures

FIGURE 1

Numerical flow of potential participants through the solicitation, screening, run-in, and randomization phases of the trial.

FIGURE 2

Time course of percentage change from baseline in bone mineral density (BMD) for the total hip and lumbar spine at 3, 6, and 12 mo of treatment with teriparatide. Open symbols represent data from the calcium phosphate group, and closed symbols represent data from the calcium carbonate group. Error bars = 1 SEM.