1. Epidemiology and Global Health

The effect of calcium supplementation in people under 35 years old: A systematic review and meta-analysis of randomized controlled trials

  1. Yupeng Liu
  2. Siyu Le
  3. Yi Liu
  4. Huinan Jiang
  5. Binye Ruan
  6. Yufeng Huang
  7. Xuemei Ao
  8. Xudong Shi
  9. Xiaoyi Fu  Is a corresponding author
  10. Shuran Wang  Is a corresponding author
  1. Department of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, China
  2. Department of Nutrition and Food Hygiene, School of Public Health and Management, Wenzhou Medical University, China
https://doi.org/10.7554/eLife.79002
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Cite this article
  1. Yupeng Liu
  2. Siyu Le
  3. Yi Liu
  4. Huinan Jiang
  5. Binye Ruan
  6. Yufeng Huang
  7. Xuemei Ao
  8. Xudong Shi
  9. Xiaoyi Fu
  10. Shuran Wang
(2022)
The effect of calcium supplementation in people under 35 years old: A systematic review and meta-analysis of randomized controlled trials
eLife 11:e79002.
https://doi.org/10.7554/eLife.79002
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  3. Download .RIS
4 figures, 7 tables and 12 additional files

Figures

Figure 1
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Study selection.
Figure 2
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Effect of calcium supplmentation on bone mineral density (BMD) in each site.
Figure 2—source data 1

Forest plots for the association between calcium supplementation and the accretion of lumbar spine bone mineral density (LSBMD).

https://cdn.elifesciences.org/articles/79002/elife-79002-fig2-data1-v1.pdf
Figure 2—source data 2

Forest plots for the association between calcium supplementation and the accretion of femoral neck bone mineral density (FNBMD).

https://cdn.elifesciences.org/articles/79002/elife-79002-fig2-data2-v1.pdf
Figure 2—source data 3

Forest plots for the association between calcium supplementation and the accretion of total hip bone mineral density (THBMD).

https://cdn.elifesciences.org/articles/79002/elife-79002-fig2-data3-v1.pdf
Figure 2—source data 4

Forest plots for the association between calcium supplementation and the accretion of total body bone mineral density (TBBMD).

https://cdn.elifesciences.org/articles/79002/elife-79002-fig2-data4-v1.pdf
Figure 3
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Effect of calcium supplmentation on bone mineral content (BMC) in each site.
Figure 3—source data 1

Forest plots for the association between calcium supplementation and the accretion of lumbar spine bone mineral content (LSBMC).

https://cdn.elifesciences.org/articles/79002/elife-79002-fig3-data1-v1.pdf
Figure 3—source data 2

Forest plots for the association between calcium supplementation and the accretion of femoral neck bone mineral content (FNBMC).

https://cdn.elifesciences.org/articles/79002/elife-79002-fig3-data2-v1.pdf
Figure 3—source data 3

Forest plots for the association between calcium supplementation and the accretion of total hip bone mineral content (THBMC).

https://cdn.elifesciences.org/articles/79002/elife-79002-fig3-data3-v1.pdf
Figure 3—source data 4

Forest plots for the association between calcium supplementation and the accretion of total body bone mineral content (TBBMC).

https://cdn.elifesciences.org/articles/79002/elife-79002-fig3-data4-v1.pdf
Figure 4
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Comparison of the effect of calcium supplementation between prepeak and peripeak participants.

Tables

Table 1
Characteristics of included studies.
StudySupplement and Ca dose (mg/day)Duration of supplement/ follow-up (years)No. of subjectsEthnicityFemale (%)Mean (SD or range) age (years)Mean baseline Cacium intake (mg/day)Site measured
Bonjour et al., 1997Milk extract, 8501/2144White1007.94 ± 0.1912 ± 42Radius, hip, LS
Cadogan et al., 1997Whole or reduced fat milk, 11251.5/1.582White10012.2 ± 0.3746TB
Cameron et al., 2004CaCO3, 12002/2128White10010.3 ± 0.2715LS, forearm, hip, TB
Cheng et al., 2005CaCO3 or dairy products, 10002/2181White10011 (10–12)<900LS, FN, TB
Chevalley et al., 2005bCaPO4, 8501/2235White07.4 ± 0.4750Radius, hip, LS
Du et al., 2004Milk, 2452/2757Chinese10011 (10–12)418Forearm, TB
Gibbons et al., 2004Dairy drink, 12001.5/2.5154White519 (8–10)934TB, hip, LS
Lau et al., 2004Milk powder, 650 or 13001.5/1.5344Chinese458 (9–10)463Hip, LS, TB
Lee et al., 1995CaCO3, 3001.5/1.5109Chinese42Age 7567Radius, LS, FN
Lee et al., 1994CaCO3, 3001.5/1.5162Chinese46Age 7280Radius
Lloyd et al., 1993CaCM, 5002/294White10011.9 ± 0.5960LS, TB
Lloyd et al., 1996CaCM, 5002/2112White10011.9 ± 0.5983LS, TB
Matkovic et al., 2005CaCM, 10007/7354White100Age 11830Radius, TB
Moyer-Mileur et al., 2003CaCO3, 8001/171White100Age 12900TB, trabecular
Prentice et al., 2005CaCO3, 10001/1143White016.8 (16–18)1190TB, LS, hip, forearm
Rozen et al., 2003Elemental calcium, 10001/111276% Jewish girls, 24% Arab10014 ± 0.5580TB, LS, FN
Specker and Binkley, 2003CaCO3, 10001/1178White474 (3–5)900TB, arm, leg
Stear et al., 2003CaCO3, 10001.3/1.3144White10017.3 ± 0.3938 ± 411TB, LS, hip, forearm
Courteix et al., 2005CaPO4, 8001/1113White10010 (8–13)980TB, LS, hip, radius
Iuliano-Burns et al., 2003Food products fortified by milk minerals, 4000.7/0.77585% White, 15% Asian1008.8 ± 0.1673TB, LS, leg, arm
Johnston et al., 1992CaCM, 10003/3140White6110 ± 2908Radius, hip, LS
Mølgaard et al., 2004CaCO3, 5001/1113White10013.2 (12.6–13.7)A: 1000–1307; B:<713TB
Nowson et al., 1997CaCO3/Ca-lactate gluconate, 10001.5/1.584White10014 ± 2.6750LS, hip, forearm, TB
Ho et al., 2005Calcium-fortified soymilk supplementation, 6001/1210Chinese10014.5 ± 0.39510LS, hip
Lu et al., 2019Milk powder, 300/600/9001.5/1.5232Chinese5013 (12–15)370TB, LS, hip
Vogel et al., 2017Dairy products, 9001.5/1.524061% Black, 35% White, 4% NS6611.8 ± 1.5700TB, hip
Ma et al., 2014Milk powder, 300/600/9001/1220Chinese5012.9 ± 0.3700TB, LS, hip
Zhang et al., 2014Milk powder or additional calcium, 300/600/9002/2220Chinese5012.9 ± 0.3700TB, LS, hip
Ward et al., 2014CaCO3, 10001/1280Black012.5 ± 0.1338LS, hip
Khadilkar et al., 2012CaCO3, 5001/1210Indian1009.9 ± 1.0250TB
Arab Ameri et al., 2012Milk, 2500.75/0.7554White010.3 ± 2.2570FN
Ekbote et al., 2011Calcium fortified laddoo, 405 mg1/160Indian502.7 ± 0.52188TB
Hemayattalab, 2010Milk, 2300.5/0.540White08.6 ± 1.1480FN
Islam et al., 2010Ca-lactate, 6001/1200White10022.9 ± 3.9<500LS, hip
Yin et al., 2010Calcium, 85/230/5002/2257Chinese4713.5 ± 0.5300TB, LS
Lambert et al., 2008Calcium-fortified fruit drink, 7921.5/3.589White10011.41 ± 0.54636TB, LS, hip
Zhu et al., 2008Milk, 6502/2757Chinese10010.1 ± 0.4436TB
Ward et al., 2007Elemental calcium, 5001/175White609.8 ± 1.6850TB, LS
Bass et al., 2007Ca-fortified foods using milk minerals, 392 ± 290.7/0.788White09.0 ± 0.3900TB, LS
Barger-Lux et al., 2005CaCO3, 5003/3121White10023.1 ± 2.7605TB, LS, hip
Chevalley et al., 2005bMilk calcium-phosphate salt extract, 8501/8149White1007.9 ± 0.5900Radius, hip, LS
Winters-Stone and Snow, 2004CaCO3, 10001/123White10023.7 ± 4.71100Hip, LS, femoral mid-shaft
Volek et al., 2003Milk, 1723 ± 2740.25/0.2528White013–171000TB

  1. CaCO3 = calcium carbonate; Ca = calcium; CaCM = calcium citrate malate; CaPO4 = calcium phosphate; LS = lumbar spine; TB = total body; FN = femoral neck; NS = not stated.

Table 2
Subgroup analysis of bone mineral density (BMD) between calcium supplementation and control for each variable at lumbar spine, femoral neck, total hip, and total body.
VariableNo. of datasetsNo. of participantsBMD difference (95% CI), p valueHeterogeneity between studiesp value*
I² (%)p value
Lumbar spine
Age
Prepeak3131040.093 (−0.047 to 0.233), 0.19271.54<0.0010.866
Peripeak43440.078 (−0.471 to 0.627), 0.78079.820.002
Duration
<18 months1414200.066 (−0.069 to 0.202), 0.33532.750.1130.905
≥18 months2121780.106 (−0.104 to 0.316), 0.32280.31<0.001
Sex
Women-only trials1314660.36 (0.067 to 0.653), 0.01683.71<0.0010.011
Trials with men and women222181−0.057 (−0.162 to 0.048), 0.28427.530.115
Regions
Asian181492−0.012 (−0.117 to −0.094), 0.82912.700.3020.177
Western1719560.222 (−0.03 to 0.473), 0.08483.62<0.001
Baseline calcium intake, mg/day
<7142320140.062 (−0.109 to 0.234), 0.47773.19<0.0010.561
≥7141214340.145 (−0.080 to 0.370), 0.20771.17<0.001
Calcium dose, mg/day
<10002621720.103 (−0.062 to 0.269), 0.22275.30<0.0010.806
≥1000910560.050 (−0.177 to 0.276), 0.66759.220.012
Types of calcium supplement
Dietary calcium1816900.104 (−0.104 to 0.311), 0.32877.83<0.0010.870
Calcium supplementation1717580.075 (−0.099 to 0.249), 0.39663.66<0.001
Supplementation with or without vitamin D
Without vitamin D2225200.140 (−0.047 to 0.327), 0.14378.59<0.0010.468
With vitamin D1310780.008 (−0.160 to 0.176), 0.92644.690.041
Femoral neck
Age
Prepeak2117950.600 (0.292 to 0.909), <0.00188.68<0.0010.138
Peripeak32230.852 (0.257 to 1.446), 0.00567.970.044
Duration
<18 months1514570.824 (0.383 to 1.266), <0.00191.06<0.0010.578
≥18 months99520.378 (0.047 to 0.709), 0.02579.12<0.001
Sex
Women-only trials88400.712 (0.149 to 1.275), 0.01390.89<0.0010.963
Trials with men and women1612620.560 (0.233 to 0.879), 0.00185.41<0.001
Regions
Asian107930.091 (−0.047 to 0.230), 0.1970.000.4410.115
Western1413091.078 (0.603 to 1.552), <0.00191.53<0.001
Baseline calcium intake, mg/day
<7141711590.581 (0.266 to 0.896), <0.00184.10<0.0010.57
≥71479030.680 (0.036 to 1.323), 0.03893.43<0.001
Calcium dose, mg/day
<10001813710.717 (0.349 to 1.085), <0.00189.52<0.0010.488
≥100067310.421 (−0.055 to 0.897), 0.08385.12<0.001
Types of calcium supplement
Dietary calcium1510710.728 (0.311 to 1.144), 0.00189.73<0.0010.635
Calcium supplementation910310.510 (0.101 to 0.919), 0.01486.60<0.001
Supplementation with or without vitamin D
Without vitamin D1013310.477 (0.045 to 0.910), 0.03191.44<0.0010.119
With vitamin D147940.758 (0.350 to 1.166), <0.00185.38<0.001
Total hip
Age
Prepeak1615390.336 (0.031 to 0.642), 0.03188.43<0.0010.119
Peripeak2144−0.465 (−1.409 to 0.479), 0.33477.900.033
Duration
<18 months64850.076 (−0.102 to 0.255), 0.4020.000.9630.935
≥18 months1212910.351 (−0.102 to 0.805), 0.12993.24<0.001
Sex
Women-only trials55270.483 (−0.479 to 1.444), 0.32595.75<0.0010.932
Trials with men and women1310700.181 (−0.103 to 0.465), 0.21183.03<0.001
Regions
Asian1311260.096 (−0.127 to 0.319), 0.39973.92<0.0010.579
Western54710.690 (−0.429 to 1.81), 0.22796.33<0.001
Baseline calcium intake, mg/day
<7141513360.179 (−0.148 to 0.507), 0.28389.55<0.0010.023
≥71432610.723 (0.245 to 1.201), 0.00360.020.082
Calcium dose, mg/day
<10001410920.189 (−0.179 to 0.557), 0.31490.28<0.0010.329
≥100045050.513 (−0.024 to 1.05), 0.06184.04<0.001
Types of calcium supplement
Dietary calcium1513690.314 (−0.006 to 0.634), 0.05488.89<0.0010.421
Calcium supplementation3228−0.046 (−1.148 to 1.056), 0.93592.84<0.001
Supplementation with or without vitamin D
Without vitamin D78940.506 (−0.138 to 1.149), 0.12394.78<0.0010.546
With vitamin D118780.101 (−0.191 to 0.393), 0.49878.22<0.001
Total body
Age
Prepeak3838830.330 (0.163 to 0.496), <0.00185.15<0.001

  • ·

Peripeak

  • ·

  • ·

  • ·

  • ·

Duration
<18 months129860.324 (0.035 to 0.614), 0.02879.55<0.0010.775
≥18 months2628970.334 (0.129 to 0.539), 0.00187.15<0.001
Sex
Women-only trials1823590.569 (0.328 to 0.810), <0.00187.66<0.0010.036
Trials with men and women2015580.104 (−0.089 to 0.296), 0.29273.86<0.001
Ethnicity
Asian2320080.274 (0.062 to 0.486), 0.01185.67<0.0010.544
Western1514690.422 (0.143 to 0.701), 0.00385.28<0.001
Baseline calcium intake, mg/day
<7142623560.363 (0.127 to 0.599), 0.00389.23<0.0010.140
≥7141212150.265 (0.136 to 0.394), <0.00122.280.225
Calcium dose, mg/day
<10002726120.392 (0.161 to 0.624), 0.00188.51<0.0010.484
≥10001112850.189 (0.073 to 0.306), 0.00111.810.332
Types of calcium supplement
Dietary calcium2424530.290 (0.054 to 0.526), 0.01688.33<0.0010.129
Calcium supplementation1414640.405 (0.195 to 0.615), <0.00174.22<0.001
Supplementation with or without vitamin D
Without vitamin D2226570.701 (0.327 to 1.076), <0.00194.83<0.0010.137
With vitamin D1516250.156 (−0.156 to 0.468), 0.32788.94<0.001
  1. *

    p value for heterogeneity between subgroups.

Table 3
Subgroup analysis of bone mineral content (BMC) between calcium supplementation and control for each variable at lumbar spine, femoral neck, total hip, and total body.
VariableNo. of datasetsNo. of participantsBMD difference (95% CI), p valueHeterogeneity between studiesp value*
I² (%)p value
Lumbar spine
Age
Prepeak3324650.173 (0.006 to 0.341), 0.04375.06<0.0010.678
Peripeak33210.047 (−0.291 to 0.384), 0.78647.680.148
Duration
<18 months2114850.063 (−0.063 to 0.190), 0.32825.210.1430.487
≥18 months1512960.293 (−0.015 to 0.602), 0.06282.27<0.001
Sex
Women-only trials1412200.327 (−0.017 to 0.672), 0.06286.55<0.0010.496
Trials with men and women2215660.076 (−0.054 to 0.207), 0.25138.520.035
Regions
Asian1512600.003 (−0.108 to 0.113), 0.9620.000.7040.112
Western2111990.319 (0.059 to 0.579), 0.01682.06<0.001
Baseline calcium intake, mg/day
<7142420300.137 (−0.075 to 0.349), 0.20681.04<0.0010.104
≥714127560.206 (0.059 to 0.354), 0.0060.000.472
Calcium dose, mg/day
<10002920480.187 (−0.013 to 0.386), 0.06778.79<0.0010.938
≥100077680.097 (−0.051 to 0.245), 0.1980.000.992
Types of calcium supplement
Dietary calcium1712670.198 (−0.119 to 0.516), 0.22186.46<0.0010.447
Calcium supplementation1915190.129 (0.024 to 0.234), 0.0160.000.664
Supplementation with or without vitamin D
Without vitamin D2620950.256 (0.056 to 0.456), 0.01278.77<0.0010.057
With vitamin D10700−0.059 (−0.214 to 0.096), 0.4560.000.608
Femoral neck
Age
Prepeak1310180.249 (0.043 to 0.454), 0.01858.270.004<0.001
Peripeak22001.045 (0.701 to 1.390), <0.0010.000.348
Duration
<18 months96480.569 (0.223 to 0.914), 0.00175.38<0.0010.194
≥18 months65700.107 (−0.062 to 0.276), 0.2130.000.467
Sex
Women-only trials53970.742 (0.267 to 1.217), 0.00274.470.0040.129
Trials with men and women107930.195 (−0.027 to 0.418), 0.08657.600.012
Regions
Asian107930.195 (−0.027 to 0.418), 0.08657.600.0120.129
Western53970.742 (0.267 to 1.217), 0.00274.470.004
Types of calcium supplement
Dietary calcium96840.218 (−0.029 to 0.464), 0.08360.890.0090.367
Calcium supplementation65060.609 (0.162 to 1.056), 0.00878.020.000
Supplementation with or without vitamin D
Without vitamin D55180.269 (−0.025 to 0.563), 0.07352.380.0780.865
With vitamin D107000.393 (0.067 to 0.719), 0.01876.45<0.001
Total hip
Age
Prepeak1311940.273 (−0.150 to 0.696), 0.20691.78<0.001<0.001
Peripeak1121−1.936 (−2.346 to −1.525), <0.0010.001.000
Duration
<18 months6542−0.226 (−0.514 to 0.061), 0.12361.790.0230.083
≥18 months87730.385 (−0.495 to 1.264), 0.39296.76<0.001
Sex
Women-only trials3420–0.202 (−1.851 to 1.448), 0.8198.13<0.0010.499
Trials with men and women118660.205 (−0.276 to 0.685), 0.40491.70<0.001
Regions
Asian108940.043 (−0.087 to 0.172), 0.5160.000.6910.914
Western43920.325 (−1.788 to 2.438), 0.76398.71<0.001
Supplementation with or without vitamin D
Without vitamin D68150.226 (−0.837 to 1.289), 0.67797.87<0.0010.981
With vitamin D85000.032 (−0.144 to 0.208), 0.7210.000.663
Total body
Age
Prepeak5037620.168 (0.029 to 0.308), 0.01879.47<0.001<0.001
Peripeak1121−0.716 (−1.086 to −0.347), <0.0010.001.000
Duration
<18 months2617600.146 (−0.095 to 0.387), 0.23583.36<0.0010.902
≥18 months2526340.143 (−0.027 to 0.313), 0.10077.82<0.001
Sex
Women-only trials2321390.227 (−0.021 to 0.476), 0.07386.47<0.0010.593
Trials with men and women2820890.082 (−0.076 to 0.240), 0.31070.54<0.001
Regions
Asian2221420.186 (−0.004 to 0.375), 0.05579.98<0.0010.569
Western2920860.120 (−0.094 to 0.334), 0.27381.74<0.001
Baseline calcium intake, mg/day
<7143027650.123 (−0.082 to 0.327), 0.23986.14<0.0010.307
≥7142114630.186 (0.014 to 0.358), 0.03459.78<0.001
Calcium dose, mg/day
<10003727790.172 (−0.017 to 0.361), 0.07484.50<0.0010.895
≥10001413140.090 (−0.075 to 0.255), 0.28351.430.013
Types of calcium supplement
Dietary calcium2620870.084 (−0.109 to 0.277), 0.39280.09<0.0010.429
Calcium supplementation2521410.215 (0.004 to 0.427), 0.04681.58<0.001
Supplementation with or without vitamin D
Without vitamin D3529100.205 (0.017 to 0.393), 0.03383.03<0.0010.320
With vitamin D1513880.030 (−0.188 to 0.249), 0.78675.35<0.001
  1. *

    p value for heterogeneity between subgroups.

Author response table 1
Information regarding vitamin D supplementation in the included trials.
SubgroupsNo. of trialsTrials
Without vitamin D supplementation32Johnston 1992; Lee 1994; Lloyd 1994; Lee 1995; Lloyd 1996; Bonjour 1997; Cadogan 1997; Nowson 1997; Sandra 2003; Rozen 2003; Volek 2003; Specker 2003; Stear 2003; Molgaard 2004; Cameron 2004; Winters-Stone 2004; Lau 2004; Gibbons 2004; Chevalley 2005; Matkovic 2005; Barger-Lux 2005; Prentice 2005; Courteix 2005; Ho 2005; Chevalley 2005; Ward 2007; Bass 2007; Lambert 2008; Yin 2010; Ekbote 2011; Ward 2014; Vogel 2017;
With vitamin D supplementation11Moyer-Mileur 2003; Du 2004; Cheng 2005; Zhu 2008; Hemayattalab 2010; Islam 2010; Khadilkar 2012; Arab 2012; Ma 2014; Zhang 2014; Lu 2019;
Author response table 2
Detailed information regarding vitamin D supplementation in the trials with vitamin D supplementation.
TrialsVitamin D Supplementation
Moyer-Mileur 2003Arm 1: 800 mg calcium carbonate and vitamin D (400 IU);
Arm 2: placebo
Du 2004Arm 1: milk;
Arm 2: milK+ vitamin D (5 or 8mg cholecalciferol);
Arm 3: control
Cheng 2005Arm 1: calcium (1000 mg) vitamin D3 (200 IU)
Arm 2: calcium (1000 mg),
Arm 3: cheese (1000 mg calcium)
Arm 4: placebo
Zhu 2008Arm 1: calcium fortified milk (Ca milk)
Arm 2: calcium and vitamin D fortified milk (CaD milk)
Arm 3: control
Hemayattalab 2010Arm 1: calcium plus vitamin D
Arm 2: control
Islam 2010Arm 1 – Arm 3: 600 mg of calcium with 10mg of VD; 600 mg of calcium plus multiple micronutrients with 10mg of VD
Arm 4: control
Khadilkar 2012Arm 1: calcium with 30,000 IU vitamin D3 (cholecalciferol);
Arm 2: calcium and multivitamin plus zinc with 30,000 IU vitamin D3
Arm 3: control
Arab 2012Arm 1: calcium plus vitamin D
Arm 2: control
Ma 2014Arm 1 – Arm 3: low, medium and high doses of calcium plus 200 IU vitamin D
Arm 4: control
Zhang 2014Arm 1 – Arm 3: low, medium and high doses of calcium plus 200 IU vitamin D
Arm 4: control
Lu 2019Arm 1 – Arm 3: milk powder fortified with vitamin D 400 IU plus calcium 300, or 600, or 900 mg
Arm 4: control
Author response table 3
Subgroup analyses by calcium supplementation with or without vitamin D on bone mineral density at lumbar spine, femoral neck, total hip and total body.
SubgroupsNo. of datasetsNo. of participantsMean difference(95% CI),P-valueHeterogeneity between studiesP-value for difference between subgroups
I² (%)P-value
Lumbar Spine
without vitamin D2225200.140 (-0.047 to 0.327), 0.14378.59<0.0010.468
with vitamin D1310780.008 (-0.160 to 0.176), 0.92644.690.041
Femoral Neck
without vitamin D1013310.477 (0.045 to 0.910), 0.03191.44<0.0010.119
with vitamin D147940.758 (0.350 to 1.166), <0.00185.38<0.001
Total Hip
without vitamin D78940.506 (-0.138 to 1.149), 0.12394.78<0.0010.546
with vitamin D118780.101 (-0.191 to 0.393), 0.49878.22<0.001
Total Body
without vitamin D2226570.701 (0.327 to 1.076), <0.00194.83<0.0010.137
with vitamin D1516250.156 (-0.156 to 0.468), 0.32788.94<0.001
Author response table 4
Subgroup analyses by calcium supplementation with or without vitamin D on bone mineral content at lumbar spine, femoral neck, total hip and total body.
SubgroupsNo. of datasetsNo. of participantsMean difference (95% CI),P-valueHeterogeneity between studiesP-value for difference between subgroups
I² (%)P-value
Lumbar Spine
without vitamin D2620950.256 (0.056 to 0.456), 0.01278.77<0.0010.057
with vitamin D10700-0.059 (-0.214 to 0.096), 0.4560.000.608
Femoral Neck
without vitamin D55180.269 (-0.025 to 0.563), 0.07352.380.0780.865
with vitamin D107000.393 (0.067 to 0.719), 0.01876.45<0.001
Total Hip
without vitamin D68150.226 (-0.837 to 1.289), 0.67797.87<0.0010.981
with vitamin D85000.032 (-0.144 to 0.208), 0.7210.000.663
Total Body
without vitamin D3529100.205 (0.017 to 0.393), 0.03383.03<0.0010.320
with vitamin D1513880.030 (-0.188 to 0.249), 0.78675.35<0.001

Additional files

Supplementary file 1

Search strategies.

https://cdn.elifesciences.org/articles/79002/elife-79002-supp1-v1.docx
Supplementary file 2

Excluded trials and reasons for exclusion.

https://cdn.elifesciences.org/articles/79002/elife-79002-supp2-v1.docx
Supplementary file 3

Risk-of-bias assessment for eligible trials.

https://cdn.elifesciences.org/articles/79002/elife-79002-supp3-v1.doc
Supplementary file 4

Sensitivity analyses excluding studies of low or medium quality.

(A) Sensitivity analyses excluding studies of low or medium quality in bone mineral density (BMD). (B) Sensitivity analyses excluding studies of low or medium quality in bone mineral content (BMC).

https://cdn.elifesciences.org/articles/79002/elife-79002-supp4-v1.docx
Supplementary file 5

Sensitivity analysis by comparisons of fixed and random-effect models.

(A) Sensitivity analysis by comparisons of fixed and random-effect models for bone mineral density (BMD). (B) Sensitivity analysis by comparisons of fixed and random-effect models for bone mineral content (BMC).

https://cdn.elifesciences.org/articles/79002/elife-79002-supp5-v1.docx
Supplementary file 6

Cumulative meta-analysis according to sample size.

(A) Cumulative meta-analysis according to sample size in lumbar spine bone mineral density (LSBMD). (B) Cumulative meta-analysis according to sample size in femoral neck bone mineral density (FNBMD). (C) Cumulative meta-analysis according to sample size in total hip bone mineral density (THBMD). (D) Cumulative meta-analysis according to sample size in total body bone mineral density (TBBMD). (E) Cumulative meta-analysis according to sample size in lumbar spine bone mineral content (LSBMC). (F) Cumulative meta-analysis according to sample size in femoral neck bone mineral content (FNBMC). (G) Cumulative meta-analysis according to sample size in total hip bone mineral content (THBMC). (H) Cumulative meta-analysis according to sample size in total body bone mineral content (TBBMC).

https://cdn.elifesciences.org/articles/79002/elife-79002-supp6-v1.doc
Supplementary file 7

Sensitivity analyses by comparisons of the pooled results of the trials included in previous study and trials newly added in our current study.

(A) Sensitivity analyses by comparisons of the pooled results of the trials included in previous study and trials newly added in our current study of bone mineral density (BMD). (B) Sensitivity analyses by comparisons of the pooled results of the trials included in previous study and trials newly added in our current study of bone mineral content (BMC).

https://cdn.elifesciences.org/articles/79002/elife-79002-supp7-v1.doc
Supplementary file 8

GRADE assessment.

https://cdn.elifesciences.org/articles/79002/elife-79002-supp8-v1.docx
Supplementary file 9

Meta-regression for age, region, Ca dosage, baseline intake and sample size on bone mineral density (BMD) and bone mineral content (BMC).

https://cdn.elifesciences.org/articles/79002/elife-79002-supp9-v1.docx
Supplementary file 10

Publication bias.

https://cdn.elifesciences.org/articles/79002/elife-79002-supp10-v1.docx
MDAR checklist
https://cdn.elifesciences.org/articles/79002/elife-79002-mdarchecklist1-v1.pdf
Reporting standard 1

PRISMA checklist.

https://cdn.elifesciences.org/articles/79002/elife-79002-repstand1-v1.docx

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  1. Yupeng Liu
  2. Siyu Le
  3. Yi Liu
  4. Huinan Jiang
  5. Binye Ruan
  6. Yufeng Huang
  7. Xuemei Ao
  8. Xudong Shi
  9. Xiaoyi Fu
  10. Shuran Wang
(2022)
The effect of calcium supplementation in people under 35 years old: A systematic review and meta-analysis of randomized controlled trials
eLife 11:e79002.
https://doi.org/10.7554/eLife.79002