The effect of combined calcium and cholecalciferol supplementation on bone mineral density in elderly women with moderate chronic kidney disease

Aims: To examine the effect of combined calcium and vitamin D(3) supplementation on bone mineral density (BMD) in patients with chronic kidney disease (CKD). Methods: We performed a post-hoc analysis of the DECALYOS II, a 2-year randomized, double-blind, placebo-controlled study of 610 women randomized to: calcium-vitamin D(3) fixed combination, calcium plus vitamin D(3) separate combination, or placebo. Both active treatment groups received the same daily amount of calcium (1,200 mg) and vitamin D(3) (800 IU). BMD of the distal radius was measured by single X-ray absorptiometry at baseline, 12 and 24 months. Results: At baseline 47.2%, 36.4% and 16.4% of the study population had an eGFR ≥ 60, 45 – 59, and < 45 ml/min/1.73 m(2), respectively. Both active regimens vs. placebo markedly increased serum 25-hydroxyvitamin D levels from baseline in all eGFR groups (p < 0.0001). Analysis of variance demonstrated an overall treatment effect on distal radius BMD (p = 0.005), with the active treatment groups showing a lower rate of BMD loss when compared to the placebo group. The effects of the intervention on BMD did not differ significantly according to baseline eGFR (interaction p > 0.22 for all time points). Conclusion: Combined calcium and vitamin D(3) supplementation was effective in reducing rate of BMD loss in women with moderate CKD.