Research Paper Volume 12, Issue 6 pp 5500—5515

The association of calcium intake with osteoporotic vertebral fractures in a large Chinese cohort

Ling Wang 1, *, , Lu Yin 2, *, , Xiaoguang Cheng 1, , Kai Li 1, , Yuebo Wang 2, , Yong Zhang 1, , Yang-yang Duanmu 1, , Xiaoyun Liu 2, , Guijuan Deng 2, , Yang Wang 2, , Nicola Veronese 3, , Wei Li 2, , Wei Tian 4, , PURE China CASH study team ,

  • 1 Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
  • 2 Medical Research and Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
  • 3 Aging Branch (N.V.), National Research Council, Neuroscience Institute, Padova, Italy
  • 4 Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
* Equal contribution

received: October 24, 2019 ; accepted: March 19, 2020 ; published: March 28, 2020 ;
How to Cite

Copyright © 2020 Wang et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


The effect of calcium on prevention of osteoporosis and related fracture which are aging issues is unclear. The aim of this study is to explore the association of calcium intake with vertebral fracture. This study enrolled 3,457 participants from China Action on Spine and Hip Status (CASH) study from 2013 and 2017. Dietary calcium intake was collected using validated food frequency questionnaires (FFQ). Vertebral fracture of CT images was defined as the primary outcome. The mean calcium intake of men and women were 522.75mg/day and 507.21mg/day, respectively. 6% reduction in the odds of fracture risk was observed per 100 unit increase of calcium intake from food among females (OR, 0.94; 95% CI, 0.89-0.99), but results among males were not significant. We divided calcium intake into quintiles when modelling its associations with fracture risk, negative associations of fracture risk with calcium intake were found among females. In a population with low usual calcium intake, higher dietary calcium intake was associated with fewer vertebral fracture in women and that no such association was seen in men.


vBMD: Volumetric bone mineral density; CASH: China Action on Spine and Hip Status; OR: Odds ratio; CI: Confidence interval; CDRI: Chinese Dietary Reference Intakes; QCT: Quantitative computed tomography; DXA: Dual-energy X-ray absorptiometry; IPAQ: International Physical Activity Questionnaire; FFQ: Food Frequency Questionnaire; ESP: European spine phantom; ISCD: International Society for Clinical Densitometry; SQ: Genant’s semiquantitative.