Research Original Research| Volume 113, ISSUE 10, P1302-1310, October 2013

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

Published:August 19, 2013DOI:



      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.


      To evaluate the influence of supplemental calcium and vitamin D on joint symptoms in the Women’s Health Initiative randomized, placebo-controlled, clinical trial.


      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.


      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).


      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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      R. T. Chlebowski is a professor of medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA.


      M. Pettinger is a senior statistician, Fred Hutchinson Cancer Research Center, Seattle, WA.


      C. L. Kooperberg is an affiliate professor, Fred Hutchinson Cancer Research Center, Seattle, WA.


      K. C. Johnson is a professor and interim chair, University of Tennessee Health Science Center, Department of Preventive Medicine, Memphis.


      R. Wallace is a professor, University of Iowa College of Public Health, Iowa City.


      C. Womack is an associate professor of medicine, Veterans Affairs Medical Center, Memphis, and University of Tennesee Health Science Center, Memphis.


      L. Carbone is a professor of medicine, Veterans Affairs Medical Center, Memphis, and University of Tennesee Health Science Center, Memphis.


      Y. Mossavar-Rahmani is an associate professor of clinical epidemiology and population health, Albert Einstein College of Medicine, Bronx, NY.


      M. Stefanick is a professor of medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA.


      J. Wactawski-Wende is a professor and associate chair, The State University of New York, Buffalo.


      B. Lu is an assistant professor, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.


      C. Eaton is a professor of family medicine and epidemiology, Brown University, Providence, RI.


      B. Walitt is an associate professor of medicine, Georgetown University Medical Center, Washington, DC.