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Randomized Controlled Trial
. 2011 Jul;94(1):270-7.
doi: 10.3945/ajcn.110.003350. Epub 2011 Apr 27.

Urinary tract stone occurrence in the Women's Health Initiative (WHI) randomized clinical trial of calcium and vitamin D supplements

Robert B Wallace  1 , Jean Wactawski-Wende, Mary Jo O'Sullivan, Joseph C Larson, Barbara Cochrane, Margery Gass, Kamal Masaki
Affiliations
Randomized Controlled Trial

Urinary tract stone occurrence in the Women's Health Initiative (WHI) randomized clinical trial of calcium and vitamin D supplements

Robert B Wallace et al. Am J Clin Nutr. 2011 Jul.

Abstract

Background: The Women's Health Initiative (WHI) randomized clinical trial (RCT) of calcium plus vitamin D (CaD) supplements found a 17% excess in urinary tract stone incidence in the supplemented group. This study evaluated whether this risk is modified by participant characteristics.

Objective: We examined the correlates of urinary tract stone occurrence in the CaD arm of the WHI trial.

Design: We analyzed an RCT involving 36,282 postmenopausal women aged 50-79 y from 40 WHI centers: 18,176 women received 500 mg calcium carbonate plus 200 IU vitamin D(3) twice daily (1000 mg and 400 IU daily, respectively), and 18,106 women received a matching placebo for an average of 7.0 y. The incidence of urinary tract stones was determined.

Results: The incidence of self-reported clinically diagnosed urinary tract stones was more common in the active CaD medication group than in the placebo group (hazard ratio: 1.17; 95% CI: 1.02, 1.34): 449 women in the CaD group and 381 women in the placebo group reported a stone during the trial. The rates of self-reported stones did not differ between various demographic, anthropomorphic, dietary, and other hypothesized risk factors according to randomization assignment. Neither the total calcium intake nor the use of calcium supplements at baseline was associated with the risk of stones. In sensitivity analyses that censored participants who were below 80% adherence, the findings were similar.

Conclusions: Daily supplementation with CaD for 7 y was associated with an increase in the number of self-reported urinary tract stones. These findings have implications for CaD supplement use. This trial was registered with the WHI at clinicaltrials.gov as NCT00000611.

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Figures

FIGURE 1.
FIGURE 1.
Progress of subjects through the phases of the Women's Health Initiative (WHI) Calcium plus Vitamin D (CaD) Supplementation Study. HT, hormone therapy; DM, dietary modification; BMD, bone mineral density.
FIGURE 2.
FIGURE 2.
Kaplan-Meier survival curve for risk of self-reported urinary tract stones in the calcium plus vitamin D (CaD; black line) and placebo (gray line) groups.
See this image and copyright information in PMC

Comment in

References

    1. National Osteoporosis Foundation. Available from: http://www.nof.org/prevention (cited 17 June 2008)
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