{"id":"f4b63afe-36ee-5f1f-a260-15bc42f42464","stable_key":"434e1e27-eb90-583a-956b-62472726ffba:cal-whi-hip-fractures","predicate":"has_reported_effect_on","statement":"WHI calcium plus vitamin D did not significantly reduce hip fractures in the intention-to-treat analysis.","claim_class":"observational","status":"source_derived_draft","evidence_grade":"ungraded","direction":"context_dependent","is_public":true,"mechanism_event_id":"8e65c85c-df2a-554d-8cc2-22e0d4fb27ae","mechanism_event_label":"A larger trial did not establish a hip-fracture benefit for its overall assigned-treatment groups.","subject":{"id":"8e2a5a1f-cd49-5f28-8611-325266fb78a6","slug":"calcium","display_name":"Calcium","entity_type_key":"nutrient_element"},"object":{"id":"05bc7f71-5c0d-5857-8233-b47b2c5de81f","slug":"hip-fracture-incidence","display_name":"Hip fracture incidence","entity_type_key":"cellular_process"},"evidence_count":1,"mechanism_event":{"id":"8e65c85c-df2a-554d-8cc2-22e0d4fb27ae","stable_key":"434e1e27-eb90-583a-956b-62472726ffba:cal-whi-hip-fractures-event","event_type":"observed_intervention","label":"A larger trial did not establish a hip-fracture benefit for its overall assigned-treatment groups.","description":"WHI calcium plus vitamin D did not significantly reduce hip fractures in the intention-to-treat analysis.","status":"provisional","compartment":null,"participants":[{"entity":{"id":"8e2a5a1f-cd49-5f28-8611-325266fb78a6","slug":"calcium","display_name":"Calcium","entity_type_key":"nutrient_element"},"role":"tested_input","stoichiometry":null,"state_label":"","sequence_order":0,"notes":""},{"entity":{"id":"05bc7f71-5c0d-5857-8233-b47b2c5de81f","slug":"hip-fracture-incidence","display_name":"Hip fracture incidence","entity_type_key":"cellular_process"},"role":"measured_outcome","stoichiometry":null,"state_label":"","sequence_order":1,"notes":""},{"entity":{"id":"4ee1cbd0-1cec-58e1-9fee-bdb2c13db94d","slug":"calcium-carbonate","display_name":"Calcium carbonate","entity_type_key":"chemical_species"},"role":"calcium_form","stoichiometry":null,"state_label":"","sequence_order":2,"notes":""},{"entity":{"id":"b162e431-b442-5400-9335-ec91f7875a4e","slug":"cholecalciferol","display_name":"Cholecalciferol","entity_type_key":"small_molecule"},"role":"cointervention","stoichiometry":null,"state_label":"","sequence_order":3,"notes":""}]},"contexts":[{"dimension":"experimental_model","value_text":"36,282 postmenopausal women; seven-year mean follow-up.","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"exposure","value_text":"1000 mg elemental calcium as carbonate plus 400 IU vitamin D3/day; hip-fracture HR 0.88, 95% CI 0.72-1.08.","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"limitations","value_text":"Adherence and background supplement use complicate comparison; a nonsignificant result is not proof of zero effect.","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"nutrient_topic","value_text":"Calcium research collection; topical membership is not evidence of a direct dietary effect.","comparator":null,"unit":null,"notes":"","entity":{"slug":"calcium","display_name":"Calcium","entity_type_key":"nutrient_element"}},{"dimension":"organism","value_text":"Homo sapiens","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"plain_language","value_text":"A larger trial did not establish a hip-fracture benefit for its overall assigned-treatment groups.","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"primary_references","value_text":"[cal-clin-jackson2006] Calcium plus vitamin D supplementation and the risk of fractures (2006). https://pubmed.ncbi.nlm.nih.gov/16481635/ DOI: 10.1056/NEJMoa055218","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"tissue_or_cell_type","value_text":"Human clinical or absorption endpoint","comparator":null,"unit":null,"notes":"","entity":null}],"evidence":[{"id":"e3313ac8-84b6-5503-a65c-63856f71c83f","evidence_kind":"source_excerpt","locator":"Lines 1211-1221","start_line":1211,"end_line":1221,"excerpt":"### cal-whi-hip-fractures\nWHI calcium plus vitamin D did not significantly reduce hip fractures in the intention-to-treat analysis.\nCondition category: normal\nnutrient_topic: Calcium research collection; topical membership is not evidence of a direct dietary effect.\nplain_language: A larger trial did not establish a hip-fracture benefit for its overall assigned-treatment groups.\norganism: Homo sapiens\ntissue_or_cell_type: Human clinical or absorption endpoint\nexperimental_model: 36,282 postmenopausal women; seven-year mean follow-up.\nlimitations: Adherence and background supplement use complicate comparison; a nonsignificant result is not proof of zero effect.\nexposure: 1000 mg elemental calcium as carbonate plus 400 IU vitamin D3/day; hip-fracture HR 0.88, 95% CI 0.72-1.08.\n[cal-clin-jackson2006] Calcium plus vitamin D supplementation and the risk of fractures (2006). https://pubmed.ncbi.nlm.nih.gov/16481635/ DOI: 10.1056/NEJMoa055218","model_system":"36,282 postmenopausal women; seven-year mean follow-up.","directness":"author_interpretation","verification_status":"source_derived_draft","notes":"Exact curation-document quotation, not publisher quotation. Study references: [cal-clin-jackson2006] Calcium plus vitamin D supplementation and the risk of fractures (2006). https://pubmed.ncbi.nlm.nih.gov/16481635/ DOI: 10.1056/NEJMoa055218","relationship":"supports","weight":1.0,"link_notes":"","source":{"id":"3c083fa0-59c6-50e9-af42-678d0e3c1006","stable_key":"import-434e1e27-eb90-583a-956b-62472726ffba","title":"Calcium: mechanism-first literature curation (2026-09-17)","document_type":"imported_text","citation_label":"AI-assisted literature curation; primary study URLs and scope retained in the document and extraction. Not publisher full text.","file_path":"","sha256":"965c934d6b147f2b62f8d45ce6d7a87681a600bfe5c46a585b4704889afd3fc1","revision_id":"543ec48b-4f70-5197-9d76-f5a3c443664c","review_status":"unverified_draft","notes":""}}],"relations":[],"conflicts":[{"id":"f04a7e40-0a28-5353-96a3-376c3dcf7890","title":"Fracture outcomes differ across calcium-plus-vitamin-D trials","kind":"context_difference","status":"open","why":"Age, baseline nutrition, setting, adherence and background supplementation differ. These are potential explanations, not demonstrated mediation or proof of a single responder threshold.","resolution":"Unresolved; needs review.","created_at":"2026-09-17 08:08:54","record_type":"conflict","display_label":"Recorded conflict","record_url":"/conflicts/f04a7e40-0a28-5353-96a3-376c3dcf7890","sides":[{"conflict_id":"f04a7e40-0a28-5353-96a3-376c3dcf7890","ordinal":0,"label":"A combined intervention reduced fractures in this older population.","revision_id":"543ec48b-4f70-5197-9d76-f5a3c443664c","start_line":1199,"end_line":1209,"quote":"### cal-chapuy-hip-fractures\nCombined calcium and vitamin D lowered hip-fracture occurrence in the elderly-women trial.\nCondition category: normal\nnutrient_topic: Calcium research collection; topical membership is not evidence of a direct dietary effect.\nplain_language: A combined intervention reduced fractures in this older population.\norganism: Homo sapiens\ntissue_or_cell_type: Human clinical or absorption endpoint\nexperimental_model: 3270 elderly women; mean age 84; 18-month randomized trial.\nlimitations: Calcium-specific attribution is impossible because vitamin D was coadministered. Completer and intention-to-treat analyses must be distinguished.\nexposure: 1.2 g elemental calcium as tricalcium phosphate plus 800 IU vitamin D3/day; 43% lower hip-fracture count among completers, with similar direction in intention-to-treat analysis.\n[cal-clin-chapuy1992] Vitamin D3 and calcium to prevent hip fractures in elderly women (1992). https://pubmed.ncbi.nlm.nih.gov/1331788/ DOI: 10.1056/NEJM199212033272305","source_key":"import-434e1e27-eb90-583a-956b-62472726ffba","source_title":"Calcium: mechanism-first literature curation (2026-09-17)","claim_ids":["9023d41e-d930-56c5-9b36-f85d61384f7f"]},{"conflict_id":"f04a7e40-0a28-5353-96a3-376c3dcf7890","ordinal":1,"label":"A larger trial did not establish a hip-fracture benefit for its overall assigned-treatment groups.","revision_id":"543ec48b-4f70-5197-9d76-f5a3c443664c","start_line":1211,"end_line":1221,"quote":"### cal-whi-hip-fractures\nWHI calcium plus vitamin D did not significantly reduce hip fractures in the intention-to-treat analysis.\nCondition category: normal\nnutrient_topic: Calcium research collection; topical membership is not evidence of a direct dietary effect.\nplain_language: A larger trial did not establish a hip-fracture benefit for its overall assigned-treatment groups.\norganism: Homo sapiens\ntissue_or_cell_type: Human clinical or absorption endpoint\nexperimental_model: 36,282 postmenopausal women; seven-year mean follow-up.\nlimitations: Adherence and background supplement use complicate comparison; a nonsignificant result is not proof of zero effect.\nexposure: 1000 mg elemental calcium as carbonate plus 400 IU vitamin D3/day; hip-fracture HR 0.88, 95% CI 0.72-1.08.\n[cal-clin-jackson2006] Calcium plus vitamin D supplementation and the risk of fractures (2006). https://pubmed.ncbi.nlm.nih.gov/16481635/ DOI: 10.1056/NEJMoa055218","source_key":"import-434e1e27-eb90-583a-956b-62472726ffba","source_title":"Calcium: mechanism-first literature curation (2026-09-17)","claim_ids":["f4b63afe-36ee-5f1f-a260-15bc42f42464"]}]}],"corrections":[],"research":null}