The People's Perspective on Medicine

How Did Doctors Go So Wrong on Calcium and Vitamin D for Bone Strength?

Every day millions of people swallow calcium and vitamin D for bone strength. How well do these supplements work to prevent fractures? What went wrong?

For decades physicians have been advising their older female patients to take extra calcium and vitamin D for bone strength. It seemed logical. Both calcium and vitamin D play a role in building bone. In theory, supplements should have helped. But was there any evidence to support these recommendations? A new study in JAMA (Dec. 26, 2017) challenges conventional wisdom. That’s because the investigators looked for data to support the standard wisdom. What they found has shocked health professionals and tens of millions of women.

Confusion About Calcium and Vitamin D for Bone Strength:

Brenda asks a good question:

“I had a hysterectomy at age 40. I was not allowed to take estrogen replacement therapy and now at 63 I have osteoporosis. I started taking calcium and Vitamin D3.  My local newspaper this morning has an article that says calcium with D3 does not help! Is this true?”

Even women who have not had a hysterectomy are wondering the same thing. The headlines are confusing. Here are just a few of this week’s health headlines:

“Vitamin D, Calcium Supplements May Not Lower Bone Fracture Risk”  NBC News

“Should You Really Be Taking Calcium and Vitamin D Supplements?”  CBS News

“Study Reveals Your Vitamin Supplements Doing No Good to Bones” Business Recorder

“Experts Rebuke Report Casting Doubt on Link Between Vitamin D, Calcium and Bone Health” Statesville Record & Landmark

What the Data Show:

The new study published in JAMA was a meta-analysis of 33 randomized controlled trials (RCTs) involving 51,145 subjects. The authors searched for RCTs in which individuals received calcium, vitamin D or both calcium and vitamin D supplements compared to placebo or no treatment. The outcomes they were evaluating were 1) hip fractures or 2) spinal fractures, non-spinal fractures and total fractures.

Results:

In two words, there was no difference between individuals who took calcium and/or vitamin D vs. placebo and the incidence of fractures. In their own words the researchers wrote:

“There was no significant association of calcium or vitamin D with risk of hip fracture compared with placebo or no treatment. There was no significant association of combined calcium and vitamin D with hip fracture compared with placebo or no treatment. No significant associations were found between calcium, vitamin D, or combined calcium and vitamin D supplements and the incidence of non vertebral, vertebral, or total fractures.”

Discussion:

“Results of this meta-analysis showed that calcium, calcium plus vitamin D, and vitamin D supplementation alone were not significantly associated with a lower incidence of hip, nonvertebral, vertebral, or total fractures in community-dwelling older adults.”

Conclusions:

“These findings do not support the routine use of these supplements in community-dwelling older people.”

In our words: taking calcium and vitamin D for bone strength was a bust because it did not prevent fractures. That is, after all, the point of taking supplements to prevent or treat osteoporosis.

Resistance: Calcium and Vitamin D for Bone Strength

If you go back up to the headline links you will see an article from the Statesville Record & Landmark titled “Experts rebuke report casting doubt on link between vitamin D, calcium and bone health”

In this report, a Creighton University scientist, Dr. Robert Recker, was quoted as saying:

“The paper in JAMA is ‘complete bull … if you excuse my expression. That’s going to cause a lot of harm.'”

Dr. Becker leads the Creighton Osteoporosis Research Center. He correctly points out that vitamin D is essential for the absorption of calcium and plays an integral role in bone formation. That said, the meta-analysis reviewed the available data on the key clinical outcomes people care about: broken bones. The results were not pretty.

We Told You So:

It is unbecoming of The People’s Pharmacy to challenge conventional wisdom. Nevertheless, if the data are not solid, it is our responsibility to point that out. Health professionals like to embrace the idea of “evidence-based medicine.” When the evidence does not pan out, however, many tend to shoot the messenger.

This is not the first time we have pointed out that there is a problem with the calcium theory of osteoporosis. We have taken a substantial amount of flak for doing so. Here is an article from about two years ago:

What Is the Story on Calcium Supplements?

If you review this article you will see two key sections:

Theory Falls Short:

Downsides of Calcium Supplements:

An even more in-depth analysis from Oct. 1, 2015 was titled:

Calcium Supplements Do NOT Prevent Broken Bones

And if you go back to 2010, we wrote about:

Calcium Supplements & Heart Attacks?

What Should You Do About Calcium and Vitamin D for bone Strength?

We are great believers in vitamin D, but we cannot promise that by itself this nutrient will prevent bone fractures. You can learn much more about vitamin D at this link:

Vitamin D Deficiency

Is It Possible to Build Bone Strength?:

To discover other ways to build strong bones, you may want to listen to a FREE one-hour interview we conducted a few years back with Walter Willett, MD, DrPH, Chairman of the Department of Nutrition and Frederick John Stare Professor of Epidemiology and Nutrition at Harvard University’s School of Public Health. In addition to Dr. Willett, we interviewed Michael Castleman, a medical journalist and author of Building Bone Vitality: A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis.

Here is a link to the radio show. If you look below Dr. Willett’s bio, there is a link to Download the mp3. When you do that you will see Show 752: Bone Vitality. Above the orange box that says ADD TO CART, is an option to Choose CD or MP3 version. If you click on the down arrow you can toggle the MP3 option which is FREE! We think you will find this interview quite fascinating and way ahead of its time.

After listening to Dr. Walter Willett and Michael Castleman, please share your thoughts in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I am 73 and I don’t take any pills for anything! I have always believed that once you start taking pills you always seen to add more pills thinking they will make you healthier. My doctor is surprised at how healthy I am, but she is from India and has the same belief as I do that your body can heal itself if you leave it alone, most of the time, at least.

Hi.
I had a hysterectomy in 1987 age 31. I had a bone test in 2014, and I have Osteoporosis. My doctor put me on Alendromate 70 mg once a week. I walk 3 times a week, 2.50 miles, and am starting weigh training. I’m on Calcium, vitamin D-3, and magnesium. Should I stay on them or go off them. I’m 71. I try to eat real food with vitamins in it. I also drink no cow’s milk, only almond milk. Should I go off the calcium?

The almond milk probably does not supply as much calcium as cow’s milk would. Consequently, you might want to continue with your current regimen.

Two things. One, it sure would be a nice thing if we could “like” a comment others have made. Some way to show that we have the same thoughts.

And request 2, is there any way the “shows” can be somehow summarized in text? I just cannot spend an hour listening. I don’t retain things well from spoken words, and it would take me far, far less time to read a summary or even a transcription. I’d love to know that the calcium show had to say.

Thanks for my favorite health site.

My husband, who majored in chemistry at the University of Kansas, told me similar information about calcium in 1980.

Vitamin D prevents falls in elderly. Do you why yet or how this works?

Dr. Diamond, Reno, Nevada has emphasized for ca 20+ years to take Calcium ONLY with at least half the amount of Magnesium, 500 mg calcium to 250mg magnesium with Boron and K2.

This is the only way to absorb it. In Dr. Diamond’s words: calcium
strengthens bones and magn. knows where to put it! Most docs do not study this and recommend the hard as a rock calcium with D 400mg. Nurses used to call them bed pan bullets, which they found intact/undissolved. I only take vit/mins in capsule form to make sure they get broken down.

So, it’s not necessarily the calcium, it is the uninformed advice
docs give out for lack of knowledge and lack of interest to study
nutrition.

I am interested in knowing what form of calcium was used. Also if participants did weight bearing exercises faithfully. Also, how much Vit. D was taken with the calcium. Also , how much MK-7 was taken with this regimen. In 2010 I was diagnosed with breast cancer, and took an aromatase inhibitor, which gets rid of all your estrogen, which naturally causes osteoporosis. My doc told me calcium will not go into your bones without estrogen. Wanted me to take a bisphosphenate(Fosimax) or others. I could not and would not take it because of my severe TMJ. I successfully raised my bone density into the normal range using a product called Bone Up, 6000 units Vit. D3, extra boron, strontium citrate, silicon drops. A very important nutrient called MK-7 is super important for getting calcium into your bones and not into your blood to damage your heart. And super important, I did much exercise on the treadmill with a high incline. My doc was impressed. My HDL is in the high 70’s and my triglycerides are about 40. My health is good. I am 74. B. Jean

I stopped taking Calcium when I read that it did nothing to prevent Ostro. That was slightly over a year ago. I was due for a bone scan right after I stopped the supplements. My Dr. agreed to postpone the test for a year to see if there was any bone loss. I had the scan about a month ago and there was absolutely no change in my scan from the year before. I still have Osteopenia but it is no worse than when I was taking horse pills of Calcium!

I am a 74 year old female. About 20 years ago, after complaining of pain in both my left knee as well as my thoracic spine, and then proceeding with MRIs and X=Rays, I was diagnosed with an increase in calcium deposits in both of these areas. I proceeded with some physical therapy for my back problem. In process, my therapist asked if I was taking calcium supplements and I responded that I was. This was our further conversation:
Therapist: Why?
My answer: Because everyone says we need more calcium.
Therapist: Do you have a family history of osteoporosis?
Me: No
Therapist: Then stop taking calcium. It may be contributing to your build-up of more bone that is now causing you pain.
(As an aside, the therapist made a comment about the Dairy Council lobby and its influence on a national increase in unnecessary supplementary calcium intake, which I found very interesting but I must admit I did no follow-up research on this information).
So, I did stop taking calcium supplements.
Then very recently, I had a bone density test, my first since 10 years ago. The result was that I have the same numbers from 10 years ago, showing on the low scale for osteopenia. Then in the report I was advised to “continue” to take the calcium I had been taking all along for the last ten years. (I had taken no calcium supplements in the past 15 years.) So calcium did nothing to either increase or decrease my bone density. Whatever I’m doing to keep these low numbers, it’s not taking calcium supplements.

A number of years ago, you pooh-poohed me when I called in and said that vitamin K would turn out to be as important as vitamin D.

I told you so.

I recently had a bone density test, am 701/2. It was suggested I take Boniva at 65, didn’t, at time seemed to be life sentence.
A month ago I did a search of related clinical trial, thought I might find drug combos now. Instead found trials with bluberries, plums, and stomping! It seems that maybe research is focusing on real food and life style now. What do you think of tentative conclusion I have reached?
I am waiting for appt with Osteoporosis expert. Have been drinking blueberry kefer with healthy additives. Thoughts? Mayo Clinic who I also research seemed to indicate it is not fosamax, but more lifestyle based, of what I preferred to think.

Interested in more info on BoneUp, also!

Where does vitamin k2 come in here?

Vitamin K keeps calcium where it belongs – in your bones instead of circulating in your blood and depositing in your heart and/or arteries.

I took calcium until I read your article some years back that it didn’t help prevent broken bones. I haven’t had a calcium pill since. Since I live where there is no sun to be seen day after day this time of year, I conscientiously take my 1000 units of vitamin D daily and get real sunshine in suitable doses when it is available.

Thank you for all the helpful information over the years.

I personally don’t think doctor’s know a damn thing about nutrition (or exercise). I’ve had some doctors tell me to take all kinds of supplements and others say “just eat a mix of healthy foods”. The supplement industry is a multi-million/billion dollar industry with no FDA overseeing (and they allow drugs on the market that prove dangerous, if not deadly). Then the drugs that cost millions to get on the market are recalled. It’s more than a “rip-off”. It’s “live free and die”.

At one point, I was taking Strontium regularly (on the advice of a doctor), to build bones. After a while, I developed a bony lump on the top of a shoulder joint. I stopped taking the Strontium, and it went away.

I am surprised that the medical establishment keeps missing out on the key to so much of this: MAGNESIUM. People are deficient due to the depletion of the soil and it is critical to depositing Calcium in the bones and out of soft tissue. Read Dr. Carolyn Dean’s The Magnesium Miracle or The Calcium Lie by Dr. Robert Thompson. Vitamin D can only be metabolized when there is enough Magnesium to do so.

I think that if you want to have strong bones you have to put a burden on them so they will stay strong. Or, begin putting a burden on them so they will get stronger.Our bodies purge themselves of what they don’t need. If you don’t need strength your muscle mass atrophies… but doesn’t abandon ship.
Bones, however, do “abandon ship.” They deteriorate and we piss away calcium getting thinner, weaker and brittle over time. Our bodies conserve energy by putting aside what they don’t need or use. It really doesn’;t matter how much calcium we take in if our bodies determine we don’t need strong bones because we never put any stress on them.
Then… they break.

I do weight resistance exercises (at the YMCA) and walk;
I also take PLANT SOURCED not limestone Calcium (by New Chapter/Vit.D and K)
and my doctor said after last bone density test: Keep on doing what you’re doing, it’s
working…….. – I do not know, whether it’s true that plant sourced calcium is better
absorbed than limestone calcium……. that’s what they tell the public………
I also do not know, whether “limestone calcium” builds up in the arteries??????!!!! another “claim”…….
I am 79……..and small boned………….

About 10 years ago I was diagnosed with sever osteoporosis and put on a medication but never improved much. Someone told me about Advacal 1000 from Lane Labs and I quit the RX and on my next bone scan, four months later I had osteopenia and I’ve never gone down from there. I’ve told many people about this calcium and they have gone on it and had the same results. Maybe it’s the wrong calcium that doesn’t help people! I’m 78 and still strong. In 2012 I had a very hard fall and hit my left rib cage against the edge of a sidewalk..it tore my spleen but didn’t even crack a rib or my hip. I’m a believer!!

It is my good fortune to have in my church congregation a well known compounding pharmacist. He makes his own capsules for osteoporosis using bone building ingredients but mainly strontium. I had osteoporosis, obediently took Fosamax and after 4 years was diagnosed with a -4.3 femur. After taking the pharmacists capsules one year the next bone density test rated that femur at plus 3.6 with improvement all up the spine. I understand strontium has been used in Europe for 50 years but because it is a natural mineral it cannot be patented so with no profit to be made big pharma won’t bother with it. We lose. If you find this incorrect, please tell me.

I wish you would include a brief summary or ideally even a transcript of your radio show contents. I have a great problem listening for an hour but can read very quickly. Please don’t keep us in the dark about this important information. How frustrating. Thank you for your great information.

I have been taking calcium since I was twenty seven because of a neck injury caused by a tumble off a horse when I was twenty. Prior to taking calcium I had constant headaches and neck pain. I was living on tylenol daily to relieve the pain. By taking calcium daily it relieved a lot of the pain I was enduring on a daily basis. I am now seventy three and am still taking calcium. If I stop the calcium the headaches and neck pain increase. I do have osteopena and so I stay active.

Agree with the posters above. I wouldn’t go NEAR a calcium supplement because of what it does to the vascular system. I had teeth pulled and the dentist told me that the roots were all calcified. I can only imagine what is/was going on in my arteries.

However, I also have Osteoporsis. I’ve had 3 Reclast infusions which didn’t seem to help much and I won’t take another Reclast infusion because of thigh and jaw pain.So where does that leave me? Well, I started taking Boron and Vitamin K. Boron to strengthen the bones and K to keep calcium already in my body where it’s supposed to be – in my bones.

I also walk, doing weight bearing exercises. Diet is harder, of course, but I try to get enough fruits and veggies. I do take vitamin D because of living in the North and little sunshine, but other than the above, I don’t see what else I can do.

Anyone have any other ideas, I would appreciate hearing them.

Eat your calcium – don’t take a pill. Here are foods high in calcium: Kale, Broccoli, Oranges, Figs, Tempeh, Tofu, Beans, Almond Butter, Tahini and Molasses are high in calcium. Excercise is the best way to build bone strength. WALK

Re: Vitamin D and calcium for bone health.

It would appear that taking Vitamin D and calcium alone might not be enough to promote good bone health. My research also calls this into question. But, there are other factors that come into play. The best analogy I can use is this : It is like putting gas into your car, not starting the engine and expecting to get somewhere. Not going to happen.

However, if you get enough Vitamin D and calcium, especially through good nutrition, proper exercise and lifestyle, it changes the equation. The system is much more complex than just taking a magic bullet.

Calcium is not the only answer for strong bones. Magnesium is also necessary. This has become a complex issue with supplements. The calcium that you take must be one that is absorbed properly. Also exercise that puts weight on the bones is important. A healthy diet with greens is also important. The information that is put out is very confusing. They tell you one thing then reverse it and tell you something else. They are not very informed about nutrition and do more harm at times then good.

At age 72 my bones are really strong. I do not take extra calcium but get it through some foods. I do take 5,000 iu of vitamin D daily and magnesium though. Also even though I’ve been disabled for many years I have used a Rebounder with a safety bar. I think this has kept me healthy and my ankles never have swollen-even after heart surgery. The Dr. couldn’t figure out why I had no swelling. I told him I use a Rebounder. He was amazed. I don’t get my minerals from veggies either because six years after chemo and radiation for cervical cancer veggies still give me diarrhea. I can sneak in avocados though and take supplements.

I keep reading about all these studies that show calcium and vitamin D supplementation to be ineffective, or worse, but I have never read about a study that looked at calcium, vitamin D plus vitamin K and other minerals such as magnesium, strontium, silicon, boron, etc. Could it be that calcium supplementation needs to include these other vitamins and minerals to be effective?

Calcium supplements, that’s another minefield to negotiate. You’re on track to get calcium naturally from organic foods, you may be interested to see how magnesium can help you with calcium (and other things). Happy, Healthy, New Year!

I have taken calcium-magnesium-zinc supplements since I was in my mid30’s. I did not know to add vitamin D3 until I was in my early 70’s. I am 84, and have had 2 back surgeries and am living with Rheumatoid Arthritis. Both my back surgeon and now my RA doctor have commented on the density and strength of my bones every time I have a bone density exam. Because of the medication I take for my RA, my RA doctor has me take a bone density exam every 15-18 months. She is satisfied. I took a mix of calcium-magnesium-zinc supplement for years after I had my children. Could the combination make a difference?

So, if Calcium& Vitamin D are ineffective for bone strengthening, what should someone over 70 take to minimize bone fragility?

I came to the conclusion some time ago, with the help of People’s Pharmacy, that calcium alone probably does more harm than good. Can the same be said of Vitamin D — were the studies done on Vitamin D separately or in conjunction with calcium?

Thank you so much for the update. It is disheartening, especially since doctors keep pushing bone density tests along with medications with some potentially awful side effects. I quit taking calcium and I guess the vitamin D my husband just bought is going by the wayside, as well.

Years ago I read a book called “The Myth of Osteoporosis,” which really made me rethink a lot of things. However, I do want to listen to Dr. Willett now for another point of view.

So far, the only consistent advice I’ve read is weight bearing exercise, which is something I try to do on a regular basis. I’m on the thin side so doctors are always pushing bone density testing, but I know they also want me to take medication, which I’m not doing.

I also have read that a supplement of the many forms of vitK is essential for vitamin d3 & calcium to do your bones any good.

None of these studies include supplementation with proper calcium/magnesium ratio or vitamin K for effective metabolism of calcium. My understanding is that both are essential for effective metabolism and bone health and that calcium (even with D) supplementation without vitamin K is (as recent research shows) close to useless and may even be harmful. (See research cited by David Williams)

My orthopedist said to take Vitamin K.

Make sure it is Vitamin K2, MK7. Vitamin K1 does not have the same benefits.

Make sure that’s K2 (as opposed to K1- they are completely different in action and come from different sources nutritionally). K2 along with D3 and A will help build strong bones and keep calcium in bones and out of soft tissues. See Vitamin K2 And The Calcium Paradox: How a Little-Known Vitamin Could Save Your Life by Kate Rheaume-Bleue (Author) for more info.

For some reason this didn’t work – “Here is a link to the radio show. If you look below Dr. Willett’s bio, there is a link to Download the mp3. When you do that you will see Show 752: Bone Vitality. Above the orange box that says ADD TO CART, is an option to Choose CD or MP3 version. If you click on the down arrow you can toggle the MP3 option which is FREE! We think you will find this interview quite fascinating and way ahead of its time.”

Please advise.
Thanks

Dr. Carolyn Dean has been warning about calcium and Vit D supplements for years. She teaches that most of us are deficient in magnesium (Mg) which is needed for over 700 processes in our bodies. When calcium is supplemented, we lose even more Mg. It is almost impossible to get enough Mg from oral supplements (think milk of magnesia!). Her products are picometer sized molecules that the cells can take up directly and have no laxative effect. Also, topical Mg products are available, and even epsom salt baths will help raise Mg levels. Mg helps keep the heart healthy.

Would love to see you do a program interviewing Zach Bush M.D. Triple board certified. Discoverer of an amazing health product for the gut called Restore. I’ve been taking it for 5 months with great results. Would love your public to know about it and Dr Bush’s mission. Lots of you tube videos to learn more. I’m just a user and get no monetary gain here . Just like to pass on the news!

I read that vitamin K2 along with vitamin D can help put the calcium back into the bones where it belongs and help stop arterial stenosis. Do you know anything about this?

In 2015 I had a atrial valve replacement. It was failing partly because of a birth defect of a bi- instead of a tri- valve but the biggest problem was the calcium buildup at the valve because of the large amounts of calcium supplements that I took over the years. I stopped the supplements and now get calcium and D through food. I also do resistance exercises and walk. My bone density tests have remained steady at upper levels of osteopenia. I am 75 years old.

Does not surprise me. For too many years my Doctors pushed Calcium; never any increase of bone density. Continued to loose bone density until I started taking Strontium Citrate in 2011, every 2 years my DEXA now shows a gain in bone density. Total 60 %.

Before starting the Strontium I had two compression fractures, NO fractures since and I live a active lifestyle at age 75.

Happy Bone Year 2018

I think the new results about Vitamin D and extra calcium not helping are generalizing and not based on specifics. Oyster shell calcium is useless. Calcium citrate is the best absorbed. What were the people taking that the researchers thought didn’t show positive results?

I have had radiation treatments for cancer twice – double of what my body is supposed to withstand. I am told to stay out of sunlight as much as possible. When my Vitamin D was checked a year or so ago, it was low. I take supplemental Vitamin D, and the range in blood tests is now normal. Calcium by itself won’t work. But taken with synergistic chromium picolinate, magnesium, and Vitamin D – yes it works. I am 83 and my bone scans every 5 years have always shown the calcium density to be that of a young woman.

The real proof of the pudding was in 2013, when I had a second aortic valve replacement, the external pacemaker fired at the same time my heart did. It stopped my heart. I underwent 6 minutes of CPR until they could open me up again and stop the hemmoraging of the new by-passes. The nurse who saved my life was amazed that none of my ribs was broken.

I’ haven’t taken calcium supplements for years — mainly because of data on heart and vascular health.

Some years ago, a meta study came out on calcium with these fair conclusions: (1) dietary calcium consumption tends to run about 600 units per day, and (2) the stronger a supplement one takes above 600 units, there is a straight line relationship with calcium deposits inside arteries, called “clogged arteries,” and the strength of the calcium supplement.

Seemed sensible because calcium particle deposits are the substance which accounts for “hardening of the arteries.”

I stopped the calcium supplements because I do consume quite a bit of dairy and a LOT of green vegetables with a high calcium content — which likely puts me over the normal 600 unit a day dietary consumption. I figured enough is enough. Just IMHO.

Vitamins D2 and D3 three are NOT the same as natural Vitamin D. They are synthetic imposters, aren’t they? Any MVIs or supplements with Vit D2 or D3 need to be avoided. If the manufacturer is willing to feed you this, you can also expect other synthetic franken monsters from them like folic acid-we need folate.

There is no mention of the calcium + Vitamin D3 + Vitamin K2 + magnesium combination and its effectiveness for bone health as well as its safety and benefits for cardiovascular health, i.e. it prevents calcium from being deposited in vascular system versus as part of bone health. Most people who are up to date on such supplementation take that combination, not just calcium and Vitamin D3.

Goodmorning! As a Viet Nam veteran, my VA physician suggested that I take Vitamin D, as he said that I was deficient. I also take a range of vitamins, calcium, fish oil and herbs and spices,[as my own personal preference], to hopefully live healthier. I do give MUCH credit to this site for questioning the “establishment”, aka JAMA, of their supposedly “wisdom” because of medical evidence. They may be educated with “book” knowledge but “at times” they don’t the brains God gave a rubber duck. You get tired of them acting like they walk on water! [ Just look at the FOOD PYRAMID they shoved down our throats all these years only to be trashed!] Keep up the good work! Thankyou for your time!

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