Increasing calcium intake or supplemental unlikely to boost bone health or prevent fractures, say experts
Increased calcium intake, either from dietary source or calcium supplements is not likely to improve bone health and is not associated with a decrease in risk of fractures in older people.
This has been suggested by a study published in British Medical Journal.
In conventional practice older men and women were recommended to ingest about 1000-1200 mg of calcium daily. This has been suggested with a notion that increased calcium ingestion is protective for bone health and decreases the risk of fractures.
It further must be mentioned that most of the diets, including Western diets, do not meet this recommendation, thus necessitating the normal diet with calcium supplements.
Up to 50% of the population has been reported to take a calcium supplement with a notion that it is good for bone health and would prevent the deficiency fractures.
As people used them, adverse effects of calcium supplements were encountered which included cardiovascular events, renal stones, and acute gastrointestinal symptoms.
The advice then shifted to get the calcium from the diet. Older people have been encouraged to increase the calcium intake through food rather than by supplementations.
The basic assumption was that the dietary calcium intake to the level of >1200 mg/day prevents fractures without causing the adverse effects of calcium supplements.
The Present Study
The researchers undertook a systematic review of studies of dietary sources of calcium or calcium supplements in older adults, age greater than 50 years with fracture as an endpoint. They looked for
- The evidence supporting the recommendation to increase dietary calcium intake to prevent fractures
- Compared the anti-fracture efficacy of increasing calcium intake through dietary sources with the anti-fracture efficacy of calcium supplements.
The study included randomized controlled trials mainly and observational studies on some occasions.
Study design and quality were taken into account to decrease bias.
They found that increasing calcium intake from dietary sources or by taking supplements produces small increases (1-2%) in bone mineral density. This minimal increase is unlikely to lead to a clinically meaningful reduction in risk of fracture. There was no benefit from calcium supplements for hip fractures, which have the greatest clinical consequences.
They found that dietary calcium intake is not associated with risk of fracture, and there is no clinical trial evidence that increasing calcium intake from dietary sources prevents fractures.
Time to Revisit Recommendations?
The researchers concluded that the dietary calcium intake is not associated with risk of fracture, and there is no evidence currently that increasing dietary calcium intake prevents fractures.
As noted, calcium supplements offer small inconsistent benefits on fracture reduction but in this case the risk: benefit profile is not favorable.
These results suggest that clinicians, advocacy organizations, and health policymakers should not recommend increasing calcium intake for fracture prevention, either with calcium supplements or through dietary sources.
It is definitely the time to revisit recommendations
- Mark J Bolland, William Leung, Vicky Tai, Sonja Bastin, Greg D Gamble, Andrew Grey, Ian R Reid. Calcium intake and risk of fracture: systematic review. BMJ, 2015; h4580 DOI: 10.1136/bmj.h4580
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