Jason Park

Calcium as an ineffective and unsafe treatment option for osteoporosis

Tiffany Lee Craig

Introduction: Osteoporosis is a chronic, progressive disease in which bones become less dense, weak and are susceptible to fracture. An estimated 10 million Americans
over the age of 50 have been diagnosed with osteoporosis (1). In the year 2000 there was an estimated 1.6 million osteoporotic hip fractures of the 9 million cases of
osteoporosis (1). Hip fractures are associated with a high mortality rate, one out of five hip fracture patients dies within a year of their injury (2). The high prevalence and
risk of mortality is evidence that osteoporosis presents a significant public health issue. Current recommendations for treatment is combined with calcium plus vitamin D
supplementation. However, emerging evidence shows that calcium supplementation alone may not be effective in reducing hip fracture risk and may actually increase risk
for cardiovascular events.
Evidence Against Calcium Supplementation:
Article

Evidence

Critique

Bolland MJ, Avenell A, Baron JA,

et al. (2010) (3)

Meta-analysis showed increased incidence of MI for participants

taking calcium supplement: patient level (HR 1.31; 95% CI 1.021.67, P=0.035), trial level patient level data (HR 1.27; 95% CI 1.011.59, P=0.038)

Excluded studies w/ co-admin of Ca w/ Vit. D.

Data for incidence of cardiovascular events was not
standardized among all trials reviewed

Jackson RD, Lacroix AZ, Gass

M, et al. (2006) (4)

Ca with Vitamin D group had non-significant 12% reduction in hip

fractures versus placebo group. No significant reduction in total
fractures between the supplement and placebo group

Bone mineral density improved in calcium supplement

group

Li K, Kaaks R, Linseisen J,
Rohrmann S. (2012) (5)

Ca supplements statistically significant increased MI risk (HR =

1.86; 95% CI 1.17-2.96)

FFQ, unidentified calcium supplements, pre-existing CVD

patients not excluded

Reid IR, Bolland MJ, Grey A.

(2008) (6)

Meta-analysis of 9 studies shows evidence that 5,500 women

using calcium monotherapy for osteoporosis had a RR of hip
fracture 1.5 (95% CI 1.062.12)

Meta-Analysis of the studies showed Vitamin D + Calcium

supplementation had a relative risk of 0.84 (95% CI 0.73
0.97) for hip fractures

Ross EA, Szabo NJ, Tebbett IR.

(2000) (7)

4/14 refined products had lead content up to 3 mcg/d of lead in

osteoporosis calcium dosages

UL for lead is 6mcg/d

Evidence For Calcium Supplementation:

Article

Evidence

Critique

Chapuy (1992) (8)

Co-admin (18 mo. double blind) found reduced hip fractures (43%),
nonvertebral fractures (32%), and increased bone density (2.7%) in
elderly women who supplemented calcium with vitamin D

Study does not represent all women at risk, especially those

living independently.

Prentice RL, Pettinger MB,

Jackson RD, et al. (2013) (9)

WHI showed risk of hip fracture in postmenopausal women

taking Ca w/ Vit. D for 5 years (HR 0.62; 95% CI 0.38-1.00)

Patient population restricted to postmenopausal women

only.

Conclusion: Although few studies have shown that calcium supplementation may increase the risk for cardiovascular events, it raises questions and doubt on the safety
of supplementation. Furthermore, calcium supplementation has not shown to significantly decrease hip fracture risk, raising questions about the efficacy of
supplementation for osteoporosis treatment. Our opinion is also shared by the The U.S. Preventive Services Task Force (USPSTF). In 2013, the USPSTF issued a report
that recommended against daily supplementation of calcium and vitamin D3 for the prevention of fractures in noninstitutionalized postmenopausal women, as there is
insufficient evidence to support this treatment (10).

Jason Park

Calcium as an ineffective and unsafe treatment option for osteoporosis

Tiffany Lee Craig

References:
1. Holroyd C, Cooper C, Dennison E. Epidemiology of osteoporosis. Best Pract Res Clin Endocrinol Metab. 2008;22(5):671-85.
2. Centers for Disease Control. Hip Fractures Among Older Adults. Available at: http://www.cdc.gov/homeandrecreationalsafety/falls/adulthipfx.html. Accessed July 25,
2013
3. Bolland MJ, Avenell A, Baron JA, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010;341(Jul29
1):c3691.
4. Jackson RD, Lacroix AZ, Gass M, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006;354(7):669-83.
5. Li K, Kaaks R, Linseisen J, Rohrmann S. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall
cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg). Heart. 2012;98(12):920-5.
6. Reid IR, Bolland MJ, Grey A. Effect of calcium supplementation on hip fractures. Osteoporos Int. 2008;19(8):1119-23.
7. Ross EA, Szabo NJ, Tebbett IR. Lead content of calcium supplements. JAMA. 2000;284(11):1425-9.
8. Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. 1992;327(23):1637-42.
9. Prentice RL, Pettinger MB, Jackson RD, et al. Health risks and benefits from calcium and vitamin D supplementation: Women's Health Initiative clinical trial and cohort
study. Osteoporos Int. 2013;24(2):567-80.
10. Moyer VA. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med.
2013;158(9):691-6.