The Calcium Supplementation Controversy: Know the Pros and Cons

Since the United States Preventive Services Task Force (USPSTF) recommended that postmenopausal women refrain from taking supplemental calcium and vitamin D, in 2013, many patients and healthcare professionals have been confused. The USPSTF based their recommendation on review of existing evidence, little of which shows that supplements prevent fractures in healthy women. They stress that this recommendation does not apply to women who have actual osteoporosis or vitamin D deficiency.

A new review published in theEuropean Journal of Endocrinologypresents the pros and cons of calcium and vitamin D supplementation succinctly. The crux of the matter is the pervasive prevalence of osteoporosis, especially among women, but also among older men. Osteoporosis creates a tremendous global economic burden, and also increases fracture risk. Once an individual who has osteoporosis incurs a fracture, risk of morbidity, and mortality escalates.

In support of calcium, and vitamin D supplementation in osteoporosis, 1 author builds the case based on the fact that these 2 substances are critical for bone building. He notes that calcium is also a crucial element in muscle health, and contributes to better bone-muscle interaction.

This author often highlights an important fact: only 1/3 of women in the United States obtain the recommended amount of calcium from diet alone. He also cites the Women's Health Initiative study (on which the USPSTF recommendations were based), indicating that in that study, women in the group that took supplements had higher bone densities at the hip. He indicates in specific populations, especially those who fail to consume enough calcium, or vitamin D, supplementation is prudent. He compares this controversy to that of a controversy surrounding statins. He notes that statins have been proven to reduce risk of myocardial infarction, but the evidence is not robust enough to justify population-based intervention.

A second author discusses the opposite side of the debate. The basis of his argument is that calcium, and vitamin D supplementation is not risk-free, and that only a small proportion of the population will benefit in terms of fracture avoidance. He opines that patients who have osteoporosis need treatment with drugs that will actually correct the problem.

Thus the controversy continues, but review of this article, and the strong points that each author makes in favor of, and against supplementation will help health care providers understand the important issues. Clinically, it makes the best sense to explain the pros and cons to patients, stress dietary intake as the best possible source of vitamins and minerals, and work with pharmacists and other care providers to determine if supplementation is important for individual patients.

Reference

Chiodini I, Bolland MJ. Calcium supplementation in osteoporosis: useful or harmful?Eur J Endocrinol. 2018;178(4):D13-D25.