- July 18, 2020
- Written by: Dr. Atul Wankhede
The views expressed here are my personal and derived from my experience so far with patients and relatives. Its based on a study by one Laird Harrison who thinks the Calcium Guidelines are Challenged by Meta-Analyses
The bulk of the evidence does not support guidelines that recommend a minimum calcium intake, or so to begin. Most people don't need to worry about their calcium at all, that's what I've started to believe.
Randomized controlled trials show calcium supplementation provides only a modest reduction in the risk for fractures, and the benefit may be outweighed by adverse reactions. Yet fractures are the primary reason cited for minimum calcium intake.
In the two meta-analyses, both published in the September 29 2015 issue of BMJ, Dr Bolland and colleagues found that neither calcium supplements nor dietary calcium significantly reduced the risk of fractures or improved bone mineral density. The findings could have broad implications because more than 30% of older women take calcium supplements in our country.
The high rates of supplementation probably result from guidelines promulgated by multiple government agencies and professional associations. For example, our books currently recommends 1200 mg per day calcium intake for women aged 51 years and older. These are by and large based on recommendations internationally as well. We're mostly trained to dole out these from the times of our training, with or without much questioning.
Some of these oral calcium supplements have shown serious adverse events, including cardiovascular events, kidney stones, and hospital admissions for acute gastrointestinal symptoms, as well as milder ones such as constipation. Some people now believe that the increased risk for cardiovascular events was "similar to or exceeded the benefits of calcium on fracture prevention."
This has led me to recommend increasing calcium consumption through dietary sources instead of supplements. Study shows intake from dietary sources increased bone density by 0.6% to 1.0%, and supplementation increased the density by 0.7% to 1.8%. But I think these increases are unlikely to prevent fracture.
In short my question persists. I'm not the only one questioning, and certainly not the only one who's not prescribing. It might be too early for me to say anything against supplements, but only time will tell. Prematurely advising women to stop taking calcium could backfire if later evidence establishes a benefit, because many women would be unwilling to start taking calcium again. But look at it this way, when there were no supplements, people would still live on, and as healthy as ever. They relied on diet, we can too!
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