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The Truth about Calcium That May Leave Supplement Companies in Pandemonium

November 9th, 2015

By: Caleb Tang

Calcium is an essential mineral and contributor to bone health that helps keep bones strong. In fact, 99% of the body’s calcium is found in bon
e.1 The human body is continually removing calcium from bone so that it can be used to aid in blood clots, muscle movement, and nerve messaging. Dietary calcium actually replenishes these losses and prevents bones from becoming weak. So why wouldn’t increasing the amount of calcium intake positively affect bone health? Imagine that your car is low on gas. Wouldn’t it obviously make sense to go to the nearest gas station and fill up your tank? In the case of bone health, the answer is not that cut and dry. Yes, calcium is an important factor, but increasing intake alone will not directly improve bone health.7

800px-500_mg_calcium_supplements_with_vitamin_DJust three weeks ago, the New York Times published an article titled, “Calcium Doesn’t Improve Bone Density, Analysis Finds”. This surprising claim was made by Nicholas Bakalar of the New York Times. He based his claim on two articles published by the British Medical Journal (BMJ) just this summer. The results from articles review made a bold claim that completely defies common household knowledge.  Aside from the fact that the two BMJ articles came to the same conclusion, the two were eerily related. Both were published on the same day (September 29, 2015) and both were associated with the University of Auckland and the University of Otago in New Zealand.

It seems illogical that increasing consumption of a crucial mineral for bone strength would not actually improve bone strength. The apparent paradox lies within biology and culture.9 It is important to realize that one simple dietary change will not affect bone strength. Consuming more calcium means nothing if the body doesn’t absorb it.1,6 Vitamin D increases calcium absorption from the small intestine, into the bloodstream, and finally to the bones. Other factors that positively affect bone health are as follows: weight-bearing exercise, tobacco avoidance, moderate alcohol intake.1

The effectiveness of calcium supplementation on bone mineral density varies according to two factors:  dietary calcium intake and stage of life.8,9 Compared to Western cultures, Asian cultures do not commonly incorporate high-calcium level foods (such as milk, cheese and other dairy products) into the everyday diet.10-12 A study in elderly Thai women found that calcium supplementation of at least 500mg/day for 2 years resulted in noticeable changes in BMD (bone marrow density) at several skeletal study points. The study’s conclusion was this: “Calcium supplementation might be crucial in people who have low calcium intake at baseline”.9 In cases like these, supplementation may be needed, but the first choice is to consume calcium from foods.8

Another important factor that plays a role in the effectiveness of calcium supplementation is the stage in life of the patient, especially if that patient is a woman. Elderly postmenopausal women experience loss of “beneficial effects of estrogen on the stimulation of intestinal calcium absorption and reduction of renal calcium excretion as well as an increase in bone turnover rate.”9 In this case, vitamin D calcium supplementation would actually help to prevent early postmenopausal bone loss.6,9

The human body surely requires at least some calcium, but currently, there is no reliable method to determine an optimal amount of daily calcium intake based on criteria such as age, gender, height, and weight.4 Even in a study where the mean calcium intake was well above the daily recommended amount (1,200mg/day), hip fractures were still evident.4 This seemingly counterintuitive finding begs that further studies explain why meeting or even exceeding a healthy limit will produce a high incidence of hip fractures.

In light of these recent scientific findings, one shouldn’t rely on calcium supplements to prevent BMD complications. Furthermore, patients who currently have osteoporosis or a high risk of fracture should never replace prescription medication with calcium supplementation. Until further evidence surfaces, people of all ages hoping to prevent later development of osteoporosis should continue to strive for a balanced diet containing adequate protein, fruits, vegetables, calcium, and vitamin D.8 Would you still consider taking a calcium supplement for the insignificant increase in bone strength it provides?

References:

  1. National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. Washington, DC: National Osteoporosis Foundation, 2010;1–56.
  2. Bolland MJ, Leung W, Tai V, et al. Calcium intake and risk of fracture: Systematic review.BMJ. 2015;351. doi: 10.1136/bmj.h4580.
  3. Tai V, Leung W, Grey A, Reid IR, Bolland MJ. Calcium intake and bone mineral density: Systematic review and meta-analysis.BMJ. 2015;351. doi: 10.1136/bmj.h4183.
  4. Cho K, Cederholm T, Lökk J. Calcium intake in elderly patients with hip fractures.Food & Nutrition Research. 2008;52:1-5.
  5. Cosman F, de Beur ,S.J., LeBoff MS, et al. Clinician’s guide to prevention and treatment of osteoporosis.Osteoporos Int. 2014;25(10):2359-2381.
  6. Kärkkäinen M, Tuppurainen M, Salovaara K, et al. Effect of calcium and vitamin D supplementation on bone mineral density in women aged 65-71 years: A 3-year randomized population-based trial (OSTPRE-FPS).Osteoporos Int. 2010;21(12):2047-2055.
  7. Kling, Juliana M.Clarke, Bart L.Sandhu,Nicole P. Osteoporosis prevention, screening, and treatment: A review.Journal of Women’s Health (15409996). 2014;23(7):563-572.
  8. Nieves JW. Skeletal effects of nutrients and nutraceuticals, beyond calcium and vitamin D.Osteoporos Int. 2013;24(3):771-786.
  9. Rajatanavin R, Chailurkit L, Saetung S, Thakkinstian A, Nimitphong H. The efficacy of calcium supplementation alone in elderly thai women over a 2-year period: A randomized controlled trial.Osteoporosis Int. 2013;24(11):2871.
  10. Kim HS, Kim JS, Kim NS, Kim JH, Lee BK (2007) Association of vitamin D receptor polymorphism with calcaneal broadband ultrasound attenuation in Korean postmenopausal women with low calcium intake. Br J Nutr 98:878–881
  11. Lau EM, Woo J, Lam V, Hong A (2001) Milk supplementation of the diet of postmenopausal Chinese women on a low calcium intake retards bone loss. J Bone Miner Res 16:1704–1709
  12. 12. Chee WS, Suriah AR, Zaitun Y, Chan SP, Yap SL, Chan YM (2002) Dietary calcium intake in postmenopausal Malaysian women: comparison between the food frequency questionnaire and three-day food records. Asia Pac J Clin Nutr 11:142–146

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14 Responses to “The Truth about Calcium That May Leave Supplement Companies in Pandemonium”

  1. Jessica Ward Says:

    Two questions:

    1. Can we decrease the negative effects of menopause by prophylactically supplementing women with both calcium and vitamin D before they reach menopause?

    2. Did the study investigating calcium hyper-supplementation find that the hip fractures were more common than in those patients not being supplemented? (“meeting or even exceeding a healthy limit will produce a high incidence of hip fractures”)

    Interesting article, Caleb! Thanks for sharing this 🙂

  2. Aaron J Oliver Says:

    This would be a good reminder for patients who want to take only calcium supplements to decrease their risk of getting osteoporosis. It is all in having a balanced diet instead of “cheating” to get calcium intake only through supplements.

  3. Nicholas Rudy Says:

    I wonder what role parathyroid hormone, which stimulates calcium resorption, plays in this? Perhaps instead of stimulating factors that cause bone formation to cure osteoporosis, research could focus on preventing parathyroid hormone from having its effect on bone?

  4. Myriam Shaw Ojeda Says:

    I recently read that overdose of Calcium can cause kidney stones. I wonder if Calcium supplementation has been over-hyped to the public without informing them about possible adverse events or ineffective prescribing?

  5. David J Fisher Says:

    Great article! What an excellent reminder that a balanced diet is a better treatment than supplements. In today’s society, where the quick and easy fix is always recommended, it makes me glad to research being done in these areas that go against popular beliefs.

  6. Dominic Yeboah Says:

    There is a talk out there that says supplements in general really does help the body more than we think, am not sure but that it seems there are more benefits taking in calcium supplement at the appropriate quantities. Through this piece I have realized that the age and time of taking supplement can determine how effective a dietary supplement can be.

  7. Jasmine Gunti Says:

    Has a study been done comparing the effect on osteoporosis of calcium obtained from the diet versus from supplementation? I think this would offer greater insight on whether calcium supplementation is beneficial, although it definitely makes more sense that calcium combined with vitamin D would offer greatest benefit.

  8. Caleb Thompson Says:

    Would patients benefit from taking both Vitamin D and calcium supplements? It would appear that increased Vitamin D would help the increased calcium from the supplement absorb and strengthen the bone. Did you find any articles that studied the two together?

  9. Dr.Hartzler Says:

    Yes! There is likely more to the story..if the patient doesn’t have adequate vitamin D and Vitamin K. The calcium isn’t getting to where it needs to be!

  10. Morgan Says:

    I thought that this article was amazing! I think this is a very interesting topic and that it needs to be shared with many people that are struggling with bone density problems. I feel like there are many people out there that think that since they are taking these supplements, then they are protected when in fact they may not be. I can only imagine how many people taking calcium supplement are not even actually absorbing the calcium and not helping them at all. This is just one example that shows that there is not just one easy way to make your body healthier, it involves multiple aspects to have positive effects.

  11. Brandon Spears Says:

    This was an extremely interesting article to me in light of the fact that I just read someone else’s article about caffeine’s effect on bone health. My question here would be, if caffeine is considered to have a negative effect on bone health and vitamin D is needed in order to absorb calcium does caffeine have any type of effect on vitamin D that makes it unable to facilitate the absorption of calcium? I do not know if you came across anything about this in your research but I thought it would be an interesting topic to study.

  12. Travis Mentch Says:

    I have always consumed a large amount of dairy products, meaning my diet is high in calcium. I also have been fortunate enough not to break a bone. I will be interested to see the condition of my bones in the future. For those people who are lactose intolerant, are there other foods that are a source of calcium? I am beginning to realize the importance of Vitamin D in normal body functions. As you mentioned in the article, I think other aspects of bone health are important too. While calcium may help physiologically, weight-bearing exercise may help structurally to build overall muscle and bone strength.

  13. Sam Franklin Says:

    Inspiring! Do you know if the studies controlled for how much API was in the pills they took? I know the FDA’s rules are so lax that natural products companies can get away with putting inaccurate doses of APIs in their products.

  14. Ankit Pandav Says:

    Great article Caleb!
    I do agree that proper diet and exercise can strengthen bone health. However, I wonder how much does a race or geographical area play a role? For example, people who are more exposed to sun light versus people who are not?

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