Wednesday, 28 Jun 2017

You are here

Calcium Supplements and Cardiovascular Risk

Several population based studies, including a recent report in Seminars in Arthritis & Rheumatism (http://buff.ly/2pUxT9M), have concluded that supplemental calcium, while being beneficial to bone health, may increase cardiovascular (CV) risks.  I've posed this issue and others to our leading expert on bone health, Dr. Nancy Lane who is the Director of the Center for Musculoskeletal Health in the University of California Davis system. 

Dear Dr. Lane,

I have a few questions on the issue of supplemental calcium:

1. The medical literature says that routine calcium use is bad for the heart - what's the risk of heart problems vs. the detriment to the bones?

  • Dr. Lane: There are a number of post-hoc analyses that have been done from placebo groups of randomized controlled trials, that do show vascular calcium deposits. However, these are not RCTs, and the studies chosen, have subjects that have co-morbidities that would increase the risk of vascular calcium, such as osteoporosis that is associated with CVD.  These studies serve a useful purpose, to educate the general public, that vitamins and minerals are good for all of us, and only at recommended doses - not superphysiologic levels.  Usually, calcium and vitamin D intakes at recommended levels are not associated with complications or vascular calcium, provided they have generally good health.

2. Who should be most worried here?

  • Dr. Lane: These reports should remind both physicians and patients that too much calcium and vitamin D may not be good, and that we should just educate patients that recommended daily allowance is adequate for maintaining good health.

3. Most patients underdose their calcium, thus who should be taking what? how much?  and should it be Calcium with Vit D or with supplemental vitamin D tabs?

  • Dr. Lane: All adults need calcium and vitamin D for bone health. The best way to get calcium and vitamin D is in foods like kale, broccholi and spinach and vitamin D enriched foods. However most Americans only get about 500mg of calcium a day so most individuals can benefit from a little bit of supplementation, just not too much.
  • All need to be on 1000 mg per day, except that women need 1200 mg daily of calcium starting at age 51 yrs (or when breast feeding) and men do not need 1200 mg/day until over the age of 71 years.
  • For vitamin D supplements the IOM Estimated Average Intake (EAR) of 400 IU (10 μg) and Recommended Dietary Allowance (RDA) of 600 IU (15 μg) for most individuals assumes little or no sunlight exposure due to the relatively little skin exposure in certain geographical regions, especially in winter.   

4. Other suggestions?

  • Dr. Lane: All physicians that take care of elderly patients should review both OTC and prescribed medications to be sure the calcium and vitamin D supplementation is adequate, recommended intakes and not too much.

 

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Bone Turnover Markers in Practice: A Guide for the Rheumatologist

Bone turnover markers (BTMs) have been eyed for decades as potential monitoring tools in osteoporosis.

However, there have been difficulties with poor between-lab reproductivity, insufficiently controlled heterogeneity, and pre-analytical variability of the assays; making BTMs vastly unpopular amongst practicing rheumatologists.

2017 ACR Guideline on Glucocorticoid-Induced Osteoporosis

The American College of Rheumatology has updated its 2010 guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. The guideline provides recommendations on assessing fracture risk and treatment for adults and special patient populations, including women of childbearing potential, adults treated with very high-dose glucocorticoids, adults with organ transplants, and children ages 4-17.

Higher Fracture Risks with Prolonged Bisphosphonate Use in Older Women

The Journal of the American Geriatric Society has reported that older women receiving bisphosphonate therapy for greater than 10-13 years were more likely to suffer from fractures.

Chondroitin Effective in Knee OA. Or is it?

Reginster and colleagues have reported on the results of the CONCEPT trial showing that osteoarthritis (OA) patients treated 800 mg/day of  pharmaceutical-grade chondroitin sulfate (CS) have less VAS pain scores and improved function over 6 months therapy. These results were superior to placebo and equivalent to celecoxib in reducing in symptomatic OA knee pain.

High Fiber Intake May Decrease Osteoarthritis Knee Pain

 

Dai, Felson and colleagues report in Annals of Rheumatic Disease that high dietary fiber lowers the risk of symptomatic osteoathritis (SxOA), but the radiographic benefits remain unclear. (Citation source http://buff.ly/2rHv9yd)