Calcium…..Friend or Foe?
For most women, the threat of osteoporosis begins to loom heavily once we pass the big “five-O”, and for as long as I can remember, the Recommended Daily Intake has been 1200mg of calcium daily for post-menopausal women as insurance against this threat. But recent studies show that calcium does not reduce incidence of hip fractures, and has only minimal impact on increasing bone density. Some conclude that calcium may compromise cardiac and kidney health. Some doctors are now saying get all your calcium only from food sources. Some are still recommending supplementing 1200 mg daily. Who’s right, who’s wrong and is calcium our friend or foe?
I decided to write about this topic after reading an article in NEJM Journal watch written by Joe Elia , who summarizes two studies published in the BMJ last month. Mr. Elia writes: “Increased calcium intake, whether from dietary sources or supplements, is unlikely to have a substantive clinical effect on bone mineral density (BMD) or fracture risk, two analyses in The BMJ find.” And he continues: “An editorialist finds “puzzling” the recommendations from various organizations for almost universal calcium supplementation in older adults and states it is surely time to reconsider such an approach.” I agree. It’s time for a fresh look at how to deal with osteoporosis, how to maximize bone health and how calcium fits into the mix.
Research has shown and integrative practitioners accept that magnesium, vitamin D, potassium, vitamin K, boron, strontium, silica…a whole host of minerals and cofactors, are necessary in maintaining proper bone health. Most of the research on bone health has studied calcium as a single variable, but we now know there is an intricate interplay of nutrients in the maintenance of healthy bone density. It’s likely that the reason why one of the studies showed a benefit (however minimal) of calcium supplementation in increasing bone mineral density, is probably because there was quite a range in the diets and eating habits of the subjects, with some diets being very adequate in supplying the range of other nutritional components for utilizing calcium and maintaining good bone health, and many diets perhaps being very inadequate.
A few years ago, health professionals were beginning to question the recommendations on calcium supplementation, when a study supported by the Health Research Council of New Zealand and published in the British Medical Journal in 2008 showed a positive correlation between calcium supplementation and increased risk of MI in older women. That study dosed calcium citrate at 400 mg am. and 600 mg. pm. If there is something to learn from this, it may be that using a highly absorbable form of calcium in high doses, (which is known to raise serum calcium levels significantly) may not be the best approach for supplementation. However, this is what many patients are still doing, as advised by their physicians.
Studies show the average intake of calcium in our population is about 700mg day from our diet, and that means the average person only needs an additional 500 mg daily to meet the recommended intake of 1200mg of calcium daily. The addition of 250 mg of calcium TID with meals may be adequate for most, being that we are generally a dairy friendly population. Taking bone health seriously, means taking the time to annually reassess the diets and supplementation patterns of patients over the age of 45, to ensure ALL the necessary nutrients for bone health are present in adequate amounts. Fortunately, there are some very comprehensive bone health formulas to choose from now, which makes it a lot easier for both you and your patients. Lower, more frequent doses of calcium combined with Vitamin D, Vitamin K, magnesium, potassium, boron, strontium, and now the availability of bone morphogenetic protein supplements, may prove to be the best defense against bone loss. Osteoporosis risk increases with advancing age as typically food intake volume also decreases, and therefore supplementation becomes more valuable and useful. Today, with so many people allergic to dairy products, avoiding dairy, avoiding calcium fortified beverages because of the sugar, adopting vegan diets or having to reduce caloric intake, calcium supplements can provide the calcium people need, but it’s our job to educate and ensure our patients understand that the presence of optimal amounts of Vitamin D, Vitamin K, magnesium, potassium and essential trace minerals are just as necessary, if not more so, than calcium itself.
Joe Elia, NEJM Journal Watch, Physicians First Watch, www.jwatch.org .Web Issue Published Sept.30, 2015. Accessed October 20, 2015
 Mark J Bolland, Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ 2008; 336:262
By Lisa Murray, RDN, LD