Calcium Supplements Probably Won't Affect Fracture Risk in Most Older Adults

Summary and Comment |
October 22, 2015

Calcium Supplements Probably Won't Affect Fracture Risk in Most Older Adults

  1. Paul S. Mueller, MD, MPH, FACP

Nor will higher dietary calcium intake.

  1. Paul S. Mueller, MD, MPH, FACP

Experts recommend that elders ingest at least 1000 to 1200 mg of calcium daily to prevent fractures, and many elders take calcium supplements to meet this recommendation. In this systematic review, investigators examined evidence from randomized, controlled trials and observational studies to determine the effects of dietary calcium and calcium supplements on fracture risk in older adults (age, >50).

Researchers analyzed 58 cohort studies of dietary calcium, milk, or dairy intake and fracture risk in >700,000 participants. Most of the studies (74%) reported no association between dietary calcium intake and risk for total fracture (14 of 22 studies), hip fracture (17 of 21 studies), vertebral fracture (7 of 8 studies), or forearm fracture (5 of 7 studies); positive associations in the remaining studies were weak. Similarly, neither milk intake nor dairy intake was associated with fracture risk. In analyses of data from 26 randomized trials (69,000 participants; mostly women) in which the effects of calcium supplements (≥1000 mg daily in most studies) on fracture risk were assessed, calcium supplements lowered risks for total fracture (relative risk, 0.89) and vertebral fracture (RR, 0.86) but not hip or forearm fracture. However, evidence of publication bias was found in some trials.

Comment

This systematic review indicates that dietary calcium, milk, and dairy intakes are not associated with fracture risk and that calcium supplements have minimal effects, at best, on fracture risk. As the authors contend, widespread untargeted use of calcium supplements in older adults is unlikely to result in lower incidence of fractures, and a companion meta-analysis shows little effect on bone density (NEJM JW Gen Med Nov 15 2015 and BMJ 2015; 351:4183). Notably, calcium supplements have been associated with harms, including adverse cardiovascular events (NEJM JW Gen Med Jun 1 2011 and BMJ 2011; 342:d2040) and gastrointestinal symptoms.

Editor Disclosures at Time of Publication

  • Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific (Patient Safety Advisory Board) Editorial boards Medical Knowledge Self-Assessment Program (MKSAP 17 General Internal Medicine Committee); MKSAP 17 General Internal Medicine (author/contributor) Leadership positions in professional societies American Osler Society (Vice President)

Citation(s):

Reader Comments (1)

Jerry Amos BSEE BSME Other, Geriatrics, Hollis, NH, USA

Journal of Gerontology 55 (2000) M585-M592 Frasetto et. al. "A high ratio of vegetable to animal protein consumption was found to be impressively associated with a virtual disappearance of bone fractures (in elderly women)". A more convenient summary and chart is on pages 206-208 of "The China Study" (2006) by Cornell nutritional biochemist prof. T. Colin Campbell. This is a very effective way to really reduce osteoporosis risk. I'm 80, ski, fall hard, no breaks. My wife's recemt pelvis and lateral hip xray shows satisfactory bony mineralization. She doesn't usually fall.

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