Health: The calcium myth
MOHLER’S MEDICATION MAXIMS
Over the last four decades, I have counseled hundreds of women and a few men to take calcium tablets. I was certain that I was contributing to the bone health of my patients and preventing osteoporosis and fractures. I was WRONG!
The role of calcium in health and it’s often present companion vitamin D, is unclear. Although Americans have the highest per capita calcium intake in the world, we also have one of the highest rates of osteoporosis. There are some parts of the calcium/osteoporosis puzzle that do not fit together well.
What we do know:
The Cochrane reviewers (among the most reliable and unbiased scientists) have shown that trials of calcium supplements in children had minimal effect on bone density.
Cochrane: Studies of older adults, living independently in communities, showed that 1000 persons with no previous fracture have to take calcium supplements with vitamin D for one year to prevent one hip fracture.
The United States Preventive Services Task Force (USPSTF) concludes that there is inadequate evidence to recommend for or against calcium/vitamin D supplementation in community dwelling older adults who have never had a fracture. They do recommend calcium/vitamin D for those who live in nursing homes.
But isn’t calcium cheap and safe?
There is a benefit for a tiny portion (1/10th of 1 percent) of consumers of calcium tablets. This small benefit of calcium supplementation is outweighed by the increased risks of kidney stones and heart attacks. Calcium tablets have an established causal relationship with kidney stones. A study in the British Medical Journal in 2011 demonstrated that taking extra calcium was almost twice as likely to induce a heart attack as it was to prevent any fracture.
Calcium is an essential requirement of our diet. Dairy products containing calcium do not appear to pose risks for kidney stones or heart attacks.
Avoid calcium supplements (pills) if you have no history of a fracture.
The USPSTF has concluded that vitamin D supplementation (dose of 800 IU per day) is effective in preventing falls in community-dwelling adults aged 65 years or older who are at increased risk for falls.
Do not do bone density screening if you are a woman under 65 years of age and have had no previous fracture. The data are insufficient to advise men without fractures regarding bone density testing.
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