New Study: Calcium supplements may not help strengthen older bones

[Brandy]

I wonder what this means for us?

Disproving their thesis is the fact that it seems like those of us who fall off our pills bones suffer mightily in a year or two. And since this is only a review of other studies, I wonder if the vitamin mix and protocol were generally bad, and not calcium supplements themselves. (For example, taking calcium at the same time as iron, using oyster shell calcium pills, ...)

On the other hand, the idea of not having to hork down all these pills or risk any more kidney stones makes me very happy. And I like the fact that they will be looking harder for a non-supplement way to help bones and that is only a good thing for everybody.

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Calcium supplements may not help strengthen older bones

Calcium supplements are recommended to older people as a way of increasing bone density and preventing fracture, but studies show they have little to no effect.

..."Most will not benefit from increasing their intakes and will be exposed instead to a higher risk of adverse events such as constipation, cardiovascular events, kidney stones, or admission for acute gastrointestinal symptoms," Michaëlsson wrote. "The weight of evidence against such mass medication of older people is now compelling, and it is surely time to reconsider these controversial recommendations."


http://www.upi.com/Health_News/2015/09/30/Calcium-supplements-may-not-help-strengthen-older-bones/1291443621027/





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AUCKLAND, New Zealand, Sept. 30 (UPI) -- Calcium supplements have long been recommended to older people as a method of increasing bone density and preventing bone fracture, however two studies have shown they have little to no effect on either.

Guidelines for older men and women suggest an intake of 1000 to 1200 mg of calcium per day, and many take supplements to meet the recommendations.

"Collectively, these results suggest that Clinicians, advocacy organisations and health policymakers should not recommend increasing calcium intake for fracture prevention, either by use of calcium supplements or dietary sources," said Dr. Mark Bolland, an associate professor of medicine at the University of Auckland, in a press release. "For most patients who are concerned about their bone health, they do not need to worry about their calcium intake."

The first study, published in the British Medical Journal, looked at whether dietary or supplemental calcium helped to increase bone density in people over age 50.

Researchers analyzed 59 controlled trials; 15 focused on dietary calcium in 1,533 participants and 51 studied the effect of supplements in 12,257 participants. The studies found that calcium acquired through diet or supplement increased bone density by between 0.6 and 2 percent over the course of two years -- which researchers conclude is unlikely to lead to a significant reduction in risk for bone fractures.

In the second study, also published in the British Medical Journal, researchers looked at 50 reports based on 44 cohort studies on the effects of dietary, milk and dairy intake. They found that most showed no relation between any form of dietary intake of calcium and incidence of fracture.

The same study also included a review of 26 studies with around 50,000 participants taking calcium supplements, finding they also had little effect on the risk for bone fracture.

Professor Karl Michaëlsson of Uppsala University writes in an editorial, also published in the British Medical Journal, that both studies call calcium intake guidelines for older people into question, and that they should be re-evaluated not only for their usefulness, but the potential health risk they may pose.

"Most will not benefit from increasing their intakes and will be exposed instead to a higher risk of adverse events such as constipation, cardiovascular events, kidney stones, or admission for acute gastrointestinal symptoms," Michaëlsson wrote. "The weight of evidence against such mass medication of older people is now compelling, and it is surely time to reconsider these controversial recommendations."

 

[newanatomy]

I would love to know more about this. In any case, I guess I need to continue taking my calcium for at least another 11 months till I turn 50, ha ha.

 

[aaa]

My physicians tell me it's carbonate that can make one more prone to kidney stones. Not citrate.

 

[southernlady]

This is what was posted in Medscape:

Calcium Guidelines Challenged by Meta-Analyses
Laird Harrison

October 01, 2015

The bulk of the evidence does not support guidelines that recommend a minimum calcium intake, including those from the Institute of Medicine, according to the authors of two new systematic reviews and meta-analyses.

"Most people don't need to worry about their calcium at all," Mark Bolland, MBChB, PhD, an associate professor of medicine at the University of Auckland in New Zealand and an author on both papers, told Medscape Medical News.

Randomized controlled trials show calcium supplementation provides only a modest reduction in the risk for fractures, and the benefit may be outweighed by adverse reactions, he said. Yet fractures are the primary reason cited for minimum calcium intake.

In the two meta-analyses, both published in the September 29 issue of BMJ, Dr Bolland and colleagues found that neither calcium supplements nor dietary calcium significantly reduced the risk of fractures or improved bone mineral density.

The findings could have broad implications because more than 30% of older women take calcium supplements in some Western countries, including the United States, Dr Bolland told Medscape Medical News.

The high rates of supplementation probably result from guidelines promulgated by multiple government agencies and professional associations, Dr Bolland said. For example, the Institute of Medicine currently recommends 1200 mg per day calcium intake for women aged 51 years and older.

A spokesperson for the Institute of Medicine said it would not provide a comment for this article.

The recommendations date back to studies in the 1970s that measured calcium intake vs calcium excretion, Dr Bolland said.

Supplement use gained momentum in 1992 with the publication of a large trial showing a 43% reduction in hip fractures among elderly women randomly assigned to take calcium and vitamin D supplements compared with a matched cohort assigned to a placebo ( N Engl J Med. 1992;327:1637-1642).

However, the women in the study were elderly, living in institutions, and had low calcium intake and low serum vitamin D at baseline, Dr Bolland pointed out. "People just assumed therefore, because there was benefit in this quite specific population group, that there would be benefits for larger populations," he said.

In the current reviews, the researchers analyzed results from 26 randomized controlled trials and found that supplements only had a modest effect. They reduced the risk for total fracture by 11% (relative risk [RR], 0.89; 95% confidence interval [CI], 0.81 - 0.96], and that for vertebral fracture by 14% (RR, 0.86; 95% CI, 0.74 - 1.00), but had no statistically significant effect on the risk for hip (RR, 0.95; 95% CI, 0.76 - 1.18) or forearm (RR, 0.96; 95% CI, 0.85 - 1.09) fracture.

At the same time, some of these trials have shown serious adverse events, including cardiovascular events, kidney stones, and hospital admissions for acute gastrointestinal symptoms, as well as milder ones such as constipation. Dr Boland and colleagues estimate that the increased risk for cardiovascular events was "similar to or exceeded the benefits of calcium on fracture prevention."

Such findings have led some experts to recommend increasing calcium consumption through dietary sources instead of supplements, but Dr Bolland and colleagues found even weaker evidence to support this approach.

Only two good randomized controlled trials have examined dietary calcium's effects on fracture risk, and they were too small to produce statistically significant results, the researchers found. In addition, they report that most cohort studies have shown no relationship between dietary calcium and fracture risk.

In the second paper, the investigators analyzed data from 59 randomized controlled trials. They conclude that increasing calcium intake from dietary sources increased density by 0.6% to 1.0%, and supplementation increased the density by 0.7% to 1.8%. But these increases are unlikely to prevent fracture, the authors write.

The researchers call for further study to see whether there are subgroups, such as the women in the 1992 trial, who might benefit from supplementation.

Questions Persist

This is not the first recent review to find a lack of evidence for calcium supplements. The US Preventive Services Task Force reached similar conclusions in 2013.

"The question is not so much why the guidelines were formed, but why is it, since there have been all these trials accumulated since 2000, they haven't changed," Dr Bolland said.

Another analysis by his group points toward a possible answer: The smallest studies were most likely to show the most significant effects for supplementation. This is a statistical red flag for a potential bias toward publication of positive trials, Dr Bolland said.

Still, it may be too early to change the guidelines, said Xuezhi (Daniel) Jiang, MD, PhD, assistant professor of obstetrics and gynecology at the Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia, Pennsylvania.

"I'm a little bit conservative," he told Medscape Medical News. "I really don't want to recommend against calcium supplementation at this point."

The research so far does not prove there are no benefits to calcium supplementation, so it is better to wait for more randomized controlled trials to settle the question, he argued. "You really need to have a well-designed randomized study, just because there are so many confounding factors," he said.

Prematurely advising women to stop taking calcium could backfire if later evidence establishes a benefit, because many women would be unwilling to start taking calcium again, he said.

Isabel Maples, MEd, RDN, a spokesperson for the Academy of Nutrition and Dietetics, argued that the recommendation to eat foods high in calcium is still a helpful one because these foods generally have additional benefits.

"For instance, besides being the top source of calcium and vitamin D, dairy foods are the number one food source of potassium in the American diet — a key nutrient in better blood pressure control," she told Medscape Medical News.

In an editorial accompanying the two studies, Karl Michaëlsson, MD, argues for official recommendations such as those in the United Kingdom and Nordic countries of 700 to 800 mg per day of calcium. Dr Michaëlsson, a professor in the Department of Surgical Sciences at Uppsala University in Sweden, points out that this level can be achieved with "a normal varied diet."

In contrast, guidelines such as those by the National Osteoporosis Foundation would require nearly the whole population older than 50 years to take supplements, he writes.

"The weight of evidence against such mass medication of older people is now compelling, and it is surely time to reconsider these controversial recommendations," he concludes.

This study was funded by the Health Research Council of New Zealand. One coauthor received research grants and/or honorariums from Merck, Amgen, Lilly, and Novartis. The other authors, Dr Jiang, Dr Michaëlsson, and Maples have disclosed no relevant financial relationships.

 

[SJB41976]

I saw this study presented on the Today show. I also wondered what it meant for Bariatric surgery. The way they explained it, taking "extra" is not helpful, getting the recommended amount is still suggested. But I would think everything would be different for a bariatric patient in interpreting studies like this.

 

[swimbikerun]

I was going to post the study if our wonderful admin didn't. I've always asked about vitamins, supplements, etc. and what has never gotten answered is because of things like this: the vast majority of people really don't need (or need as much) supplements. Its a billion dollar not regulated industry.

I suspect the same would hold true if people ate pretty good. If you are going back to sodas, McDonalds, I can see needing something because you are getting calories and sugar, fat, but not healthier foods.

 

[bearmom]

I too had too many questions about that study, but also took issue with "increased bone density by between 0.6 and 2 percent over the course of two years" like that is not a big deal?

When my main concern is not LOSING bone density, I'd be thrilled to gain 2%.