Rethinking Calcium Supplements


By Ameya Kulkarni, MD

Most of us know that calcium is critical to make our bones strong and healthy. Calcium is an essential building block of bone tissue, so it follows naturally that more calcium would result in better bone health. But as we age, the rate of building new bone tissue slows down, so our bones become weaker and more brittle. When the brittleness reaches a point where fractures are much more likely, we call it osteoporosis.

Osteoporosis is a very common and potentially dangerous condition, affecting 10 million Americans and resulting in approximately 2 million fractures every year, according to the National Osteoporosis Foundation. Women, who account for 80 percent of osteoporosis diagnoses, are more prone to the disease than men because women start with thinner bones and then lose estrogen, a hormone that protects against bone loss, around menopause.

Given what we know about the risks of fractures and the central role calcium plays in protecting bone health, it would seem an obvious solution to take calcium supplements, along with Vitamin D to assist with absorption. As a result, many older Americans have started taking calcium supplements to protect themselves against the risks of osteoporosis.

But, as is the case with all medicines and supplements we take, the decision to take one should be based on a careful evaluation of risks and benefits. And in recent years, some concerns have been raised about whether the risks involved with taking calcium supplements outweigh the benefits for some people.

Health Benefits in Question

In 2018, the U.S. Preventive Services Task Force, an independent body charged with reviewing all the evidence and offering recommendations on strategies to prevent clinical events, made a new recommendation regarding calcium supplements.

Based on the review of the data, the task force found insufficient evidence to support the use of calcium supplements in all but the highest risk people: patients with existing calcium/Vitamin D deficiencies, prior fractures, or severe osteoporosis. This means that for the vast majority of people, there is not enough evidence to say that calcium supplements help to protect bones.

But even if there is no clear data to say calcium supplement are going to help, they likely won’t hurt, right? Unfortunately, in some cases, calcium may be harmful.

Health Risks to Consider

The most common risk associated with calcium supplements is kidney stones. Intuitively this makes sense. As we increase the amount of calcium in our bodies, there is a higher risk of calcium forming crystals and creating kidney stones.

Other studies suggest more surprising and insidious side effects. One such study, published in the Journal of the American Heart Association in 2016, showed an association between calcium supplements and plaque buildup in the heart arteries, a potential precursor to a heart attack. Though observational, the possibility that there is a relationship between increased calcium intake and cardiovascular disease means that the calculation of the balance between risks and benefits becomes more complicated.

The Upshot

Whether you decide to take a supplement or not, remember that supplements are not the only way to take care of your bones or get calcium. Exercise, especially weight-bearing and muscle-strengthening exercise, helps keep bones strong, so get plenty of it. Eating well is also an important safeguard: Calcium from food is an effective way to increase the building blocks of your bones. Dietary calcium is also safer, since it is difficult to ingest enough calcium through your diet to cause some of the worrisome side effects. You can get calcium from many foods, including dairy products and leafy green vegetables like spinach and kale.

The bottom line is that supplements are not effective for everyone and come with potential health risks, so the best way to determine if you should take a calcium supplement is by talking with your doctor in the same way you would discuss a potential prescription medication. Your doctor may recommend additional testing or may suggest that calcium supplementation is right for you. In any case, careful attention to healthy bones and a conversation with your doctor about the factors that matter to you are excellent steps toward a healthier you.

For more information on healthy living, visit MAPMG’s Staying Healthy page.

Ameya Kulkarni, M.D., is a board-certified interventional cardiologist with the Mid-Atlantic Permanente Medical Group. He sees patients at the Kaiser Permanente Tysons Corner Medical Center. He received his medical degree from Yale University School of Medicine and completed his fellowship at Massachusetts General Hospital in Boston and University of California San Francisco Medical Center.

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