IS YOUR CALCIUM SUPPLEMENT SAFE? The answer is likely yes. Many of my patients take calcium supplements intending to strengthen their bones. But are they off the mark? Do calcium supplements improve bone health, and what are the potential downsides? Today we explore calcium and bone health.

We need calcium to build and maintain strong bones. Our muscles, nerves, and heart also need the substance to function properly.

Some research hints that calcium (in combination with vitamin D) may have other upsides, including protecting against diabetes, high blood pressure, and cancer. The evidence for such benefits is not definitive.

The amount of calcium you need depends on your age and sex. The Mayo Clinic (USA) states that men ages 19 to 70 should get 1,000 milligrams daily. For men 71 and older, 1,200 milligrams is recommended. For women 19 to 50 years, 1,000 milligrams of calcium is advised. Women 51 and older should consider 1,200 milligrams daily.

Do you prefer to get your calcium through your diet? One thousand milligrams translates to two servings of calcium-rich foods. Examples include dairy or foods or beverages with added calcium.

You probably get adequate calcium (and don’t need a supplement) if you consume milk, yogurt, cheese, and fortified beverages daily.

The recommended upper limit for calcium is 2,500 milligrams each day for adults 19 to 50. For those 51 and older, the limit is 2,000 milligrams a day.

Are you at higher risk for too little calcium?

The United States National Institutes of Health (NIH) reminds us that the following groups are among those most likely to need extra calcium:

• Postmenopausal women. Menopause leads to bone loss (secondary to drops in estrogen production; this loss of hormones reduces calcium absorption and increases urinary calcium loss and calcium resorption from bone). Women lose about one percent of their bone mineral density yearly following menopause.

Approximately 30 percent of postmenopausal women in Europe and the United States have severe bone loss (osteoporosis). Of this group, at least 40 percent will develop one fragility fracture, a bone break that occurs after minor trauma).

• Individuals avoiding dairy products. Many individuals have lactose intolerance, an allergy to milk, or avoid dairy consumption. Such people have a higher risk of inadequate calcium intake.

Does calcium improve our bones?

If I asked you, “What is the best way to prevent bone fractures?” how would you respond? I bet your answer included calcium (along with vitamin D and weight-bearing exercise; some of you might add vitamin K to your response).

But, as we will see shortly, calcium is not completely risk-free. So the question of whether calcium supplements reduce bone fractures is quite relevant.

A 2015 analysis of tons of research concludes that calcium consumption at recommended levels doesn’t reduce fracture risk, even among those over 50. Here are the study authors’ words in their piece Calcium intake and risk of fracture: [a] systematic review:

“Dietary calcium intake is not [emphasis added] associated with risk of fracture, and there is no clinical trial evidence that increasing calcium intake from dietary sources prevents fractures. Evidence that calcium supplements prevent fractures is weak and inconsistent.”

Increasing calcium alone (by diet or supplementation) appears insufficient to reduce bone fractures. Moreover, calcium supplementation may not even significantly increase bone mineral density, according to an analysis published in the same issue of the British Medical Journal.

Let’s look at each of these studies in more detail. Dr. Mark Bolland and his New Zealand colleagues first identified a cardiovascular risk associated with calcium supplements. They examined over 70 studies (either observational or randomized) on whether dietary calcium and calcium supplements helped to prevent bone fractures.

Bolland et al. report that neither dietary calcium nor calcium supplements appeared to be associated with a reduction in fractures.

Researchers reviewed 59 randomized clinical trials evaluating calcium intake and bone density for the second paper. Fifteen studies focused on dietary calcium, while 44 examined calcium supplements.

The results? Getting a minimum of 800 milligrams of calcium from diet daily (or at least 1,000 milligrams from supplements) increased bone density. However, the density increased by only 0.6 to 1.8 percent, an amount too low to chance fracture risk.

So how did we get to current recommendations?

Dr. Bolland points to a seminal study that they believe heavily influenced today’s recommendations Researchers completed a randomized trial that included 3,800 women with an average age of 84. All lived in assisted living.

The French women initially had a low calcium intake of about 500 milligrams daily, low vitamin D levels, and low bone density. The individuals receiving 1,200 milligrams of calcium and 800 international units (IU) of vitamin D supplements daily for three years had a nearly one-quarter (23 percent) drop in hip fracture risk and a one-sixth (17 percent) lower risk of fractures overall compared with those taking placebos.

Moreover, the women taking calcium built bone; those on placebos continued to lose it. Bolland reminds us that these results — reported in 1992 and 1994 — are often cited by experts drafting calcium recommendations for the general public.

Bolland goes a step further, offering that active people who aren’t deficient in calcium or vitamin D are not likely to get the same protection from taking that much calcium.

Calcium — What to do?

For those not at high risk for fractures, I would not take calcium with the expectation that I would prevent bone fractures. Still, adequate calcium, vitamin D, and vitamin K are essential for healthy bones. We all want to dodge diseases such as rickets or osteomalacia (bone softening).

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Thank you for joining me today in this look at calcium and bone health.

The information I provided in this blog is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you seek medical advice, diagnoses, or treatment. I am not liable for risks or issues associated with using or acting upon the information in this blog.