October 6th, 2015
Podcast 186: Stop supplementing calcium!
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Two analyses in the BMJ show little or no benefit from loading up older patients with calcium — indeed, the bad side effects of doing so (kidney stones and cardiovascular problems, to name two) outweigh the benefits.
Our conversation with Dr. Mark Bolland should offer reassurance to clinicians and their patients that a normal diet will provide enough of the stuff for good health.
BMJ studies (free)
Physician’s First Watch coverage (free)
[Running time: 18 minutes]
3 Responses to “Podcast 186: Stop supplementing calcium!”
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I would like you to address something not covered in the podcast or the method sections in the BMJ papers.
The conclusions re: BMD loss and fracture prevention draw at the population level.
Can we extrapolate findings to individuals with T-scores of -3, however? In other words, in folks not in institutions with bonafide osteoporosis, can we make the same Ca++ and Vit D recs?
Thanks
Bradley Flansbaum DO, MPH
NYC
What about patients already on calcium and vitamin D supplements and bisphosphonates with T<-2.5, would you stop the calcium and vitamin D supplements? Would you continue vitamin D?
In answer to Bradley Flansbaum:
There were no studies of calcium supplements with fracture or bone density as the outcome where there was an entry criterion of osteoporosis by bone density criteria. Thus, there are no data to directly address your question.
There were several studies of institutionalised patients who had low bone density, mostly with bone density as the primary outcome. These studies had the most inconsistent outcomes, ranging from the largest increases in bone density at some sites, through to no effect at other sites.
In answer to Lina Bissar:
There are no trials with fracture as the primary outcome comparing treatment with calcium +/- vitamin D with a bisphosphonate to treatment with a bisphosphonate alone. However, existing trials do show that the addition of calcium supplements to alendronate had no effect on bone density, and changes in bone turnover and bone density with zoledronate were similar when calcium and vitamin D were co-prescribed to when it was not. Clodronate and hormone replacement therapy used without calcium and vitamin D reduced fracture risk in large trials. So, it seems likely that the majority of people prescribed anti-resorptive treatment are unlikely to benefit from coprescription of calcium and vitamin D. Therefore calcium supplements can be discontinued in the patient you describe and vitamin D supplements are only needed (to prevent osteomalacia) if patients are at risk of having very low 25OHD levels.