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Do calcium and vitamin D supplements reduce fracture risk?

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An expert panel recently reviewed the current evidence on the pros and cons of taking calcium supplements, with or without vitamin D supplements.

The expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF) concluded that evidence favours use of calcium and vitamin D supplements for those at high risk of insufficiency and in individuals receiving treatment for osteoporosis. The panel also said that there is “inadequate evidence” for the assertion that calcium with vitamin D supplementation increases cardiovascular risk.

Professor René Rizzoli, chair of the ESCEO Scientific Advisory Board, said: “Our aim was to comprehensively appraise current knowledge relating to the efficacy of calcium supplementation, particularly in combination with vitamin D supplementation, for healthy musculoskeletal ageing, and specifically for reduction of fracture risk. We also felt it was important to address the evidence supporting claims of adverse health outcomes from supplementation as conflicting reports have caused some confusion among healthcare professionals, patients and the general public.”

Based on current evidence, the expert panel said that calcium and vitamin D supplementation leads to a modest reduction in fractures. However, use of calcium supplementation alone is not robustly supported.

In particular, there is strong evidence for calcium and vitamin D supplementation for fracture reduction in those who are likely to be at greatest risk of calcium and/or vitamin D insufficiency.

Although calcium is “intimately involved in muscle physiology”, the clinical evidence suggests that vitamin D optimisation, rather than supplementation with calcium, leads to reduced risk of falls.

The experts also noted that calcium supplements are associated with gastrointestinal side effects and a small increased risk of renal stones. But despite claims that taking calcium and vitamin D supplements increases cardiovascular risk, several studies demonstrate the converse or no cardiovascular effect.

A large randomised control trial of calcium supplementation designed to detect validated fractures and cardiovascular events is required to ultimately clarify this issue, the experts said.

They concluded that, on the basis of the current evidence, calcium and vitamin D supplements are generally appropriate for those with a high risk of calcium and vitamin D insufficiency and in those who are receiving treatment for osteoporosis.

The review has been published in the journal Osteoporosis International.


http://link.springer.com/article/10.1007 %2Fs00198-016-3773-6