Safety Of Calcium Supplements Research Articles

Evaluating adherence, tolerability and safety of oral calcium citrate in elderly osteopenic subjects: a real-life non-interventional, prospective, multicenter study

BackgroundOsteoporosis is a common concern in the elderly that leads to fragile bones. Calcium supplementation plays a crucial role in improving bone health, reducing fracture risk, and supporting overall skeletal strength in this vulnerable population. However, there is conflicting evidence on the safety of calcium supplements in elderly individuals.AimThe aim of this study was to evaluate the adherence, safety and tolerability of calcium citrate supplementation in elderly osteopenic subjects.MethodsIn this non-interventional, prospective, multicenter study, subjects received daily 500 mg calcium citrate supplementation for up to one year. Adherence was calculated based on compliance and persistence. Safety was assessed through adverse reactions (ARs), deaths, and clinical laboratory evaluations.ResultsA total of 268 Caucasian subjects (91.4% female, mean age 70 ± 4.5 years) participated in the study. Mean adherence to treatment was 76.6 ± 29.5% and half of subjects had an adherence of 91% and ~ 33% of participants achieved complete (100%) adherence. ARs were reported by nine (3.9%) subjects, primarily gastrointestinal disorders, with no serious ARs. The frequency of all adverse events (including ARs) was significantly higher in subjects with adherence of < 80% (41.6%; 32/77) vs. those with adherence ≥ 80% (11%; 16/145, p < 0.0001). Both systolic and diastolic blood pressure decreased from baseline to follow-up visit (change of -2.8 ± 13.9 mmHg, p = 0.0102 and -2.1 ± 10.4 mmHg, p = 0.0116, respectively).ConclusionThis study demonstrated favorable adherence to calcium citrate supplementation in elderly osteopenic subjects. The occurrence of ARs, though generally mild, were associated with lower adherence to calcium supplementation.

Calcium, Is It Better to Have Less?--Global Health Perspectives.

Appropriate calcium intake is necessary for the accrual and maintenance of bone mass. A significant proportion of the world's population does not have adequate calcium intake, and thus, supplementation plays a key role in maintaining bone homeostasis and other aspects of health. Since a series of reports from the Auckland calcium study and meta-analysis indicated that calcium supplementation was associated with an increased risk for adverse cardiovascular events, concern over the safety of calcium supplementation has grown; however, considerable inconsistencies in the reproducibility were found and questions regarding the study methodologies have been raised. In addition, since the increased adverse cardiovascular events by calcium supplementation were observed in calcium-replete subjects, it should be clarified whether the same risk profile would be observed in countries with low calcium intake. Dietary calcium intake varies widely across the world; cardiovascular event risk factors and outcomes also vary and appear to be the opposite of calcium intake levels. Furthermore, the effects of calcium supplementation were shown to depend on dietary calcium intake, with a better bone mineral density response for low calcium intake subjects compared to that in calcium-replete subjects. Based on these evidences, the risk-benefit ratio of calcium supplement is likely to be different in different region of the world. Therefore, accumulation of evidence to establish population-specific guidelines for calcium supplementation is warranted before extrapolating the results obtained from a limited number of studies to the other people with different age, gender, ethnicity and risk profile across the world.

Efficacy, effectiveness and side effects of medications used to prevent fractures.

There is an increasing number of effective therapies for fracture prevention in adults at risk of osteoporosis. However, shortcomings in the evidence underpinning our management of osteoporosis still exist. Evidence of antifracture efficacy in the groups of patients who most commonly use calcium and vitamin D supplements is lacking, the safety of calcium supplements is in doubt, and the safety and efficacy of high doses of vitamin D give cause for concern. Alendronate, risedronate, zoledronate and denosumab have been shown to prevent spine, nonspine and hip fractures; in addition, teriparatide and strontium ranelate prevent both spine and nonspine fractures, and raloxifene and ibandronate prevent spine fractures. However, most trials provide little information regarding long-term efficacy or safety. A particular concern at present is the possibility that oral bisphosphonates might cause atypical femoral fractures. Observational data suggest that the incidence of this type of fracture increases steeply with duration of bisphosphonate use, resulting in concern that the benefit-risk balance may become negative in the long term, particularly in patients in whom the osteoporotic fracture risk is not high. Therefore, reappraisal of ongoing use of bisphosphonates after about 5 years is endorsed by expert consensus, and 'drug holidays' should be considered at this time. Further studies are needed to guide clinical practice in this area.

Does oral calcium intake or body habitus relate to the degree of valvular calcification and adverse events in patients with severe aortic stenosis?

The safety of calcium supplements has drawn much controversy, especially since its use is becoming more prevalent. A recent meta-analysis shows that there is an increased risk of incident myocardial infarction in patients taking calcium [ [1] Bolland M. Avenell A. Baron J. et al. Effects of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010; 341: c3691 Crossref PubMed Scopus (850) Google Scholar ]. While calcium use appears to contribute to the risk of cardiovascular events, it does not seem to have an effect on aortic valve calcification (AVC). A study on patients taking calcium supplementation demonstrates that these subjects do not experience an accelerated rate of progression in AVC [ [2] Bhakta M. Bruce C. Messika-Zeitoun D. et al. Oral calcium supplements do not affect the progression of aortic valve calcification or coronary artery calcification. J. Am.Board Fam. Med. 2009; 22: 610-616 Crossref PubMed Scopus (24) Google Scholar ]. The relationship between body mass index (BMI) and cardiovascular events in aortic stenosis (AS) has also been well-established. It is found that in asymptomatic patients with AS, being overweight or obese does not influence AS progression or rate of AS-related or ischemic cardiovascular events but is associated with increased mortality [ [3] Rogge B. Cramariuc D. Lønnebakken M. et al. Effect of overweight and obesity on cardiovascular events in asymptomatic aortic stenosis: a SEAS substudy (Simvastatin Ezetimibe in Aortic Stenosis). J. Am. Coll. Cardiol. 2013; 62: 1683-1690 Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar ]. Overall, there are limited studies examining the relationships between calcium use, BMI and cardiovascular events in patients with severe AS. Corrigendum to “Does oral calcium intake or body habitus relate to the degree of valvular calcification and adverse events in patients with severe aortic stenosis?” [Int. J. Cardiol. 180 (2015) 74–75]International Journal of CardiologyVol. 199PreviewWe sincerely apologize for the amendments caused and thank you very much for your help. Full-Text PDF Corrigendum to “Does oral calcium intake or body habitus relate to the degree of valvular calcification and adverse events in patients with severe aortic stenosis?” [Int. J. Cardiol. 180C (2014) 74–75]International Journal of CardiologyVol. 191PreviewThe authors regret for the error occurred in Table 2 and the corrected version is provided below. Full-Text PDF

Calcium Supplements and Cardiovascular Disease: A Review.

Dietary or supplemental calcium intake has long been encouraged for optimal bone health. However, more recently, the safety of calcium supplementation has been questioned because of a possible association between supplemental calcium and cardiovascular risk. Whereas calcium may have a beneficial or neutral effect on cardiovascular risk factors such as blood pressure, cholesterol, weight, and diabetes, available evidence does not provide a definitive answer for an association with cardiovascular disease (CVD). To date, no calcium trials have studied cardiovascular disease as a primary end point, and larger trials with longer follow-up are needed. In this review, we present results from observational studies and randomized controlled trials (RCTs) that have evaluated calcium intake (dietary or supplemental) in relation to cardiovascular risk factors and cardiovascular disease as a secondary outcome. Results from RCTs are mixed regarding CVD risk in those using supplemental calcium with or without vitamin D, and more large-scale randomized trials designed specifically with CVD as the primary end point are needed. Evidence suggests that it is reasonable to encourage adequate dietary calcium intake, especially for postmenopausal women who are at greatest risk for osteoporotic fracture.

Abstract P363: Association of Twenty-Four Hour Urine Calcium Excretion with Cardiovascular Events and Mortality: Data from the Heart and Soul Study

Background: Recent studies have raised concerns about the cardiovascular (CV) safety of calcium supplementation, particularly in regards to risk of myocardial infarction (MI). However, most prior studies have been limited by imprecise calcium ascertainment using food frequency questionnaires. In contrast, twenty-four hour urinary calcium excretion (UCE) provides an objective, quantitative measure of total daily calcium intake. Therefore, we sought to evaluate the association of UCE with CV events or death in persons with stable coronary heart disease (CHD). Methods: Between 2000-02, 849 subjects with prevalent CHD provided twenty-four hour urine collections and UCE was measured. We used Cox proportional hazards models to evaluate the association of UCE with the composite endpoint of CV events (MI, heart failure, stroke) or all-cause mortality, which were determined by blinded review of medical records. Results: During a mean follow-up of 7 ± 2 years, 374 subjects (44%) had a CV event or died. The mean UCE was 105.7 ± 111.4 mg/day. Following multivariate adjustment for demographics, traditional CV risk factors, and kidney function, there was no association between UCE and the composite of CV events or all-cause mortality ( Table ). Evaluation of individual CV outcomes revealed no association between UCE (entered per 20 mg/day greater urine calcium) and heart failure (HR 1.01, 95% CI 0.98-1.05, p=0.48) or stroke (HR 0.94, 95% CI 0.87-1.02, p=0.13), but a lower rate of MI (HR 0.94, 95% CI 0.89-1.00, p=0.04). The association was similar by sex, presence of chronic kidney disease, and use of calcium supplements (all p interactions &gt; 0.10). Conclusions: Greater UCE is not associated with higher overall CV event rates or mortality in outpatients with stable CHD, and may be associated with a modestly lower rate of MI. These findings suggest that greater daily calcium intake does not confer CV harm in outpatients with prevalent CHD.

Nanotherapeutics: Novel engineered nanoparticles promote bone accretion in vivo

epidemiological evidence that serum calcium levels in the upper part of the normal range are a risk factor for vascular disease, and that calcium supplements acutely elevate serum calcium a combination of findings that lends plausibility to supplementation increasing vascular risk. Since there are reasonable grounds for doubting the safety of calcium supplements, and since the evidence for their efficacy in fracture prevention remains marginal, we suggest there should be a reappraisal of their role in the management of osteoporosis, with a greater emphasis on agents known to prevent fractures.

Efficacy of calcium supplements on bone mass in postmenopausal women.

THE consistent loss of bone with age is due to inadequate calcium intake, inadequate calcium absorption or excessive excretory loss, or a combination of these problems. The Institute of Medicine recommends that postmenopausal women should ingest 1,200 mg of calcium daily (1). However, the usual daily intake of calcium for 5O--70-year-old American women is about 600 mg/day (2). Fifty-five percent of these estrogen-deprived women have insufficient absorption to maintain calcium balance at an intake equal to 800 mg/day (3). Nearly one fourth would still be in negative balance at an intake of 1,500 mg/day (3). In spite of the poor absorption and bioavailability of calcium in postmenopausal women, taking calcium supplements seems to be the most convenient, easy, safe, and inexpensive way to achieve the requirement and to help prevent or treat osteoporosis. Calcium supplements are particularly important for women who do not consume a sufficient quantity of dairy products or calcium-rich foods to meet their daily calcium needs. This review will summarize the recent clinical studies of the effects of calcium supplements on bone mass in postmenopausal women, discuss the factors that may influence the effectiveness of calcium supplements in preventing bone loss, and report the safety of calcium supplements.

Contempo 1997: Obstetrics and Gynecology

To the Ediotr. —I disagree with the recommendation of Drs DeCherney and Koos 1 to administer 1.5 to 2 g/d of elemental calcium to pregnant women at high risk for developing preeclampsia. The studies included in the meta-analysis on which this recommendation was based were principally studies of healthy nulliparous women. 2 There is no information with respect to the use of calcium supplementation for prevention of preeclampsia in women with multiple pregnancies, chronic hypertension, diabetes mellitus, or prior preeclampsia. As described elsewhere, 3 many of the previous studies had serious methodological shortcomings. Moreover, the safety of calcium supplementation cannot be assured in women with hypercalcemia, renal disease, or a history of urolithiasis. The multicenter trial of Calcium for Preeclampsia Prevention (CPEP) 3,4 supported by the National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute found that calcium did not prevent preeclampsia or