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Physicians Update

 
Spring 2011

Excessive Supplementation of Calcium May Pose Health Risks

05/13/2011

PU-Spring11-Dr. Aurelia NattivVitamin D and calcium are important to prevent osteoporosis, yet some Americans get too much of these essential nutrients, which may be as harmful as getting too little, according to some studies.

“More is not always better,” says Aurelia Nattiv, M.D., director of the UCLA Osteoporosis Center. “There has been so much hype in the media about the benefits of calcium and vitamin D that many people take much higher doses than are generally recommended, thinking that higher doses will provide even greater protection against osteoporosis, when, in fact, higher doses may cause other health problems in some people, especially with regard to calcium supplementation.”

According to findings from a meta-analysis published last year in the British Medical Journal, doses of dietary calcium greater than 800 milligrams (mg) per day from supplements were associated with a higher risk for cardiovascular disease, including heart attack and stroke. While these findings differ from previously published studies (a 2007 study published in Circulation found that calcium/vitamin D supplementation had no effect on coronary or cerebrovascular risk in generally healthy postmenopausal women), Dr. Nattiv says the results warrant further investigation, particularly regarding the fundamental difference between dietary calcium and supplemental calcium.

“We advise people to get most of their recommended daily intake of calcium from dietary sources, rather than from supplements,” she says. Most Americans need 700 to 1,300 mg of calcium and 600 to 800 international units (IUs) of vitamin D per day — based on their age — to promote bone health, according to the most recent dietary reference intake (DRI) amounts published by the Institute of Medicine (IOM).

In order to help patients understand the types of foods and servings necessary to meet these guidelines, Dr. Nattiv offers her patients educational materials, including lists of calcium and vitamin D rich sources of foods, and directs them to online resources such as the National Osteoporosis Foundation for more detailed nutritional information. Some patients, however, including those who are lactose intolerant, will still be unable to achieve DRI amounts through diet alone, she says. In such cases, small amounts of calcium supplements (up to 500 mg per day) may be recommended. Vitamin D supplementation is still recommended to maintain adequate bone health and has not been linked to increases in heart disease. Dr. Nattiv emphasizes that the IOM DRI ranges reflect general public health guidelines and are not adequate for all patients.

“If a patient has vitamin D insufficiency or deficiency, then he or she will likely need specific treatment that may be higher than what is recommended for prevention of osteoporosis and for skeletal health,” Dr. Nattiv says. A low-impact fracture, another condition common among patients at high risk for osteoporosis, should also be considered a “red flag” for the disease, and patients presenting with these injuries should be screened with a bone density (dual energy X-ray absorptiometry, or DXA) scan and treated ideally within six months, she says.

“It’s very important to take appropriate steps to prevent osteoporosis, because once a patient develops the condition, it’s much more difficult to address,” Dr. Nattiv says. “Having one fracture places a patient at increased risk for additional fractures for the rest of his or her life, so avoiding that first fracture is really the key.”PU-Spring11-Dietary Reference





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