It’s routine advice: ensure you get enough calcium and vitamin D as you age, particularly as women approach menopause, to prevent osteoporosis.
New research, however, suggests calcium supplements have “very little place” in modern medical practice, and vitamin D supplements are generally useless as well.
For most people, food, exercise and sunshine, are enough for adequate calcium and vitamin D.Credit:Getty
The review, published in the Medical Journal of Australia on Monday, found that while the nutrients in themselves are important, the evidence for their benefit in supplement form was lacking and may increase the risk of adverse health outcomes.
“The major trials in community-dwelling individuals have not demonstrated fracture prevention with either calcium, vitamin D or their combination,” said the authors, Professor Ian Reid, and Associate Professor Mark Bolland from the University of Auckland.
“Calcium supplements in healthy individuals are not needed, nor are they required in most people receiving treatment for osteoporosis.”
They added: “Calcium supplements cause constipation, bloating and kidney stones, and some evidence suggests they may cause a small increase in the risk of myocardial infarction. Low dose vitamin D is safe, but high doses result in more falls and fractures. Current evidence does not support the use of these supplements in healthy community-dwelling adults.”
Instead of supplements as an insurance policy for healthy bones or as a “general tonic”, we should focus on obtaining these nutrients naturally.
“Why calcium supplements act differently to calcium-rich foods is not really known, but it is likely that the food matrix and delivery of the calcium may be key,” said accredited practising dietitian, Dr Joanna McMillan.
Calcium is a mineral that is essential for healthy bones, as well as organ and muscle function. It is found in dairy foods, salmon and sardines, broccoli, mustard cabbage, bok choy, silverbeet, cucumber, celery and chickpeas as well as almonds, dried figs and apricots. Regular weight-bearing exercise also helps.
Vitamin D is also important for building and maintaining strong bones and it helps calcium absorption. It is made in the skin when we are exposed to sunlight (lack of exposure is the cause among most people who are deficient, like the elderly), but it is also found naturally in fatty fish, like tuna, mackerel, and salmon, as well as beef liver, cheese and egg yolks.
As we age, we become more at risk of becoming deficient in these nutrients (it is worth noting that what constitutes deficiency is controversial) as our intake and exposure lessen along with our bodies' ability to absorb them effectively.
Menopausal women (generally those aged from 45 onwards) are at an even higher risk of osteoporosis, where bones lose density and fracture more easily because oestrogen levels drop. Oestrogen is an important hormone for bone strength.
“My advice would be not to routinely take these supplements just because you are in your menopausal years, ” McMillan said. “Women do because the hormone changes at this time of life cause a drop in bone density. However, if your bones are strong to start with you can cope with this.”
Currently, more than 40 per cent of Australian adults regularly take supplements, the majority of whom are women, feeding an industry that was worth nearly $183 billion in 2018.
Calcium and vitamin D supplements are among the most popular, with vitamin D supplements continuing to rise across the world.
There are specific conditions for which these supplements are useful, like osteomalacia (a condition similar to rickets that causes soft, weak bones), Reid and Bolland said.
“Their use as adjunctive therapy in osteoporosis has been the convention, but … there is little evidence that this alters outcomes,” they added.
But for the rest of us, including the healthy ageing adults and women approaching or experiencing menopause, such supplements are a waste of money and we’re better off focusing on food, sunlight and exercise.
“Supplements have value in overtly deficient individuals, but not across the healthy older population. Based on the consistency of the data, we believe that a recommendation not to provide supplements routinely to healthy older individuals can be judged to be evidence-based … and no longer a matter of controversy,” wrote Reid and Bolland.
“In summary, small doses of vitamin D have a place in the prevention of osteomalacia in individuals with specific risk factors. Calcium supplements have very little place in contemporary medical practice.”
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