Endocrinol Metab.  2015 Mar;30(1):27-34. 10.3803/EnM.2015.30.1.27.

The Risks and Benefits of Calcium Supplementation

• Shin CS
• Kim KM

• KMID: 2407100
• DOI: http://doi.org/10.3803/EnM.2015.30.1.27

Abstract

The association between calcium supplementation and adverse cardiovascular events has recently become a topic of debate due to the publication of two epidemiological studies and one meta-analysis of randomized controlled clinical trials. The reports indicate that there is a significant increase in adverse cardiovascular events following supplementation with calcium; however, a number of experts have raised several issues with these reports such as inconsistencies in attempts to reproduce the findings in other populations and questions concerning the validity of the data due to low compliance, biases in case ascertainment, and/or a lack of adjustment. Additionally, the Auckland Calcium Study, the Women's Health Initiative, and many other studies included in the meta-analysis obtained data from calcium-replete subjects and it is not clear whether the same risk profile would be observed in populations with low calcium intakes. Dietary calcium intake varies widely throughout the world and it is especially low in East Asia, although the risk of cardiovascular events is less prominent in this region. Therefore, clarification is necessary regarding the occurrence of adverse cardiovascular events following calcium supplementation and whether this relationship can be generalized to populations with low calcium intakes. Additionally, the skeletal benefits from calcium supplementation are greater in subjects with low calcium intakes and, therefore, the risk-benefit ratio of calcium supplementation is likely to differ based on the dietary calcium intake and risks of osteoporosis and cardiovascular diseases of various populations. Further studies investigating the risk-benefit profiles of calcium supplementation in various populations are required to develop population-specific guidelines for individuals of different genders, ages, ethnicities, and risk profiles around the world.

Keyword

Calcium; Supplement; Cardiovascular disease; Fracture

MeSH Terms

Bias (Epidemiology)
Calcium*
Calcium, Dietary
Cardiovascular Diseases
Compliance
Far East
Osteoporosis
Publications
Risk Assessment*
Women's Health
Calcium
Calcium, Dietary

Figure

• 

  Fig. 1 Worldwide distribution of dietary calcium intake. Data obtained from the EFSA Panel on Dietetic Products [21], Weaver and Heaney [22], Wang and Li [23], and Pinheiro et al. [24].

• 

  Fig. 2 Multivariable adjusted spline curves displaying the relationships among cumulative average dietary intake (A and C) and total calcium intake (B and D) with the time to death from all causes (A and B) and cardiovascular disease (C and D). Adjusted for age, total energy, and vitamin D intake, healthy dietary patterns, body mass index, height, living alone, educational level, physical activity level, smoking status, use of calcium-containing supplements, and score on the Charlson Comorbidity index. The reference value for estimation was set at 800 mg, which corresponds to the Swedish recommended calcium intake for females older than 50 years of age. Adapted from Michaelsson et al., with permission from BMJ Publishing Group Ltd. [65].

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