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The role of calcium supplementation in healthy musculoskeletal ageing

An 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)

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Abstract

The place of calcium supplementation, with or without concomitant vitamin D supplementation, has been much debated in terms of both efficacy and safety. There have been numerous trials and meta-analyses of supplementation for fracture reduction, and associations with risk of myocardial infarction have been suggested in recent years. In this report, the product of an 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), we review the evidence for the value of calcium supplementation, with or without vitamin D supplementation, for healthy musculoskeletal ageing. We conclude that (1) calcium and vitamin D supplementation leads to a modest reduction in fracture risk, although population-level intervention has not been shown to be an effective public health strategy; (2) supplementation with calcium alone for fracture reduction is not supported by the literature; (3) side effects of calcium supplementation include renal stones and gastrointestinal symptoms; (4) vitamin D supplementation, rather than calcium supplementation, may reduce falls risk; and (5) assertions of increased cardiovascular risk consequent to calcium supplementation are not convincingly supported by current evidence. In conclusion, we recommend, on the basis of the current evidence, that calcium supplementation, with concomitant vitamin D supplementation, is supported for patients at high risk of calcium and vitamin D insufficiency, and in those who are receiving treatment for osteoporosis.

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Acknowledgments

The meeting was funded by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), a Belgian not-for-profit organisation.

Author information

Authors and Affiliations

  1. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

    N. C. Harvey & C. Cooper

  2. NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK

    N. C. Harvey & C. Cooper

  3. Service of Bone Diseases, University Hospitals Geneva, Geneva, Switzerland

    E. Biver & R. Rizzoli

  4. Department of Internal Medicine, section Endocrinology, Ghent University, Ghent, Belgium

    J.-M. Kaufman

  5. Department of Geriatric Medicine, Klinikum, Carl von Ossietzky University, Ammerländer Heerstrasse 114-118, 26129, Oldenburg, Germany

    J. Bauer

  6. CEDOC - NOVA Medical School, UNL and Rheumatology Department, CHLO/Hospital Egas Moniz, Lisbon, Portugal

    J. Branco

  7. Head, Bone and Mineral Metabolic Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy

    M. L. Brandi

  8. Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium

    O. Bruyère

  9. INRA, UMR 1019, UNH, CRNH Auvergne, F-63000, Clermont-Ferrand, France

    V. Coxam

  10. Clermont Université, Université d’Auvergne, Unité de Nutrition Humaine, BP 10448, F-63000, Clermont-Ferrand, France

    V. Coxam

  11. Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (Irycis), Madrid, Spain

    A. Cruz-Jentoft

  12. Department of Bone and Joint Diseases, Faculty of Health Sciences, Krakow Medical Centre, Jagiellonian University, Krakow, Poland

    E. Czerwinski

  13. Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria

    H. Dimai

  14. CHU Amiens, Université Picardie - Jules Verne, INSERM U 1088, Amiens, France

    P. Fardellone

  15. Geriatric Department, Catholic University of Sacred Heart, Milan, Italy

    F. Landi

  16. Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium

    J.-Y. Reginster

  17. Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA

    B. Dawson-Hughes

  18. Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK

    J. A. Kanis

  19. Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia

    J. A. Kanis

  20. Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK

    C. Cooper

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  1. N. C. Harvey
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  2. E. Biver
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  3. J.-M. Kaufman
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  4. J. Bauer
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Corresponding author

Correspondence to C. Cooper.

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Conflict of interest

N. Harvey has received consultancy, lecture fees and honoraria from Alliance for Better Bone Health, AMGEN, MSD, Eli Lilly, Servier, Shire, Consilient Healthcare and Internis Pharma. C. Cooper has received consultancy, lecture fees and honoraria from AMGEN, GSK, Alliance for Better Bone Health, MSD, Eli Lilly, Pfizer, Novartis, Servier, Medtronic and Roche. V. Coxam has received Institutional funding and honoraria for an oral intervention at a scientific meeting Le Centre National Interprofessionnel de l’Economie Laitière (CNIEL). J.-M. Kaufman has received speaker or consultant fees from Amgen, Eli Lilly, Servier. E. Czerwinski has received research support and lecture fees from Amgen. O. Bruyere has received grant support from IBSA, MSD, Nutraveris, Novartis, Pfizer, Rottapharm, Servier, and Theramex; consulting or lecture fees from Bayer, Genevrier, IBSA, Rottapharm, Servier, SMB and TRB Chemedica. B. Dawson-Hughes has received research funding and consultancy from Pfizer Inc. E. Biver, J. Bauer, J. Branco, M.L. Brandi, A. Cruz-Jentoft, H. Dimai, P. Fardellone, F. Landi, J.Y. Reginster, J.A. Kanis and R. Rizzoli declare that they have no conflict of interest. ESCEO and IOF disclosures: none in relation to this paper.

Additional information

Nicholas C Harvey and Emmanuel Biver are joint first authors.

Rene Rizzoli and Cyrus Cooper are joint senior authors.

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Harvey, N.C., Biver, E., Kaufman, JM. et al. The role of calcium supplementation in healthy musculoskeletal ageing. Osteoporos Int 28, 447–462 (2017). https://doi.org/10.1007/s00198-016-3773-6

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