Friday, October 13, 2017

Supplemental Calcium for the Prevention and Treatment of Osteoporosis: New Guidelines by the EMAS


Eye opening stats:
-  Approximately 50% of women and 20% of men will become osteoporotic and suffer some type of fracture within their lifetime.
-  Spine and hip fractures can be debilitating, life changing events leading to long term pain and rehabilitation.
-  Twenty-eight percent of women and thirty-seven percent of men who sustain a hip fracture die within a year.

What can be done?:
These abysmal numbers DON'T have to be that way! Osteoporosis, for the most part, IS preventable. We do NOT have to see such large numbers of fracture rates if we could increase awareness and focus on prevention. Leading a healthy lifestyle is extremely important for reducing osteoporosis risk. This includes good nutrition, maintaining regular physical activity, and not engaging in destructive alcohol, tobacco and/or drug use. Along with eating a healthy diet high in fruits and vegetables and adequate protein, sufficient calcium intake is extremely important for bone health.

But what if a person already has osteoporosis and they are 60, 70 or 80 years old? Is there no hope for them? Is prevention the only thing we can do? NO! In fact I just spoke with an very nice 78-year-old woman tonight who has sustained multiple fractures of her spine and a hip fracture. She was distraught that there might not be anything that could be done for her...that she would simply have to live in fear of more fractures and continued pain. I have been working with patients with osteoporosis for almost 20 years now and have seen other patients with similar scores and in similar situations. And I know for a fact that there IS a lot that can be done to help. That there IS hope and PLENTY of it. But we can't be passive. We need to attack situations like hers from ALL directions. But improvement CAN be had...slow and steady, like putting
At 17,500 feet on Mt K. "Just Keep Going"...and you will get there.
one foot in front of the other. But it will happen. We just need to get up EVERY day and do things to improve. Slowly, slowly...just keep grinding away...but yes, improvement will come. Not to get too off track here but I think this is why I so love challenges like competing in Ironman triathlons or running up Mt. Washington, or Mt. Kilimanjaro. These goals are long and arduous, and rewards come from "just keeping on going".

There are lots of pieces to the complex puzzle of osteoporosis. Mineral intake is just one of those pieces. I must admit that I rarely write about supplemental calcium but a newly released clinical guide for the prevention of postmenopausal osteoporosis by the European Menopause and Andropause Society (EMAS) prompted this blog.

We all know that calcium IS necessary for strong bones but recent epidemiological studies linking excess calcium intake with "possible" cardiovascular risk has confused the waters. Many patients and doctors alike are questioning if supplemental calcium is safe and indeed if it is necessary at all. In response to these questions, the EMAS released new, updated guidelines. The following is a summary of the publication's most important points:


Insufficient calcium intake
   increases fracture risk AND an
   adequate daily intake is
   important for preventing 
   osteoporosis.

-  An intake of 700 to 1200 mg of
    calcium every day is important.

-  When possible, dietary calcium
    should be the preferred choice
    over supplemental calcium.

-  If dietary calcium intake is
    insufficient, supplemental
     intake is recommended.

-  Data from the National Health and
    Nutrition Examination Survey
    (NHANES) database shows that
     less than one-third of women 
    consumes enough calcium from
    their diet.

-  Excess intake of calcium does not
    help to reduce fracture risk.

There is no conclusive evidence
    that excess calcium intake causes
    harm.  [It is our opinion at OsteoNaturals that large doses of calcium (over 500 mg)
    should not be taken at one sitting, and that total daily supplemental intake be limited
    to 600 to 1,000 mg over the course of the day (depending on how much calcium is
    obtained from the diet).]

There is no doubt, CALCIUM is VERY IMPORTANT for skeletal health and not just for the prevention of osteoporosis but also for its treatment. The problem with relying on dietary calcium is that absorption of calcium from food does not exceed 35%. For this reason alone, calcium supplementation is a good idea. Adequate calcium intake is important, not just when we reach age 50, and not just when we have been diagnosed with osteopenia or osteoporosis...but when we are young and healthy! It is difficult to obtain sufficient calcium from diet alone, so no matter how you cut it, calcium supplementation is the best way to ensure sufficient intake.

Many patients do not adhere to calcium recommendations by their doctors because supplements are often poorly tolerated. Inexpensive drugstore-brand calcium products are especially difficult to absorb. Constipation, abdominal cramping and bloating are common side effects of calcium supplements. The reason for this is that most of these products contain cheap calcium sources such as calcium carbonate, dolomite, and/or oyster shell calcium. Not only are these forms of calcium not well tolerated but their absorption is low.

Take home message...check labels before purchasing calcium supplements...eat calcium-rich foods...and take quality supplemental calcium. Your bones will be healthier and stronger for it.


Cano, A., et al. Calcium in the prevention of postmenopausal osteoporosis: EMAS clinical guide. Maturitas https://doi.org/j.maturitas.2017.10.004.







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