The Current Science on Calcium Supplementation for Postmenopausal Women and the Treatment of Osteoporosis (March 2022)
Throughout my career, I have heard most of the physicians I work with recommend calcium supplements if someone’s intake of calcium rich foods is less than optimal. I have also heard that taking calcium is a good idea if a woman is small boned or framed. This is what I have personally been told my whole life, as I am a smaller framed athletic female with thin privilege.
Current guidelines for the prevention and treatment of osteoporosis recommend that adults age 50 and older get 700-1,200 milligrams of dietary calcium per day. These recommendations came from the National Osteoporosis Foundation in 2014, the American Association of Clinical Endocrinologists and American College of Endocrinology in 2016, and the National Osteoporosis Guideline Group in 2017. The guidelines also state that if intake of food sources of calcium is insufficient, then calcium supplements are recommended.
However, the recommendation to take calcium supplements has been questioned for postmenopausal women in recent years, including in two new analyses of randomized controlled trials, one in the journal Nutrients and one in the Journal of American College of Cardiology.
The JACC study1 looked at fatty deposits and calcium deposits in the arteries of patients with coronary artery disease (CAD) who received calcium supplements compared with patients who did not. Each of the patients had been enrolled in one of nine randomized controlled trials. The average age was 58 years, and about three-fourths of the patients were men. The researchers concluded that oral calcium supplementation may increase calcium deposits in the coronary arteries whether or not there are changes in the volume of fatty deposits. However, the supplement dosages are not noted on the analysis paper, which would have been good information to have. The authors also pointed out said more research is needed to understand the impact of these calcium deposits on the stability of plaques in the arteries and cardiovascular outcomes, such as heart attack. While plaque buildup in the arteries is never good, unstable plaques are riskier.
The Nutrients study,2 a meta-analysis of 13 randomized controlled trials, concluded that calcium supplementation of 1,000 milligrams per day increased the risk of cardiovascular disease (CVD) and CAD by about 15% in healthy postmenopausal women. It’s worth noting that this is a 15 percent increase of what someone’s underlying risk already was. For example, if you, based on all your personal risk factors, had a 30 percent chance of developing CVD or CAD, taking a 1,000-milligram calcium supplement daily could increase that risk to 36 percent. The authors also noted that some of the data they used in their analysis had not been published—which means it was not peer-reviewed—and that some of the included studies may have been too small to provide clear answers about any calcium-CVD links.
Concerns about the potential role of calcium supplements in CVD continue, and research studies have frustratingly provided differing answers. For example, a rigorous review of the evidence3 at the end of 2016 by the National Osteoporosis Foundation and the American Society of Preventive Cardiology found that calcium intake from food and supplements that doesn’t exceed 2000-2500 milligrams (mg) per day should be considered safe from a cardiovascular standpoint.
Since I selected my profession based on my family history of CAD and hyperlipidemia (high cholesterol), I am aware of my genetic risk for these conditions. As a result of these studies, until there is more data to share, I will be recommending food sources of calcium to all postmenopausal women.
Use these studies as food for thought to help you explore your options for calcium rich foods and perhaps consider food sources that you had not considered before. When in doubt, seeking consultation with a registered dietitian can help you increase variety and diversity in your diet.
1. Bazarbashi N, Kapadia SR, Nicholls SJ, et al. Oral Calcium Supplements Associate With Serial Coronary Calcification: Insights From Intravascular Ultrasound. JACC Cardiovasc Imaging. 2021 Jan;14(1):259-268.
2. Myung S-K, Kim H-B, Lee Y-J, Choi Y-J, Oh S-W. Calcium Supplements and Risk of Cardiovascular Disease: A Meta-Analysis of Clinical Trials. Nutrients. 2021; 13(2):368.
3. Kopecky SL, Bauer DC, Gulati M, Nieves JW, Singer AJ, Toth PP, Underberg JA, Wallace TC, Weaver CM. Lack of Evidence Linking Calcium With or Without Vitamin D Supplementation to Cardiovascular Disease in Generally Healthy Adults: A Clinical Guideline From the National Osteoporosis Foundation and the American Society for Preventive Cardiology. Ann Intern Med. 2016 Dec 20;165(12):867-868.