Are calcium supplements safe?

New research is prompting questions about the safety of the calcium supplements that so many women age 50 and older take to strengthen their bones. One recent study suggests these pills raise a person's risk for a heart attack, and another new study—scheduled to be presented next month—is expected to raise more safety questions, continuing the debate that erupted this summer.
The controversy began in July when the British Medical Journal published a study that raised troubling questions about the calcium supplements taken by millions of Americans to ward off the bone thinning that comes as we age.

This latest research may call into question the popular practice of getting calcium from pills, but it has not suggested any heart risk from calcium in the diet. Researchers say that may be because food doesn't cause the same temporary, short-term boost in blood calcium as supplements. The authors say this boost produces calcium deposits that may harden the blood vessels or make the blood more likely to clot.

But U.S. doctors widely recommend calcium supplements, especially to postmenopausal women at risk for osteoporosis—thinning and fractured bones—and some say the evidence linking the pills to heart risk is not yet persuasive enough to change that policy. "I don't think it's enough to tell our patients to stop using calcium," says Lynne Braun, a researcher and nurse practitioner who counsels patients on cardiovascular risk at the Heart Center for Women at Rush University Medical Center in Chicago. "I personally use calcium supplementation. Would I stop based on this [study]? The answer is no."

Braun says the new study suffers from the usual shortcomings of meta-analysis, a statistical method that pools data from a variety of studies that haven't necessarily gathered information on the same questions or in the same ways.

Where's the vitamin D?

Others argue that the recent analysis is all but irrelevant, since it excluded patients also taking vitamin D, which may protect the heart by helping the body absorb calcium, and which is nearly always prescribed along with calcium supplements. "The field has moved on from the calcium-alone issue to the combination of calcium and vitamin D, because they work in concert to protect bones," says Bess Dawson-Hughes, M.D., director of the USDA Nutrition Center at Tufts University in Boston.
The Women's Health Initiative, a national study involving 36,000 participants, looked at women taking both calcium and vitamin D, and in 2006 reported no overall cardiovascular effects from the supplements.

What are the benefits?

Despite the widespread use of calcium supplements for bone health, there remains some debate about just how useful they are in preventing fractures. A 2006 report on data from the Women's Health Initiative found no statistically significant reduction in fractures among healthy postmenopausal women taking calcium and vitamin D, although women over age 60 who closely followed their supplement regimens did suffer fewer hip breaks. Meanwhile, this 2006 report suggested the pills might promote kidney stones, which can be quite painful.

On the other hand, says Weinerman, even the potential risk of kidney stones, to say nothing of cardiovascular risk, argues for greater caution against the overuse of calcium pills. Though the average American diet is deficient in calcium, he says he often sees patients whose eating habits, combined with excessive supplementation, give them more calcium than they need (about 1,200 mg daily for people 50 and above, according to Institute of Medicine guidelines). "That doesn't make any sense."

Sunshine Vitamin D

Vitamin D got its nickname, "the sunshine vitamin," because sun exposure helps promote vitamin D production in the body. This essential nutrient is also found naturally in a few foods such as oily fish (mackerel, salmon) and is used to fortify milk, baby formula, cereal, and juice. But changing lifestyles and diets mean that many of us are lacking in vitamin D. In fact, it's estimated that about 75 percent of American teens and adults don't get enough vitamin D, and studies suggest that this may play a role in several chronic diseases, including arthritis.
Arthritis and Vitamin D: What the Research Says - research has found that vitamin D may play a significant role in joint health, and that low levels may increase the risk of rheumatologic conditions such as arthritis. Several studies have found low blood levels of vitamin D in patients with osteoarthritis of the hip and knee. In another study of more than 2,000 people, researchers found that vitamin D deficiency was strongly associated with disabling symptoms among those with rheumatoid arthritis. While it may be true that people with arthritis don't get as much sun exposure — exposure to the sun helps promote vitamin D production in the body — the study authors adjusted for that and still found that being vitamin D deficient was linked to arthritis pain.

Getting Enough Vitamin D - in addition to helping prevent arthritis, getting enough vitamin D may also lower the risk for other autoimmune diseases, cancer, heart disease, type 2 diabetes, bone fractures, depression, and even the flu. If vitamin D has the potential to improve your arthritis symptoms and your overall health, you want to know that you're getting enough.

Consider these strategies to keep your vitamin D levels optimal:

• Spend some time in the sun. Dermatologists will tell you to slather on sunscreen any time you're outside to avoid skin cancer — and rightfully so since skin cancer can be deadly. Nevertheless, sun exposure is a good way to build up your levels of vitamin D. Luckily, it takes just a few minutes of sun exposure for your body to use the sun's rays to make vitamin D. Be sure to apply or reapply sunscreen after getting some brief exposure to sunshine each day.
• Consider a daily supplement. In addition to soaking up some sun, it's probably a good idea to take a vitamin D supplement to be sure you're getting enough, especially if you live in northern states where the sun's rays may not be strong enough for your body to make enough vitamin D in the winter. Doctors recommend taking 800 to 1,000 international units, or IU, of vitamin D a day. (Some multivitamins include 1,000 IU of vitamin D, so check the label.) If you buy the supplement separately from your multivitamin, be sure to choose vitamin D3, a natural form of vitamin D that lasts longer in your body, advises Dr. Dean.
• Get tested. Symptoms of vitamin D deficiency include chronic pain, frequent infections, gastrointestinal problems, depression, and weak bones. If you think you may be deficient, or if you're thinking about taking more than 1,000 IU of vitamin D a day, have your doctor test your blood levels, Dean suggests. Then you'll be able to take a safe and effective dose.

Although vitamin D is found in some foods, it can be hard to get it from your diet. Fatty fish such as salmon, tuna, and mackerel contain vitamin D, but they may also contain mercury and shouldn't be eaten in large quantities. Foods that are fortified, such as milk, have the synthetic form of vitamin D and don't offer as many long-term benefits.

 

Focus on getting a healthy amount of sun exposure and consider taking a supplement that contains vitamin D3 to help with arthritis symptoms.

How Often Do Women Really Need Bone Density Tests?

Screening for osteoporosis can protect against fractures, but many women may be getting tested too often.

Older women are at higher risk of developing osteoporosis and bone loss, which can lead to potentially debilitating bone fractures. To gauge bone strength in these patients, many doctors order bone mineral density tests every two years — which is how often Medicare reimburses the test — but a new study finds that such screenings can be delayed much longer.

The latest research, published in the New England Journal of Medicine, suggests that most women with normal or near-normal scores of bone density on an initial test may not need another one for up to 15 years.

The study addresses a difficult question that many doctors caring for older patients face. Bone mineral density readings, or T scores, which measure bone thickness at certain spots, usually the hip and spine, compare patients’ bone density to that of a healthy young adult. So, a T score of -2.5 or lower qualifies as osteoporosis, and women at these levels are recommended to continue testing regularly and begin drug treatments to strengthen their bones. But what about women with slightly higher readings? Do they need to be monitored as often?

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