Is calcium supplementation recommended for osteoporosis?

From the Guidelines

Calcium supplementation is recommended for individuals with osteoporosis, but it should be part of a comprehensive treatment approach that includes adequate vitamin D intake and other bone-specific treatments. Adults with osteoporosis typically need 1,000-1,200 mg of calcium daily, preferably obtained through diet first, with supplements making up any shortfall 1. Common calcium supplements include calcium carbonate (40% elemental calcium, taken with food) and calcium citrate (21% elemental calcium, can be taken without food). For better absorption, calcium supplements should be taken in divided doses of no more than 500-600 mg at once. Vitamin D supplementation (800-1,000 IU daily) is also essential as it helps with calcium absorption and has been shown to reduce the risk of non-vertebral fractures by 15-20% when combined with adequate calcium intake 1.

Some key points to consider when recommending calcium supplementation for osteoporosis include:

• Calcium alone is insufficient for treating established osteoporosis and should be combined with prescription medications like bisphosphonates, denosumab, or other bone-specific treatments 1.
• Excessive calcium intake (over 2,000-2,500 mg daily) should be avoided as it may increase the risk of kidney stones and cardiovascular issues in some individuals.
• Non-pharmacological treatments, such as stopping smoking and limiting alcohol intake, are also important in the prevention of fractures in high-risk patients 1.
• A comprehensive treatment approach that includes calcium supplementation, vitamin D intake, and other bone-specific treatments can help to slow bone loss and reduce the risk of fractures in individuals with osteoporosis.

It's worth noting that the evidence from the 2017 study 1 is more recent and of higher quality than the 2013 study 1, and therefore takes precedence in guiding clinical decision-making.

From the FDA Drug Label

In a clinical study of postmenopausal women with osteoporosis who received 1000 mg of supplemental calcium and at least 400 IU of vitamin D, daily teriparatide increased urinary calcium excretion. The answer is: Yes, Calcium supplementation is recommended for osteoporosis, as the study mentions that the patients received 1000 mg of supplemental calcium and at least 400 IU of vitamin D, implying that calcium supplementation is a part of the treatment regimen for osteoporosis 2.

• Key points:
  • Calcium supplementation was given to patients with osteoporosis
  • The dosage was 1000 mg of supplemental calcium
  • Vitamin D was also supplemented at a dose of at least 400 IU

From the Research

Calcium Supplementation for Osteoporosis

• Calcium supplementation is recommended for osteoporosis treatment, particularly in postmenopausal women and those with existing osteoporosis, as stated in the study 3.
• The combination of calcium and vitamin D supplementation is effective in reducing the incidence of non-vertebral and hip fractures, as suggested by the study 4.
• Calcium supplementation, with concomitant vitamin D supplementation, is supported for patients at high risk of calcium and vitamin D insufficiency, and in those receiving treatment for osteoporosis, according to the study 5.
• Calcium lowers the fracture risk when given together with vitamin D, and supplements are indicated when calcium intake cannot be increased by nutrition, as mentioned in the study 6.
• However, some studies suggest that calcium supplements have little role to play in the modern therapeutics of osteoporosis, and that dietary calcium intake is preferred due to the potential adverse effects associated with supplements, as stated in the study 7.

Recommended Calcium Intake

• The recommended daily calcium intake is 1,000 mg for women before menopause and 1,500 mg after menopause, as stated in the study 3.
• The American Institute of Medicine recommends 1,200 mg of calcium per day, but 1,000 mg may be sufficient in the presence of vitamin D sufficiency, as mentioned in the study 6.
• Calcium supplements should be given in two or three divided doses, and calcium carbonate should be the main calcium supplement when possible, as stated in the study 3.

Combination with Vitamin D

• Vitamin D supplementation is essential, particularly in patients with osteoporosis, as it helps to reduce falls risk and fracture risk, as mentioned in the studies 4, 5, and 6.
• The combination of calcium and vitamin D supplementation is more effective than calcium supplementation alone, as stated in the studies 4 and 5.
• Vitamin D deficiency is common in patients with osteoporosis, especially in advanced age, and supplementation is necessary to achieve optimal treatment outcomes, as mentioned in the study 6.