WIDESPREAD use of calcium supplements to prevent fractures is no longer appropriate, according to a controversial analysis that has been questioned by Australian experts.

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Based on a meta-analysis of unpublished data, researchers from the Bone and Joint Research Group at the University of Auckland said calcium supplements increased the risk of myocardial infarction and stroke by about 25% and 15–20% respectively.

In an article published by Australian Prescriber, Professor Ian Reid and colleagues said the co-administration of vitamin D did not mitigate the risks.

They also said calcium and vitamin D supplements were not always necessary for bisphosphonates to be effective. However, they acknowledged the supplements did prevent fractures in institutionalised elderly women.

“For the majority of patients, the weak effects that calcium supplements have on fracture risk are outweighed by the increased cardiovascular risk.

Recommendations for the widespread use of calcium supplements are no longer appropriate and should be reconsidered,” they said.

Meanwhile, a strategy on osteoporosis prevention, published in an MJA Open supplement sponsored by Osteoporosis Australia, said calcium supplements may be beneficial for general health as well as reducing fracture risk in people not getting enough in their diet. Supplementation should be limited to 50–600mg per day.

The latest RACGP Red Book warns GPs to exercise caution with calcium supplementation in light of controversial level II evidence of increased cardiovascular risk in postmenopausal women.

Australian Prescriber 2013, online 1 Feb; MJA Open 2013, online 4 Feb


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