Current Osteoporosis Reports

, Volume 12, Issue 2, pp 211–218 | Cite as

Calcium Supplementation: Is Protecting Against Osteoporosis Counter to Protecting against Cardiovascular Disease?

Nutrition, Exercise, and Lifestyle in Osteoporosis (C Weaver and S Ferrari, Section Editors)


Calcium is the dominant mineral in bone and is a shortfall nutrient in the diet. For those consuming inadequate dietary calcium, calcium supplements have been a standard strategy for prevention of osteoporosis. Recently, calcium supplementation has been linked to both increased and decreased cardiovascular disease risk creating considerable uncertainty. Moreover, recent reports have shed uncertainty over the effectiveness of calcium supplements to reduce risk of fracture. The evidence for calcium supplementation effects to both reduce risk of fracture and increase coronary heart disease and mortality are reviewed. Although the importance of good calcium nutrition is well known, determining the advantage of calcium supplementation to either bone or heart health has been hampered by poor subject compliance and study design flaws. At present, the current Recommended Dietary Allowances for calcium still appear to be a good target with potential risks for chronic disease if intakes fall too short or greatly exceed these recommendations.


Calcium Cardiovascular disease Osteoporosis Vascular calcification Myocardial infarction 


Compliance with Ethics Guidelines

Conflict of Interest

C. M. Weaver declares that she has no conflicts of interest.

Human and Animal Rights and Informed Consent

All studies by the author involving animal and/or human subjects were performed after approval by the appropriate institutional review boards. When required, written informed consent was obtained from all participants.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Bone health and osteoporosis: a report of the Surgeon General. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Office of the Surgeon General; Washington, DC: 2004. p. 436.Google Scholar
  2. 2.
    Bolland MJ, Barber PA, Doughty RN, Mason B, Horne A, Ames R, et al. Vascular events in healthy older women receiving calcium supplementation: randomized controlled trial. BMJ. 2008;336:262–6.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.•
    Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010;341:c3691. This is the meta-analysis that led to concern about calcium supplementation and risk of myocardial infarction.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Bolland MJ, Grey A, Avenell A, Gamble DG, Reid IR. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis. BMJ. 2011;342:c2040.CrossRefGoogle Scholar
  5. 5.
    2012 CRN Consumer Survey on Dietary Supplements. Available at:
  6. 6.
    Gahche J, Bailey R, Burg V, Hughes J, Yetley E, Dwyer J. Dietary supplement use among US adults has increased since NHANES III (1988-1994). NCHS Data Brief. 2011;1–8.Google Scholar
  7. 7.
    Reid IR, Bolland MJ, Avenell A, Grey A. Cardiovascular effects of calcium supplementation. Osteoporos Int. 2011;22:1649–58.PubMedCrossRefGoogle Scholar
  8. 8.
    Reid IR. Cardiovascular safety of calcium supplements. Ch. 36. In: Burckhardt P, Dawson-Hughes B, Weaver CM, editors. Nutritional influences on bone health. London: Springer; 2013. p. 365–72.Google Scholar
  9. 9.
    Weaver CM. Calcium is not only safe but important for health. Ch. 35. In: Burckhardt P, Dawson-Hughes B, Weaver CM, editors. Nutritional influences on bone health. Lausanne, Switzerland. London: Springer; 2013. p. 359–64.Google Scholar
  10. 10.
    Cauley JA. The Women's Health Initiative: hormone therapy and calcium/vitamin D supplementation trial. Curr Osteoporos Rep. 2013;11:171–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Spence LA, Weaver CM. Calcium intake, vascular calcification, and vascular disease. Nutr Rev. 2013;71:15–22.PubMedCrossRefGoogle Scholar
  12. 12.
    Ross CA, Taylor CL, Yaktine AL, Del Valle HB, editors. Committee to review dietary reference intakes for vitamin D and calcium; Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington, DC: National Academy Press; 2011. Available at: Accessed 31 May 2012.
  13. 13.
    World Health Organization and Food and Agriculture Organization of the United Nationals. Vitamin and Mineral Requirements in Human Nutrition. 2nd ed. Geneva, Switzerland: World Health Organization; 2004. Available at: Accessed 31 May 2012.
  14. 14.
    Jackson RD, La Croix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006;354:669–83.PubMedCrossRefGoogle Scholar
  15. 15.
    Bailey RL, Dodd KW, Goldman JA, Gahche JJ, Dwyer JT, Moshfegh AJ, et al. Estimation of total usual calcium and vitamin D intakes in the United States. J Nutr. 2010;140:817–22.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.•
    Prentice RL, Pettinger MB, Jackson RD, Wactawaski-Wende J, LaCroix AZ, Anderson GL, et al. Health risks and benefits from calcium and vitamin D supplementation: Women’s Health Initiative clinical trial and cohort study. Osteoporos Int. 2013;24:567–80. This paper analyses the benefits and risks to bone, CVD, and mortality from the largest and longest RCT of calcium and vitamin D supplementation from the WHI with subanalysis for adherent participants and those not taking their own calcium and vitamin D supplements at baseline. It also includes an analysis of a large prospective observational cohort from the same catchment as the RCT.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Cauley JA, Chlebowski RT, Wactawski-Wende J, Robbins JA, Rodabough RJ, Chen Z, et al. Calcium plus vitamin D supplementation and health outcomes five years after active intervention ended: The Women’s Health Initiative. J Women's Health. 2013;22:915–29.CrossRefGoogle Scholar
  18. 18.
    Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, Burckhardt P, Li R, Spiegelman D, et al. Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr. 2007;86:1780–90.PubMedGoogle Scholar
  19. 19.
    Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fracture and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007;370:657–66.PubMedCrossRefGoogle Scholar
  20. 20.
    Cranney A, Horsley T, O’Donnell S, Weiler H, Puil L, Ooi D. Effectiveness of safety of vitamin D in relation to bone health. Evidence report/technology assessment no. 158. Rockville, MD: Agency for Healthcare Research and Quality; 2007. Available at: Accessed 31 May 2012.
  21. 21.
    Chung M, Balk EM, Brendel M, Ip S, Lau J, Lee J. Vitamin D and calcium: a systematic review of Health Outcomes. Evidence report/technology assessment no. 183. Rockville, MD: Agency for Healthcare Research and Quality; 2009. Available at: Accessed 31 May 2012.
  22. 22.
    Chung M, Lee J, Terasawa T, Lau J, Trikalinos TA. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the US Prevention Services Task Force. Ann Intern Med. 2011;155:827–38.PubMedCrossRefGoogle Scholar
  23. 23.•
    Moyer VA, on behalf of the U.S. Preventative Services Task Force. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventative Services Task Force Recommendation Statement. Ann Intern Med. 2013;158:691–6. The recommendation of the USPSTF discourages use of calcium supplements of ≤1000 mg/d and vitamin D 3 supplements of ≤400 IU/d for preventing fracture and concludes the evidence for insufficient benefits and harm for supplementing at higher levels.Google Scholar
  24. 24.
    National Osteoporosis Foundation responds to the US Prevention Services Task Force Recommendations on Calcium and Vitamin D. Accessed 26 February 2013.Google Scholar
  25. 25.
    Bauer DC. Calcium supplements and fracture prevention. N Engl J Med. 2013;369:1537–43.PubMedCrossRefGoogle Scholar
  26. 26.
    Seeman E. Evidence that calcium supplements reduce fracture risk is lacking. Clin J Am Soc Nephrol. 2010;5:S3–S11.PubMedCrossRefGoogle Scholar
  27. 27.
    Reid IR, Mason B, Horne A, Ames R, Clearwater J, Bava U, et al. Effect of calcium supplementation on serum lipid concentrations in normal older women: a randomized controlled trial. Am J Med. 2002;112:343–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Heaney RP, Kopecky S, Maki KC, Hathcock J, MacKay J, MacKay D, et al. A review of calcium supplements and cardiovascular disease risk. Adv Nutr. 2012;3:763–71.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Lewis JR, Zhu K, Prince RL. Adverse events from calcium supplementation: relationship to errors in myocardial infarction self-reporting in randomized controlled trials of calcium supplementation. J Bone Miner Res. 2012;27:719–22.PubMedCrossRefGoogle Scholar
  30. 30.••
    Rautiainen S, Wang L, Manson JE, Sesso HD. The role of calcium in the prevention of cardiovascular disease: a review of observational studies and randomized clinical trials. Curr Atherolscler Rep. 2013;15:362. This is the newest systematic review of calcium intake from diet and supplements and serum concentrations on CVD from experimental, epidemiologic, and clinical studies.CrossRefGoogle Scholar
  31. 31.
    Xiao Q, Murphy RA, Houston DK, Harris TB, Chow WH, Park Y. Dietary and supplemental calcium intake and cardiovascular disease mortality: the National Institutes of Health-AARP diet and health study. JAMA Intern Med. 2013;173:639–46.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Lewis J, Rejnmark L, Ivey K, Prentice R, Prince R. The cardiovascular safety of calcium supplementation with or without vitamin D in elderly women: a collaborative meta-analysis of published and unpublished trial level evidence from randomized controlled trials. J Bone Miner Res. 2013;28:1002.Google Scholar
  33. 33.
    Ebeling P, English D, Nowson C, Daly R, Khan B. Long term effects of higher dietary calcium intake on vertebral fractures and severe abdominal aortic calcification in older Australians. J Bone Miner Res. 2013;28:S492.Google Scholar
  34. 34.
    Bauer D, Harrison S, Cawthon P, Barrett-Connor E, Shikany J, Ensrud K, et al. Dietary and supplemental calcium intake and the risk of mortality in older men: the MrOS study. J Bone Miner Res. 2013;28:1001.Google Scholar
  35. 35.
    Van Hemelrijck MV, Michaelsson K, Linseisen J, Rohrmann S. Calcium intake and serum concentration in relation to risk of cardiovascular death in NHANES III. PLoS One. 2013;8(e61037):1–9.Google Scholar
  36. 36.
    Wang L, Manson JE, Song Y, Sesso HD. Systematic review: vitamin D and calcium supplementation in prevention of cardiovascular events. Ann Intern Med. 2013;152:315–23.CrossRefGoogle Scholar
  37. 37.
    David V, Dai B, Martin A, Huang J, Han X, Quarles DL. Calcium regulates FGF-23 expression in bone. Endocrinology. 2013. doi: 10.1210/en.2013–1627.PubMedGoogle Scholar
  38. 38.
    Rejnmark L, Avenell A, Masud T, Anderson F, Meyer HE, Sanders KM, et al. Vitamin D with calcium reduces mortality: patient level pooled analysis of 70,528, patients from eight major vitamin D trials. J Clin Endocrin Metab. 2012;97:2670–81.CrossRefGoogle Scholar
  39. 39.
    Grant AM, Avenell A, Campbell MK, McDonald AM, MacLennan GS, McPherson GC, et al. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium or Vitamin D, RECORD): a randomized placebo-controlled trial. Lancet. 2005;365:1621–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Langsetmo L, Berger C, Kreiger N, Kovacs CS, Hanley DA, Jamal SA, et al. Calcium and vitamin D intake and mortality: results from the Canadian multicenter osteoporosis study (CaMos). J Clin Endocrin Metab. 2013;98:3010–8.CrossRefGoogle Scholar
  41. 41.
    Michaelsson K, Melhus H, Warensjo LE, Wolk A, Byberg L. Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study. BMJ. 2013;346:f228.PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Kaluza J, Orsini N, Levitan EB. Dietary calcium and magnesium intake and mortality: a prospective study of men. Am J Epidemiol. 2010;171:801–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Nurmi-Lüthje I, Sund R, Juntunen M, Lüthje P. Post-hip fracture use of prescribed calcium plus vitamin D or vitamin D supplements and antiosteoporotic drugs is associated with lower mortality; a nationwide study in Finland. J Bone Miner Res. 2011;26:1845–53.PubMedCrossRefGoogle Scholar
  44. 44.
    Givens DI. Milk in the diet: good or bad for vascular disease? Proc Nutr Soc. 2012;71:98–104.PubMedCrossRefGoogle Scholar
  45. 45.
    Rice BH, Cifelli CJ, Pikosky MA, Miller GD. Dairy components and risk factors for cardiometabolic syndrome: recent evidence and opportunities for future research. Adv Nutr. 2011;2:396–407.PubMedCentralPubMedCrossRefGoogle Scholar
  46. 46.
    Aslibekyan S, Campos H, Baylin A. Biomarkers of dairy intake and the risk of heart disease. Nutr Metab Cardiovasc Dis. 2012;22:1038–45.CrossRefGoogle Scholar
  47. 47.
    Ivey KL, Lewis JR, Hodgson JM, Zhu K, Dhaliwal SS, Thompson PL, et al. Association between yogurt, milk and cheese consumption and common carotid artery intima-media thickness and cardiovascular disease risk factors in elderly women. Am J Clin Nutr. 2011;94:234–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Talbot JR, Guardo P, Seccia S, Gear L, Lubary DR, Saad G, et al. Calcium bioavailability and parathyroid hormone acute changes after oral intake of dairy and nondairy products in healthy volunteers. Osteoporos Int. 1999;10:137–42.PubMedCrossRefGoogle Scholar
  49. 49.
    Green JH, Booth C, Bunning R. Postprandial metabolic responses to milk enriched with milk calcium are different from responses to milk enriched with calcium carbonate. Asia Pac J Clin Nutr. 2003;12:109–19.PubMedGoogle Scholar
  50. 50.
    James MFM, Roche AD. Dose-response relationship between plasma ionized calcium concentration and thromboelastography. J Cardiothorac Vasc Anesth. 2004;18:581–6.PubMedCrossRefGoogle Scholar
  51. 51.
    Nestel PJ, Pally S, MacIntosh GL, Greeve MA, Middleton S, Jowett J, et al. Circulating inflammatory and atherogenic biomarkers are not increased following single meals of dairy foods. Eur J Clin Nutr. 2012;66:25–31.PubMedCrossRefGoogle Scholar
  52. 52.
    Burt MG, Mangelsdorf BL, Drivastava D, Petersons CJ. Acute effect of calcium citrate on serum calcium and cardiovascular function. J Bone Miner Res. 2013;28:412–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Samelson EJ, Booth SL, Fox CS, Tucker KL, Wang TJ, Hoffmann U, et al. Calcium intake is not associated with increased coronary artery calcification: the Framingham study. Am J Clin Nutr. 2012;96:1274–80.PubMedCentralPubMedCrossRefGoogle Scholar
  54. 54.
    Wastney M, Lee W, Jackson GS, Alloosh M, Sturek M, Lachcik P, et al. Soft tissue calcification in the Ossabaw miniature pig: experimental and kinetic modeling studies. Osteoporos Int. 2012. doi: 10.1007/s00198-012-2229-x.PubMedGoogle Scholar
  55. 55.
    Phillips A, McKenney M, Bahls M, Newcomer S, Radcliffe S, Van Alstein W, et al. Impact of high calcium intake from calcium carbonate on dairy on cardiovascular function and the progression of coronary artery disease in Ossabaw Minature Swine. J Bone Min Res. 2013;28, MO0184.Google Scholar
  56. 56.
    Phillips A, Martin B, Jackson G, Radcliffe S, Van Alstine W, McKenney M, et al. Calcium intake and source effects on soft tissue calcification in Ossabaw miniature swine. Am Heart Assoc. 2013; [Abstract #2043].Google Scholar
  57. 57.
    Dietary Guidelines Advisory Committee. Report of the dietary guidelines advisory committee on the dietary guidelines for Americans, 2010. Washington, DC: U.S. Department of Agriculture, Agricultural Research Service; 2011.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Nutrition SciencePurdue UniversityWest LafayetteUSA

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