Osteoporosis International

, Volume 28, Issue 2, pp 447–462 | Cite as

The role of calcium supplementation in healthy musculoskeletal ageing

An expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF)
  • N. C. Harvey
  • E. Biver
  • J.-M. Kaufman
  • J. Bauer
  • J. Branco
  • M. L. Brandi
  • O. Bruyère
  • V. Coxam
  • A. Cruz-Jentoft
  • E. Czerwinski
  • H. Dimai
  • P. Fardellone
  • F. Landi
  • J.-Y. Reginster
  • B. Dawson-Hughes
  • J. A. Kanis
  • R. Rizzoli
  • C. CooperEmail author


The place of calcium supplementation, with or without concomitant vitamin D supplementation, has been much debated in terms of both efficacy and safety. There have been numerous trials and meta-analyses of supplementation for fracture reduction, and associations with risk of myocardial infarction have been suggested in recent years. In this report, the product of an expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF), we review the evidence for the value of calcium supplementation, with or without vitamin D supplementation, for healthy musculoskeletal ageing. We conclude that (1) calcium and vitamin D supplementation leads to a modest reduction in fracture risk, although population-level intervention has not been shown to be an effective public health strategy; (2) supplementation with calcium alone for fracture reduction is not supported by the literature; (3) side effects of calcium supplementation include renal stones and gastrointestinal symptoms; (4) vitamin D supplementation, rather than calcium supplementation, may reduce falls risk; and (5) assertions of increased cardiovascular risk consequent to calcium supplementation are not convincingly supported by current evidence. In conclusion, we recommend, on the basis of the current evidence, that calcium supplementation, with concomitant vitamin D supplementation, is supported for patients at high risk of calcium and vitamin D insufficiency, and in those who are receiving treatment for osteoporosis.


Calcium supplementation Fracture reduction Myocardial infarction Vitamin D supplementation 



The meeting was funded by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), a Belgian not-for-profit organisation.

Compliance with ethical standards

Conflict of interest

N. Harvey has received consultancy, lecture fees and honoraria from Alliance for Better Bone Health, AMGEN, MSD, Eli Lilly, Servier, Shire, Consilient Healthcare and Internis Pharma. C. Cooper has received consultancy, lecture fees and honoraria from AMGEN, GSK, Alliance for Better Bone Health, MSD, Eli Lilly, Pfizer, Novartis, Servier, Medtronic and Roche. V. Coxam has received Institutional funding and honoraria for an oral intervention at a scientific meeting Le Centre National Interprofessionnel de l’Economie Laitière (CNIEL). J.-M. Kaufman has received speaker or consultant fees from Amgen, Eli Lilly, Servier. E. Czerwinski has received research support and lecture fees from Amgen. O. Bruyere has received grant support from IBSA, MSD, Nutraveris, Novartis, Pfizer, Rottapharm, Servier, and Theramex; consulting or lecture fees from Bayer, Genevrier, IBSA, Rottapharm, Servier, SMB and TRB Chemedica. B. Dawson-Hughes has received research funding and consultancy from Pfizer Inc. E. Biver, J. Bauer, J. Branco, M.L. Brandi, A. Cruz-Jentoft, H. Dimai, P. Fardellone, F. Landi, J.Y. Reginster, J.A. Kanis and R. Rizzoli declare that they have no conflict of interest. ESCEO and IOF disclosures: none in relation to this paper.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  • N. C. Harvey
    • 1
    • 2
  • E. Biver
    • 3
  • J.-M. Kaufman
    • 4
  • J. Bauer
    • 5
  • J. Branco
    • 6
  • M. L. Brandi
    • 7
  • O. Bruyère
    • 8
  • V. Coxam
    • 9
    • 10
  • A. Cruz-Jentoft
    • 11
  • E. Czerwinski
    • 12
  • H. Dimai
    • 13
  • P. Fardellone
    • 14
  • F. Landi
    • 15
  • J.-Y. Reginster
    • 16
  • B. Dawson-Hughes
    • 17
  • J. A. Kanis
    • 18
    • 19
  • R. Rizzoli
    • 3
  • C. Cooper
    • 1
    • 2
    • 20
    Email author
  1. 1.MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
  2. 2.NIHR Southampton Biomedical Research CentreSouthamptonUK
  3. 3.Service of Bone DiseasesUniversity Hospitals GenevaGenevaSwitzerland
  4. 4.Department of Internal Medicine, section EndocrinologyGhent UniversityGhentBelgium
  5. 5.Department of Geriatric Medicine, KlinikumCarl von Ossietzky UniversityOldenburgGermany
  6. 6.CEDOC - NOVA Medical School, UNL and Rheumatology DepartmentCHLO/Hospital Egas MonizLisbonPortugal
  7. 7.Head, Bone and Mineral Metabolic Unit, Department of Surgery and Translational MedicineUniversity of FlorenceFlorenceItaly
  8. 8.Department of Public Health, Epidemiology and Health EconomicsUniversity of LiègeLiègeBelgium
  9. 9.INRA, UMR 1019, UNH, CRNH AuvergneClermont-FerrandFrance
  10. 10.Clermont Université, Université d’Auvergne, Unité de Nutrition HumaineClermont-FerrandFrance
  11. 11.Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (Irycis)MadridSpain
  12. 12.Department of Bone and Joint Diseases, Faculty of Health Sciences, Krakow Medical CentreJagiellonian UniversityKrakowPoland
  13. 13.Department of Internal Medicine, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
  14. 14.CHU Amiens, Université Picardie - Jules Verne, INSERM U 1088AmiensFrance
  15. 15.Geriatric DepartmentCatholic University of Sacred HeartMilanItaly
  16. 16.Department of Public Health, Epidemiology and Health EconomicsUniversity of LiègeLiègeBelgium
  17. 17.Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts UniversityBostonUSA
  18. 18.Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
  19. 19.Institute for Health and AgeingCatholic University of AustraliaMelbourneAustralia
  20. 20.Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research CentreUniversity of OxfordOxfordUK

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