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Calcium citrate: from biochemistry and physiology to clinical applications

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Abstract

Adequate daily calcium intake should normally be achieved by dietary sources. Since low calcium diets are quite common in subjects that do not reach the recommended intake and particularly those at risk of fractures, calcium supplements may become necessary. Different forms of calcium salts are available, but products containing calcium citrate and calcium carbonate complexes are the most frequently used. Although only limited evidence on the efficacy and long-term safety of calcium citrate is available, these supplements may represent a valuable product for the management of different chronic pathological conditions. The aim of this review was to evaluate the current and potential clinical applications of calcium citrate. In particular, we focused on the use of calcium citrate supplementation in subjects with osteoporosis or in bariatric patients. Other pathological conditions that could benefit calcium citrate supplementation may include achloridria, chronic hypoparathyroidism and hypocitraturic subjects with moderate/high risk of nephrolithiasis. Indeed, citrate salts are widely used in the treatment of nephrolithiasis, since they have shown an inhibitory effect on kidney stone formation and recurrence.

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Abbreviations

ATF6α:

activating transcription factor 6α

CaSR:

calcium sensing receptor

BMD:

bone mineral density

CI:

confidence interval

CIC:

mitochondrial citrate carrier

CTX:

C-terminal telopeptide (serum Beta cross laps)

ER:

endoplasmic reticulum

PCC:

potassium calcium citrate

PFK1:

phosphofructokinase 1

PFK2:

6-phosphofructo-2-kinase/fructose-2,6-biphosphatases

PTH:

parathyroid hormone

RR:

relative risk

TRPV6:

transient receptor potential vanilloid type 6

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Authors and Affiliations

  1. Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy

    Andrea Palermo, Anda Mihaela Naciu, Gaia Tabacco & Silvia Manfrini

  2. Department of Nuclear Medicine and Thyroid Centre, Imaging Institute of Southern Switzerland, Lugano, Switzerland

    Pierpaolo Trimboli

  3. Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia of Udine, 33100, Udine, Italy

    Fabio Vescini

  4. Istituto Auxologico Italiano, IRCCS, Unit for Bone Metabolism Diseases and Diabetes & Lab of Endocrine and Metabolic Research, University of Milan, Milan, Italy

    Alberto Falchetti

  5. EndOsMet, Villa Donatello Private Hospital, Florence, Italy

    Alberto Falchetti

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  1. Andrea Palermo
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Correspondence to Andrea Palermo.

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The authors Anda Mihaela Naciu, Gaia Tabacco, Silvia Manfrini and Pierpaolo Trimboli, declare that they have no conflict of interest. Andrea Palermo, Fabio Vescini and Alberto Falchetti have received research grants from Amgen and Abiogen.

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Palermo, A., Naciu, A.M., Tabacco, G. et al. Calcium citrate: from biochemistry and physiology to clinical applications. Rev Endocr Metab Disord 20, 353–364 (2019). https://doi.org/10.1007/s11154-019-09520-0

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