“All my friends around my age are all starting to take calcium supplements, must I take as well? They all say we need it for menopause”, asked a client in her late forties.  Indeed, such concern is common, and not without merits.

During menopause, oestrogen levels in the body naturally decline. Besides its important effects on the female reproductive system, oestrogen also plays an important role in the growth and maturation of bone and the regulation of bone turnover. The reduction in oestrogen levels leads to the disruption in calcium metabolism and bone turnover, which accelerates bone loss. Women may experience bone loss of 2% – 5% per year starting from menopause and bone loss may continue until 10 years later[1].

The strength of the bone is measured by bone mineral density (BMD), and the excessive decrease in BMD is defined as osteoporosis, a condition known to increase the risk of fractures [2]. As such, calcium supplementation was recommended by health authorities as a means to prevent osteoporosis in post-menopausal women in early last decade [3]. This has made calcium supplement to be the most widely used dietary supplements.

Research evidence, however, has shown that calcium supplementation may not be as effective in preventing fractures as initially thought. Although supplementing calcium and vitamin D greatly reduced the risk of fracture in institutionalised older women with low dietary calcium intake and a very high prevalence of vitamin D deficiency as shown in one study; many other studies that examined the risk of fracture and calcium supplementation in other healthier population did not show similar effect [4]. While initially thought to be safe and with no adverse side-effects other than constipation and mild gastrointestinal symptoms, the use of calcium supplementation was found to have other potential adverse effects such as increased risk of kidney stones, severe gastrointestinal disorder, as well as acute abdominal pain [4].

The adverse events of most concern, however, are cardiovascular events, more specifically heart attack (myocardial infarction) and stroke. Many studies have highlighted the potential increased risk of cardiovascular disease (CVD) among those who use of calcium supplementation regularly over the last 10 years. A meta-analysis of 15 trials, with a total of more than 20,000 participants followed up to 4 years, found that calcium supplements increased the risk of heart attack by 27–31% and death by CVD by 27–31% [5]. A recent study that followed 5448 adults free of clinically diagnosed CVD for 10 years reported that calcium supplement use was associated with the increased coronary artery calcification (CAC), i.e. the deposit of calcium at the coronary artery. CAC is a reliable indicator of atherosclerosis, a risk factor for cardiovascular events [6].

On the contrary, higher calcium intake from diet alone was found to associated with a decreased risk of incident atherosclerosis over long-term [6]. All these findings have put the need of calcium supplementation into question.

Do not jump on the bandwagon of taking calcium supplements just because you are approaching menopause! To prevent osteoporosis, it is better to eat a healthy diet high in calcium and vitamin D, as well as increase exercise to achieve better bone health [7,8]. They are better and safer approach to prevent fractures in post-menopausal women than calcium supplementation.

References

[1]        J. Thulkar, S. Singh, Overview of research studies on osteoporosis in menopausal women since the last decade., J. Midlife. Health. 6 (2015) 104–7. doi:10.4103/0976-7800.165589.

[2]        The ESHRE Capri Workshop Group, Bone fractures after menopause, Hum. Reprod. Update. 16 (2010) 761–773. doi:10.1093/humupd/dmq008.

[3]        M. Spangler, B.B. Phillips, M.B. Ross, K.G. Moores, Calcium supplementation in postmenopausal women to reduce the risk of osteoporotic fractures, Am. J. Heal. Pharm. 68 (2011) 309–318. doi:10.2146/ajhp070175.

[4]        M.J. Bolland, A. Grey, I.R. Reid, Calcium supplements and cardiovascular risk: 5 years on, Ther. Adv. Drug Saf. 4 (2013) 199–210. doi:10.1177/2042098613499790.

[5]        M.J. Bolland, A. Avenell, J.A. Baron, A. Grey, G.S. MacLennan, G.D. Gamble, I.R. Reid, Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis, Bmj. 341 (2010) c3691–c3691. doi:10.1136/bmj.c3691.

[6]        J.J.B. Anderson, B. Kruszka, J.A.C. Delaney, K. He, G.L. Burke, A. Alonso, D.E. Bild, M. Budoff, E.D. Michos, Calcium intake from diet and supplements and the risk of coronary artery calcification and its progression among older adults: 10-year follow-up of the multi-ethnic study of atherosclerosis (MESA), J. Am. Heart Assoc. 5 (2016) 1–13. doi:10.1161/JAHA.116.003815.

[7]        S. Sahni, K.M. Mangano, R.R. McLean, M.T. Hannan, D.P. Kiel, Dietary approaches for bone health: Lessons from the Framingham osteoporosis study., Curr. Osteoporos. Rep. 13 (2015) 245–55. doi:10.1007/s11914-015-0272-1.

[8]        L.D.F. Moreira, M.L. de Oliveira, A.P. Lirani-Galvão, R.V. Marin-Mio, R.N. dos Santos, M. Lazaretti-Castro, Physical exercise and osteoporosis: effects of different types of exercises on bone and physical function of postmenopausal women., Arq. Bras. Endocrinol. Metabol. 58 (2014) 514–22. http://www.ncbi.nlm.nih.gov/pubmed/25166042 (accessed December 26, 2017).