title: Assessing the potential adverse consequences of supplemental calcium on cardiovascular outcomes: should we change our approach to bone health?
abstract: OBJECTIVE
  To assess cardiovascular risks associated with supplemental calcium use to assist clinicians with evidence-based recommendations for patients who have, or who are at risk for, osteoporosis or osteopenia.
  
  
  METHODS
  Literature was accessed through December 2011 using MEDLINE, Cochrane Library, and International Pharmaceutical Abstracts using the terms calcium compounds and cardiovascular disease. In addition, reference citations from the publications identified were reviewed.
  
  
  METHODS
  All English-language articles were evaluated. Randomized controlled trials, observational studies, and meta-analyses were included.
  
  
  RESULTS
  While supplemental calcium and vitamin D have been demonstrated to improve bone mineral density and decrease the risk of fractures, there have been recent reports that calcium supplements may increase the risk for cardiovascular events. Nine clinical trials and/or meta-analyses were reviewed; 3 documented increases in cardiovascular risk associated with calcium supplements, and 6 did not. No studies were designed to assess cardiovascular outcomes as primary end points. Balancing the evidence from these analyses with the results of randomized controlled trials assessing the effect of calcium on fracture prevention suggests that the benefits of calcium outweigh the cardiovascular risk.
  
  
  CONCLUSIONS
  At this time, there is no cause to change routine practice surrounding supplemental calcium use in patients who have, or are at risk for, osteoporosis or osteopenia.
authors.affiliation: Schlegel-University of Waterloo Research Institute on Ageing & School of Pharmacy, University of Waterloo, Ontario, Canada. carlos.rojas-fernandez@uwaterloo.ca
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Rojas-Fernandez
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Maclaughlin
authors.forename: Naomi L
authors.initials: NL
authors.lastname: Dore
authors.forename: Sally
authors.initials: S
authors.lastname: Ebsary
mesh_terms: D002136:Calcium, Dietary / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D019587:Dietary Supplements / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012306:Risk
chemical_list: D002136:Calcium, Dietary