title: 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).
abstract: 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.
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.|NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: N C
authors.initials: NC
authors.lastname: Harvey
authors.affiliation: Service of Bone Diseases, University Hospitals Geneva, Geneva, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Biver
authors.affiliation: Department of Internal Medicine, section Endocrinology, Ghent University, Ghent, Belgium.
authors.forename: J-M
authors.initials: JM
authors.lastname: Kaufman
authors.affiliation: Department of Geriatric Medicine, Klinikum, Carl von Ossietzky University, Ammerländer Heerstrasse 114-118, 26129, Oldenburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Bauer
authors.affiliation: CEDOC - NOVA Medical School, UNL and Rheumatology Department, CHLO/Hospital Egas Moniz, Lisbon, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Branco
authors.affiliation: Head, Bone and Mineral Metabolic Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
authors.forename: M L
authors.initials: ML
authors.lastname: Brandi
authors.affiliation: Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
authors.forename: O
authors.initials: O
authors.lastname: Bruyère
authors.affiliation: INRA, UMR 1019, UNH, CRNH Auvergne, F-63000, Clermont-Ferrand, France.|Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, BP 10448, F-63000, Clermont-Ferrand, France.
authors.forename: V
authors.initials: V
authors.lastname: Coxam
authors.affiliation: Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (Irycis), Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Cruz-Jentoft
authors.affiliation: Department of Bone and Joint Diseases, Faculty of Health Sciences, Krakow Medical Centre, Jagiellonian University, Krakow, Poland.
authors.forename: E
authors.initials: E
authors.lastname: Czerwinski
authors.affiliation: Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Dimai
authors.affiliation: CHU Amiens, Université Picardie - Jules Verne, INSERM U 1088, Amiens, France.
authors.forename: P
authors.initials: P
authors.lastname: Fardellone
authors.affiliation: Geriatric Department, Catholic University of Sacred Heart, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Landi
authors.affiliation: Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Reginster
authors.affiliation: Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Dawson-Hughes
authors.affiliation: Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.|Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia.
authors.forename: J A
authors.initials: JA
authors.lastname: Kanis
authors.affiliation: Service of Bone Diseases, University Hospitals Geneva, Geneva, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Rizzoli
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. cc@mrc.soton.ac.uk.|NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK. cc@mrc.soton.ac.uk.|Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK. cc@mrc.soton.ac.uk.
authors.forename: C
authors.identifier: http://orcid.org/0000-0003-3510-0709
authors.initials: C
authors.lastname: Cooper
mesh_terms: D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002118:Calcium / Q000009:adverse effects / Q000627:therapeutic use*; D019587:Dietary Supplements / Q000009:adverse effects; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D007669:Kidney Calculi / Q000139:chemically induced; D015201:Meta-Analysis as Topic; D018482:Muscle, Skeletal / Q000187:drug effects / Q000502:physiology; D010024:Osteoporosis / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000517:prevention & control*; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D014807:Vitamin D; D002118:Calcium
keywords: Calcium supplementation; Fracture reduction; Myocardial infarction; Vitamin D supplementation