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Calcium Supplementation: A Review of Oral Calcium Intake on Human Health

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DOI: 10.32474/OAJOM.2019.03.000151

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 Open Access Journal of Oncology
and Medicine
DOI: 10.32474/OAJOM.2019.03.000151

ISSN: 2638-5945 Mini Review

Calcium Supplementation: A Review of Oral Calcium

Intake on Human Health

Dr. Gurmeet Singh Sarla*

Department of General Surgery, Military Hospital Devlali, India

*Corresponding author: Dr. Gurmeet Singh Sarla, Senior Advisor Surgery, MH Devlali, Devlali, Nasik, Maharashtra, India

Received: June 11, 2019 Published: June 18, 2019

Abstract
Adequate calcium intake is essential for the maintenance of bone health and the preservation of bone mineral density. The lay
person believes that calcium is always good for health. Successful marketing and various clinical practice guidelines have made
prescribing calcium supplements a billion dollar market in recent years. The aim of this study was to scan the literature and find
out whether calcium supplements should be prescribed to all patients with fractures so as to improve their bone healing or should
it be restricted to elderly post- menopausal females who have osteoporotic bones. The inference drawn was that dietary calcium
is easier to absorb and may have beneficial effects as compared to calcium supplements and it should be limited to the total daily
intake to 1000–1200 mg optimally from dietary sources. Calcium supplementation does not significantly reduce fracture risk in
postmenopausal women but it reduces the risk of osteoporosis. It increases the risk of urolithiasis. A favourable role of calcium has
been seen in postmenopausal women, elderly population, children and adolescents. Calcium is a double-edged sword, which may
be both potentially crucial and perilous and hence should be prescribed with caution.

Keywords: calcium; Osteoporosis; Dementia; Kidney stones; Constipation

Introduction
Discussion
A frequently asked question by a healthy, young lady
presenting with a limb fracture being managed conservatively A. Introduction: Osteoporosis is one of the leading causes
with immobilisation in a plaster is “Should I take Calcium of disability in the elderly. Because calcium deficiency contributes
supplementation so that my fracture heals well?.” Adequate calcium to osteoporosis, daily dietary calcium intake of 1,000–1,200 mg is
intake is essential for the maintenance of bone health during recommended [4]. Such a large calcium intake through diet alone
growing phases [1] and the preservation of bone mineral density can be difficult; therefore, calcium supplements are widely used
in elderly individuals [2]. Calcium supplementation is a widespread [4]. Epidemiological studies have demonstrated that a significant
practice in different age-groups and has been promoted widely to number of population throughout the globe fail to achieve the
improve bone density [3]. The lay person believes that calcium is recommended daily calcium intake [5]. In addition to its pivotal role
always good for health due to successful marketing and various in bone metabolism, the potential role of calcium in non-skeletal
clinical practice guidelines and prescribing calcium supplements tissues has also been investigated, particularly in elderly people [6].
has become a billion dollar market in recent years and has been B. Role of Calcium: Calcium is an important and integrative
taken by millions of both men and women, children, adults, and the component of human body with 99% of the body’s calcium being
elderly wishing to improve their skeletal health. contained within the skeleton [7]. Calcium homeostasis plays a
Aim major role in maintaining human life activities, such as maintenance
of the skeleton, regulation of hormonal secretion, transmission
The aim of this review article was to find out whether calcium
of nerve impulses, and vascular activities [8]. The homeostasis of
supplements should be prescribed to all patients with fractures so
calcium is mainly maintained by both parathyroid hormone (PTH)
as to improve their bone healing or should it be restricted to elderly
and calcitonin [9].
post- menopausal females who have osteoporotic bones.

Copyright © All rights are reserved by Gurmeet Singh Sarla. 226

Open Acc J Oncol Med Volume 3 - Issue 1 Copyrights @ Gurmeet Singh Sarla.

Benefits of Calcium Supplementation could reduce the risk of death from all causes and cardiovascular
diseases [16]. Another study conducted among postmenopausal
A. Osteoporosis: Osteoporosis is a skeletal disorder
women revealed that high intake of dietary and supplemental
associated with aging and characterized by compromised bone
calcium were associated with a decrease in the mortality of
strength due to reduced bone mass and reduced bone quality
ischemic heart disease [17].
leading to increased bone fragility thereby predisposing a person to
increased risk of fracture, notably at the vertebrae, hip, and forearm. F. Gastrointestinal tract: A randomized, double-blind
It is suggested that Vitamin D and calcium supplementation, either trial performed on people with a history of colorectal adenomas,
in the form of calcium supplements or dietary calcium, plays a receiving either 1,200 mg/d elemental calcium or placebo has
positive role in prevention od osteoporosis in people of different revealed a significant reduction in the risk of recurrent colorectal
ages and genders. Calcium supplementation plays a protective adenomas with calcium supplementation6. Calcium carbonate is
role for bone health, improving bone mass density (BMD) and more often associated with gastrointestinal side effects, including
decreasing morbidity of osteoporosis and osteoporotic fractures in constipation, flatulence, and bloating [18]. The explanation behind
different genders and age-groups [10]. those findings is the ability of calcium to combine with bile acids in
the intestines, reducing the rectal epithelial proliferation rate [19].
B. Postmenopausal women: Bone remodelling is
accelerated in the peri-menopausal and postmenopausal periods Adverse effects of Calcium Supplementation
and is characterized by a decrease in estrogen production and
A. Cardiovascular System: It is estimated by a meta-
an increase in resorption of calcium from bone resulting in a
analysis (including eleven randomized controlled trials) that
marked decrease in bone density. Calcium supplementation may
calcium supplements have up to 30% increase risk for myocardial
be recommended in postmenopausal women with a history of
infarction [20]. The explanation behind these findings is that
osteoporotic fractures, a diagnosis of osteoporosis, vitamin D
calcium supplements potentially contribute to elevated serum
deficiency, or a high risk for osteoporosis (eg, primary ovarian
calcium levels and possibly accelerated cardiovascular calcification
insufficiency) [11] but are not of any proven benefit in primary
[21].
prevention of fractures in community dwelling asymptomatic
premenopausal women [12]. B. Gastrointestinal Diseases: Calcium supplements may
increase the incidence of constipation, severe diarrhoea, and
C. Pregnant and lactating women: Calcium
abdominal pain [22].
supplementation in pregnant or lactating women for the skeletal
health of foetus and mother is of doubtful benefit. In a study in C. Renal Stones: A major concern regarding the safety of
pregnant women in Gambia, West Africa, with low calcium intakes, calcium has been the occurrence of kidney stones. An abnormality
calcium supplement resulted in significantly lower bone mineral of urinary super-saturation is one of the main factors for the
content, bone area, and BMD at the hip throughout 12-month formation of kidney stones23. Individuals who consumed any
lactation. The women also had greater decreases in bone mineral amount of supplemental calcium had an increased risk for
during lactation at the lumbar spine and distal radius and had kidney stones compared with individuals who did not consume
biochemical changes consistent with greater bone mineral supplemental calcium [24].
mobilization [13]. In pregnant and lactating women with low
D. Age Related Macular Degeneration: A recent cross-
calcium intakes, calcium supplementation is recommended [14].
sectional study found that >800 mg/d of calcium consumption in
D. Children: For growing children, bone modeling (i.e., people aged >67 years may increase the risk of age related macular
formation over resorption) is the predominant skeletal process degeneration compared with those who do not take calcium [25].
which requires mineralization; hence, calcium requirements
E. Dementia and Alzheimer’s Disease: Some trials have
are increased, particularly during neonatal and pubertal growth
reported an association between calcium supplementation and
spurts. For healthy children, there has been no recommendation
increased risk for vascular events [26]. Vascular risk factors are
for routine calcium supplementation, however children with a
related to vascular dementia and Alzheimer disease [27]. Calcium
high risk of osteoporosis (eg, celiac disease, inflammatory bowel
supplementation might have direct toxic effects on vulnerable
disease, or congenital bone disorder) or low calcium intake may
neurons, because the increased calcium levels may amplify
benefit from calcium supplementation. In a study conducted in
ischemic cell death and worsen the outcome after cerebrovascular
rural Gambian children accustomed to a low-calcium diet, calcium
events [19]. calcium influx and intracellular calcium overload have
supplementation resulted in higher bone mineral content and BMD
a crucial role in apoptosis and necrosis [28]. The mechanism of
[15].
calcium supplements in the pathogenesis of dementia could be the
E. Cardiovascular System: A study conducted among an steep increase in serum calcium levels caused by the supplements
elderly Chinese population indicated that dietary calcium intake [20]. Calcium plays a central role in the mechanisms of cell death.

Citation: Gurmeet Singh Sarla. Calcium Supplementation: A Review of Oral Calcium Intake on Human Health. Open Acc J Oncol Med 3(1)-
2019. OAJOM.MS.ID.000151. DOI: 10.32474/OAJOM.2019.03.000151. 227
Open Acc J Oncol Med Volume 3 - Issue 1 Copyrights @ Gurmeet Singh Sarla.

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Citation: Gurmeet Singh Sarla. Calcium Supplementation: A Review of Oral Calcium Intake on Human Health. Open Acc J Oncol Med 3(1)-
2019. OAJOM.MS.ID.000151. DOI: 10.32474/OAJOM.2019.03.000151. 229

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