I just blogged about how I started calcium. You know, prompted by my mom’s terrible hip fracture (okay, there is probably no good hip fracture, but hers was particularly nasty).

I will confess that I have never been on the vitamin band wagon. I managed to choke down prenatal vitamins for 22 weeks, but then when my pregnancy went to hell in a hand basket, I thought, “‘Ha, just as I expected.”

I’ve always felt the best source of vitamins, minerals and other goodies that keep our parts working are best derived from a balanced omnivorous diet, preferable low in fat. When the study came out recently that vitamin takers were more likely to die early, I felt vindicated in my belief that we are meant to slowly digest vitamins and other nutrients, not get them in a bolus (understand this approach doesn’t apply if you have a deficiency, but rather to the otherwise healthy, non-nutritionally deficient population).

But the hip fracture hip close to home. I reviewed the Institute of Medicine’s recommendation that a 45 year old woman should have 1,000 mg of calcium a day. I figured I was getting 400-500 a day from my diet, so added in a 600 mg daily supplement.

And then I did some additional reading today at lunch and, well, holy calcium controversy batman.

A recent article from the British Medical Journal re-analyzed the Women’s Health initiative (Bollan et al, BMJ 2011342:d2040) and calcium supplements with or without vitamin D actually increased the the risk of cardiovascular events (which are not good events, like parties, in case you are wondering). Especially heart attacks. The study estimates that treating 1000 people with calcium for 5 years will prevent 3 fractures and cause six heart attacks! Yikes.

So I read more. Calcium, it turns out is pretty good at slowing bone loss (Tang et al. Lancet 2007), but it only seems to be helpful in reducing fractures for people at greatest risk (elderly, low calcium intake, living in an institution etc).  Although, to tell you the truth there was so much back in forth in the various studies between “calcium helps prevent fractures” and “calcium doesn’t reduce fracture risk” that I was getting vertigo.

It seem there are studies on both sides of the table. Calcium increasing heart attack risk and calcium not having a negative effect. Calcium helping bones and calcium not really reducing fractures. At times, I wonder if we torture the numbers enough if they will simply to confess to anything?

The few things my non-endocrinologist brain could glean from the 14 papers (yup, 14) that I read (honestly, I didn’t have the stomach or balance for more) were the following:

– the risk of heart attack for women was not increased with a dietary calcium intake below 800 mg a day

– cardiovascular “events” are predominantly seen in studies with calcium supplements of 1,000 mg a day or more

– if you have kidney disease (like I do), calcium is even more likely to be bad for your heart and blood vessels.

– an optimal vitamin D level (and God, that’s a controversy in itself) is needed

– calcium from food is good for bones

My plan for osteoporosis prevention: salmon and yogurt (and

weight bearing exercise).

Oh, and I will never, ever again write a post sourced alone from the Institute of Medicine.

Join the Conversation


  1. I have pretty similar feelings about vitamins. I’d be interested in your thoughts on stinky baby iron drops. (Sort of related? No? Not at all?) I hate those with a passion. Please tell me they aren’t worth it.

  2. Dear Jen, thank you so much for posting this! I especially appreciate that you rethought your decision, sought information, evaluated it and then were willing to change your mind. In some ways I wonder if the drugs promoted for “bone health” represent the HRT of the current century. And women who don’t have the training to understand the studies have no hint that there might be a reason not to take them. I wonder how many doctors even consider the possibility.

  3. Thanks for the follow-up! I read your last post carefully — my mom has osteoporosis and has been on my case about starting calcium for YEARS. I’m also not on the vitamin bandwagon, but the info in both posts was super good. I’ll appease my mom by focusing on getting yogurt VERY regularly. I eat pretty well and am pretty active, so I hope this’ll do the job.

  4. The old calcium intake requirements are based on short-term data (see http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/calcium-full-story/index.html#calcium-from-milk).

    Agree that the cardiovascular concerns are an issue and that the body of evidence we have suggests high dose supplementation is a bad idea overall. Long-term proton-pump inhibitor and H2-blocker therapies reduce absorption of calcium and most (all?) minerals.

    Also need to remember that vitamin D, vitamin K, and boron are all important for bone health. We’d all be loads better off if we ate a couple of servings per day of varied cooked and raw greens. This would be a lot to expect from most of my current rehab patient population, but I do it for myself.

  5. I think the weight bearing exercise being the key here. It doesn’t have to mean doing deadlifts or heavy squats! Just walking! If you want carry a 1 lb hand weight in your hand if you are fair & thin otherwise your body-weight is enough.
    I hate taking pills! Especially huge mineral pills…but most peeps are low on minerals b/c our ground is depleted. So how do you know if you are deficient with out expensive lab testing via anti-aging places?
    I try to take a whole food milt-vitamin & Mineral tab (w/o iron Swanson Ultra) and eat healthy.

  6. My cell biology professor always told us that vitamins are a great way of making expensive urine. On a cellular level, your body can’t make use of a single large dose of vitamins and minerals so most of that daily pill is going to waste. I’m now a veterinary toxicologist working with nutritional chemists and some microbiologists, and none of my coworkers take daily vitamins, although many take omega 3s and/or a vitamin D supplement.

  7. Fabulous blog. For osteoporosis information, check out Dr. Susan Ott’s pages at the University of Washington. http://courses.washington.edu/bonephys/ She knows the literature. I’m a research chemist and I’ve been scouring the vitamin D literature for the last year or so. The need for vitamin D is real, and it’s probably something that can be taken as supplements. The Inuit have been living with vitamin D supplements for centuries, and cod liver oil was very successful in the UK. Unfortunately, they gave up on it and started promoting sunscreen instead…

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