Calcium intake and risk of fracture: systematic review
- PMID: 26420387
- PMCID: PMC4784799
- DOI: 10.1136/bmj.h4580
Calcium intake and risk of fracture: systematic review
Abstract
Objective: To examine the evidence underpinning recommendations to increase calcium intake through dietary sources or calcium supplements to prevent fractures.
Design: Systematic review of randomised controlled trials and observational studies of calcium intake with fracture as an endpoint. Results from trials were pooled with random effects meta-analyses.
Data sources: Ovid Medline, Embase, PubMed, and references from relevant systematic reviews. Initial searches undertaken in July 2013 and updated in September 2014.
Eligibility criteria for selecting studies: Randomised controlled trials or cohort studies of dietary calcium, milk or dairy intake, or calcium supplements (with or without vitamin D) with fracture as an outcome and participants aged >50.
Results: There were only two eligible randomised controlled trials of dietary sources of calcium (n=262), but 50 reports from 44 cohort studies of relations between dietary calcium (n=37), milk (n=14), or dairy intake (n=8) and fracture outcomes. For dietary calcium, most studies reported no association between calcium intake and fracture (14/22 for total, 17/21 for hip, 7/8 for vertebral, and 5/7 for forearm fracture). For milk (25/28) and dairy intake (11/13), most studies also reported no associations. In 26 randomised controlled trials, calcium supplements reduced the risk of total fracture (20 studies, n=58,573; relative risk 0.89, 95% confidence interval 0.81 to 0.96) and vertebral fracture (12 studies, n=48,967. 0.86, 0.74 to 1.00) but not hip (13 studies, n=56,648; 0.95, 0.76 to 1.18) or forearm fracture (eight studies, n=51,775; 0.96, 0.85 to 1.09). Funnel plot inspection and Egger's regression suggested bias toward calcium supplements in the published data. In randomised controlled trials at lowest risk of bias (four studies, n=44,505), there was no effect on risk of fracture at any site. Results were similar for trials of calcium monotherapy and co-administered calcium and vitamin D. Only one trial in frail elderly women in residential care with low dietary calcium intake and vitamin D concentrations showed significant reductions in risk of fracture.
Conclusions: Dietary calcium intake is not associated with risk of fracture, and there is no clinical trial evidence that increasing calcium intake from dietary sources prevents fractures. Evidence that calcium supplements prevent fractures is weak and inconsistent.
© Bolland et al 2015.
Conflict of interest statement
Competing interests: All authors have completed the ICMJE uniform disclosure form at
Figures
Comment in
-
ACP Journal Club. Review: Calcium supplementation and risk for fracture in persons > 50 years of age.Ann Intern Med. 2016 Jan 19;164(2):JC4. doi: 10.7326/ACPJC-2016-164-2-004. Ann Intern Med. 2016. PMID: 26784494 No abstract available.
-
[High calcium intake does not help old bones].MMW Fortschr Med. 2015 Dec 14;157(21-22):49. doi: 10.1007/s15006-015-7612-z. MMW Fortschr Med. 2015. PMID: 26960866 German. No abstract available.
Similar articles
-
Calcium intake and bone mineral density: systematic review and meta-analysis.BMJ. 2015 Sep 29;351:h4183. doi: 10.1136/bmj.h4183. BMJ. 2015. PMID: 26420598 Free PMC article. Review.
-
Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis.Lancet Diabetes Endocrinol. 2018 Nov;6(11):847-858. doi: 10.1016/S2213-8587(18)30265-1. Epub 2018 Oct 4. Lancet Diabetes Endocrinol. 2018. PMID: 30293909
-
Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217. Cochrane Database Syst Rev. 2022. PMID: 36321557 Free PMC article.
-
Effectiveness and safety of vitamin D in relation to bone health.Evid Rep Technol Assess (Full Rep). 2007 Aug;(158):1-235. Evid Rep Technol Assess (Full Rep). 2007. PMID: 18088161 Free PMC article. Review.
-
Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis.JAMA. 2017 Dec 26;318(24):2466-2482. doi: 10.1001/jama.2017.19344. JAMA. 2017. PMID: 29279934 Free PMC article. Review.
Cited by
-
Nutrition and Osteoporosis Prevention.Curr Osteoporos Rep. 2024 Dec;22(6):515-522. doi: 10.1007/s11914-024-00892-0. Epub 2024 Sep 25. Curr Osteoporos Rep. 2024. PMID: 39322861 Review.
-
Is there an Association between Dietary Micronutrients Intake and Bone Fractures among Malaysian Reproductive-Age Women? The PURE Malaysia Study.Ann Glob Health. 2024 Sep 4;90(1):55. doi: 10.5334/aogh.4445. eCollection 2024. Ann Glob Health. 2024. PMID: 39246662 Free PMC article.
-
Impact of Vitamin D Status and Nutrition on the Occurrence of Long Bone Fractures Due to Falls in Elderly Subjects in the Vojvodina Region of Serbia.Nutrients. 2024 Aug 14;16(16):2702. doi: 10.3390/nu16162702. Nutrients. 2024. PMID: 39203838 Free PMC article.
-
The Effects of Different Dietary Patterns on Bone Health.Nutrients. 2024 Jul 17;16(14):2289. doi: 10.3390/nu16142289. Nutrients. 2024. PMID: 39064732 Free PMC article. Review.
-
A prospective study of vitamin D, proinflammatory cytokines, and risk of fragility fractures in women on aromatase inhibitors for breast cancer.Breast Cancer Res Treat. 2024 Nov;208(2):349-358. doi: 10.1007/s10549-024-07423-6. Epub 2024 Jul 8. Breast Cancer Res Treat. 2024. PMID: 38976164
References
-
- IOM (Institute of Medicine). Dietary reference intakes for calcium and vitamin D. National Academies Press, 2011. - PubMed
-
- Anderson JJ, Roggenkamp KJ, Suchindran CM. Calcium intakes and femoral and lumbar bone density of elderly U.S. men and women: National Health and Nutrition Examination Survey 2005-2006 analysis. J Clin Endocrinol Metab 2012;97:4531-9. - PubMed
-
- Castro-Lionard K, Dargent-Molina P, Fermanian C, Gonthier R, Cassou B. Use of calcium supplements, vitamin D supplements and specific osteoporosis drugs among French women aged 75-85 years: patterns of use and associated factors. Drugs Aging 2013;30:1029-38. - PubMed
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical