Should We Prescribe Calcium Supplements For Osteoporosis Prevention?
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Advocacy for the use of calcium supplements arose at a time when there were no othereffective interventions for the prevention of osteoporosis. Their promotion was basedon the belief that increasing calcium intake would increase bone formation. Our currentunderstandings of the biology of bone suggest that this does not occur, though calciumdoes act as a weak antiresorptive. Thus, it slows postmenopausal bone loss but, despitethis, recent meta-analyses suggest no significant prevention of fractures. In sum, there islittle substantive evidence of benefit to bone health from the use of calcium supple-ments. Against this needs to be balanced the likelihood that calcium supplement use in-creases cardiovascular events, kidney stones, gastrointestinal symptoms, and admis-sions to hospital with acute gastrointestinal problems. Thus, the balance of risk and ben-efit seems to be consistently negative. As a result, current recommendations are to ob-tain calcium from the diet in preference to supplements. Dietary calcium intake has notbeen associated with the adverse effects associated with supplements, probably be-cause calcium is provided in smaller boluses, which are absorbed more slowly since theycome together with quantities of protein and fat, resulting in a slower gastric transittime. These findings suggest that calcium supplements have little role to play in themodern therapeutics of osteoporosis, which is based around the targeting of safe andeffective anti-resorptive drugs to individuals demonstrated to be at increased risk of fu-ture fractures.
Abstract
Advocacy for the use of calcium supplements arose at a time when there were no othereffective interventions for the prevention of osteoporosis. Their promotion was basedon the belief that increasing calcium intake would increase bone formation. Our currentunderstandings of the biology of bone suggest that this does not occur, though calciumdoes act as a weak antiresorptive. Thus, it slows postmenopausal bone loss but, despitethis, recent meta-analyses suggest no significant prevention of fractures. In sum, there islittle substantive evidence of benefit to bone health from the use of calcium supple-ments. Against this needs to be balanced the likelihood that calcium supplement use in-creases cardiovascular events, kidney stones, gastrointestinal symptoms, and admis-sions to hospital with acute gastrointestinal problems. Thus, the balance of risk and ben-efit seems to be consistently negative. As a result, current recommendations are to ob-tain calcium from the diet in preference to supplements. Dietary calcium intake has notbeen associated with the adverse effects associated with supplements, probably be-cause calcium is provided in smaller boluses, which are absorbed more slowly since theycome together with quantities of protein and fat, resulting in a slower gastric transittime. These findings suggest that calcium supplements have little role to play in themodern therapeutics of osteoporosis, which is based around the targeting of safe andeffective anti-resorptive drugs to individuals demonstrated to be at increased risk of fu-ture fractures.
참고문헌 (34)
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