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Evidence Summary

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In people over 50 years of age, dietary or supplemental calcium increases bone mineral density

Tai V, Leung W, Grey A, et al. Calcium intake and bone mineral density: systematic review and meta-analysis. BMJ. 2015 Sep 29;351:h4183.

Review question

In people over 50 years of age, does increasing calcium in the diet or with supplements affect bone mineral density (BMD)? See related Evidence Summary of a review by Bolland.

Background

Calcium is important for bone health, but people often don’t get enough of it in the food they eat. As we age, we lose bone mass. Doctors often recommend eating more calcium-rich foods or taking calcium supplements to improve bone mass, which is measured as BMD.

How the review was done

The researchers did a systematic review, including studies up to September 2014. They found 15 randomized controlled trials of dietary calcium that included 1533 people and 51 randomized controlled trials of calcium supplements that included 12 257 people.

Dietary sources of calcium were milk or milk powder, dairy products, or hydroxyapatite (a supplement that is made from bone and has other minerals, hormones, protein, and amino acids in addition to calcium).

The main results were BMD at the lumbar spine (lower back), femoral neck (top part of the thigh bone that connects to the ball of the hip joint), total hip, and forearm.

What the researchers found

21 trials had a low risk of bias.

Dietary calcium increased BMD by 0.7% to 1.8% at lumbar spine, femoral neck, and total hip at 2 years.

Calcium supplementation increased BMD by 1.0% to 1.8% after 2.5 years.

The reviewers did not assess whether people taking additional calcium had fewer bone problems such as fractures.

Conclusion

In people over 50 years of age, dietary calcium or calcium supplements increase bone mineral density by less than 1.8%.

Dietary calcium or calcium supplements in people over 50 years of age

Bone mineral density (BMD) measurement site

Source of calcium

Number of trials (number of people)

Effect of calcium on BMD

Lumbar spine

Diet

8 trials (816 people)

Increased BMD by 0.7% at 2 years

Femoral neck

Diet

7 trials (783 people)

Increased BMD by 1.8% at 2 years

Total hip

Diet

5 trials (689 people)

Increased BMD by 1.5% at 2 years

Forearm

Diet

2 trials (171 people)

No difference in effect at 2 years

Lumbar spine

Supplements

8 trials (3,861 people)

Increased BMD by 1.0% after 2.5 years

Femoral neck

Supplements

5 trials (2,257 people)

Increased BMD by 1.5% after 2.5 years

Total hip

Supplements

6 trials (3,835 people)

Increased BMD by 1.2% after 2.5 years

Forearm

Supplements

5 trials (437 people)

Increased BMD by 1.8% after more than 2.5 years

 




Glossary

Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Risk of bias
Possibility of some systematic error in the studies.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Web Resources

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    This patient decision aid helps women who have gone through menopause and may have osteoporosis decide on methods to keep your bones healthy. It facilitates the process by outlining and comparing the choices such as medicine, menopausal hormone therapy (MHT), and exercise.
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    Osteoporosis Canada recommends everyone over age 65 have routine bone density tests. Start routine testing earlier if you are at increased risk for broken bones. Use the FRAX tool to predict your risk of having a fracture related to osteoporosis (link in this resource).
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

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