Recently I asked myself a question about whether there were any topics of nutrition that I could write about that very few people in the nutrition world were already providing. The conclusion that I came to was the findings of my systematic review that I did in my final year at university. This was on the topic of whether calcium and vitamin D supplements reduce the risk of fractures in the elderly.
I chose this subject because there had been no clear answer in the research. I figured that it’s something that I could share that nobody else could.
It never made sense to me why there was no clear result in the research. Calcium has always been strongly linked to increases or maintenance of bone mineral density. It only makes sense that it would reduce the risk of fractures.
Meanwhile, the body of research had mixed results suggesting that calcium supplementation reduces the risk of fractures and other results showing that it does not have a significant effect.
This was quite confusing and I can see why it isn’t common knowledge about whether or not calcium supplements are effective for reducing the risk of fractures.
The key point I found was that all the studies using less than 1200mg of calcium carbonate had no significant effect and the people that used at least 1200mg did find a reduction in the risk of fractures.
This makes sense. If the dosage utilised is too low of course the results won’t be significant.
This can make the research looked mixed. But when you narrow it down to only include studies with sufficient dosages it looks clearcut.
That factor is only part of the equation though.
Getting People to Take Calcium Supplements is Surprisingly Hard
The most interesting thing I found was that in at least one study, a lot of the participants didn’t take the supplements as frequently as required. This caused the study results to be insignificant. If you looked at the people who actually took their supplements as planned, they had a reduction in their risk of fractures.
I think this is an issue that is extremely transferable to the real world. Even with the knowledge that something as simple as taking a certain dose of a supplement may reduce the risk of serious concern, people need to be motivated to actually follow through.
The other factor is that calcium supplementation is typically best taken as a split dosage, for example, 600mg in the morning and 600mg at night. This is because there is a limit on absorption, which is below the optimal daily dosage.
Taking a supplement as a split dosage makes it a bit more inconvenient which although it doesn’t seem like a big deal, can be a major factor in reducing compliance.
Should You Be Taking Calcium Supplements?
This is a difficult question to answer since it depends on the individual situation.
The research showed that 1200mg of calcium carbonate reduced the risk of fractures in people aged 50 years or older. But this could be misleading since it didn’t account for calcium in the diet. Perhaps there would have been less of an effect for people who were consuming adequate calcium in their diet and more of an effect for people who didn’t consume enough.
To put things into terms of food, for men aged 51-70 years old the recommended number of serves of dairy is 2 ½ and this goes up to 3 ½ when they are 70+ years old. Women aged 50+ are recommended to have 4 serves of dairy per day. This is a pretty high amount of dairy and is beyond anything that I typically recommend, even as somebody who is overly passionate about calcium.
A serve of dairy is one cup of milk, two slices of cheese, ¾ cup of yoghurt or one cup of an alternative milk drink (e.g. soy) with at least 100mg of calcium. For some people, these goals are pretty easy to meet, but I can definitely see why some people can’t really see themselves consuming four serves of dairy every day.
Alternatively, you can get your calcium from sources apart from dairy. The recommended daily intake of calcium is 1000-1300mg per day depending on your age group. Some non-dairy foods high in calcium are canned salmon with bones (230mg per can), leafy green vegetables (75mg in a cup of Bok Choy, 95mg in a cup of Kale), almonds (70mg in ¼ of a cup), oranges (65mg in one orange) and calcium set tofu (430mg in ¼ of a cup).
It is possible to tailor your diet to make sure you are getting enough calcium without consuming dairy. However once again, I can see why people could also see that as unrealistic for them as an individual.
Getting the calcium from food sources is better because it has other nutritional benefits – for example, the calories and protein in dairy products can help maintain muscle mass which could reduce the risk of falls. They also contain micronutrients such as B Vitamins, phosphorus and potassium.
Although food is preferable, if it is clear that you are not getting enough calcium in your diet it is likely that calcium supplementation will help maintain your bone mineral density and reduce your risk of fractures.