Connect
MJA
MJA

In defence of calcium

B E Christopher Nordin
Med J Aust 2011; 194 (1): . || doi: 10.5694/j.1326-5377.2011.tb04133.x
Published online: 3 January 2011

Reports of adverse events related to calcium supplementation should be supported by rigorous evidence

Calcium is an essential nutrient, not only because of its major role in bone, where 99% of it is stored, but because of its central role in neuromuscular function. It is this latter role that explains why ionised calcium in the blood and tissue fluids is one of the most tightly controlled analytes of those that are commonly measured.1 However, maintenance of the calcium level in tissue fluids carries with it the penalty of continuous loss of calcium through the kidneys, bowel and skin, even on a low calcium intake, which is why the recommended daily calcium allowance for adults is relatively high, at 1000 mg.2


  • 1 Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA.
  • 2 Discipline of Medicine, University of Adelaide, Adelaide, SA.



  • 1. Morris HA, Cleghorn BD, Need AG, et al. The 5-year reproducibility of calcium-related biochemical variables in post-menopausal women. Scand J Clin Lab Invest 1995; 55: 383-389.
  • 2. National Health and Medical Research Council. Nutrient reference values for Australia and New Zealand. Canberra: NHMRC, 2006.
  • 3. Shen V, Birchman R, Xu R, et al. Short-term changes in histomorphometric and biochemical turnover markers and bone mineral density in estrogen and/or dietary calcium-deficient rats. Bone 1995; 16: 149-156.
  • 4. Heaney RP. Long-latency deficiency disease: insights from calcium and vitamin D. Am J Clin Nutr 2003; 78: 912-919.
  • 5. Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-281.
  • 6. Recker R, Lappe J, Davies KM, Heaney R. Bone remodelling increases substantially in the years after menopause and remains increased in older osteoporosis patients. J Bone Miner Res 2004; 19: 1628-1633.
  • 7. Nordin BEC, Wishart JM, Clifton PM, et al. A longitudinal study of bone-related biochemical changes at the menopause. Clin Endocrinol (Oxf) 2004; 61: 123-130.
  • 8. O’Loughlin PD, Morris HA. Oestrogen deficiency impairs intestinal calcium absorption in the rat. J Physiol 1998; 511: 313-322.
  • 9. Morris HA, Porter SJ, Durbridge TC, et al. Effects of oophorectomy on biochemical and bone variables in the rat. Bone Miner 1992; 18: 133-142.
  • 10. Tang BMP, Eslick GD, Nowson C, et al. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 2007; 370: 657-666.
  • 11. Abrahamsen B. Patient level pooled analysis of 68 500 patients from seven major vitamin D fracture trials in US and Europe. BMJ 2010; 340: b5463.
  • 12. Bolland MJ, Avenell A, Baron JA, et al. Effect of calcium supplements on risk of myocardial infraction and cardiovascular events: meta-analysis. BMJ 2010; 341: c3691.
  • 13. Duque G, Close JJ, de Jager JP, et al. Treatment for osteoporosis in Australian residential aged care facilities: consensus recommendations for fracture prevention. Med J Aust 2010; 193: 173-179. <MJA full text>
  • 14. Chapuy MCF, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 1992; 327: 1637-1642.
  • 15. Reid IR, Mason B, Horne A, et al. Randomized controlled trial of calcium in healthy older women. Am J Med 2006; 119: 777-785.
  • 16. Boonen S, Lips P, Bouillon R, et al. Need for additional calcium to reduce the risk of hip fracture with vitamin D supplementation: evidence from a comparative meta-analysis of randomized controlled trials. J Clin Endocrinol Metab 2007; 92: 1415-1423.
  • 17. Wang L, Manson JE, Song Y, Sesso HD. Systematic review: vitamin D and calcium supplementation in prevention of cardiovascular events. Ann Intern Med 2010; 152: 315-323.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.