Letters
Endocrinology
Volume 194 - Issue 8

In defence of calcium

Authors:  Gustavo Duque, on behalf of Jacqueline J Close, Julien P de Jager, Peter R Ebeling, Charles Inderjeeth, Stephen Lord, Andrew J McLachlan, Ian R Reid, Bruce R Troen and Philip N Sambrook

Med J Aust 2011; 194 (8): 430-431. || doi: 10.5694/j.1326-5377.2011.tb03048.x
Published online: 18 April 2011
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To the Editor: We read with interest the recent editorial by Nordin,1 which makes several imprecise observations on our recent position statement in the Journal.2 Here, we analyse some of his statements, as we believe that they are misleading to your readers and hazardous to institutionalised older persons.

The Consensus Conference on Treatment of Osteoporosis in Residential Aged Care Facilities (RACFs) was organised as a unique type of meeting in which Australian experts in osteoporosis and geriatric medicine, including representatives from the Australian and New Zealand Bone and Mineral Society (ANZBMS) and Osteoporosis Australia, participated in multiple interactive sessions with 50 geriatricians and general practitioners who practise in RACFs. The goals were to appraise current evidence in the field of falls and fracture prevention in RACFs and to define practical, evidence-based recommendations. A similar meeting took place in 2004 in Canada,3 where conclusions played a pivotal role in optimising osteoporosis care in RACFs. Conclusions of the Australian meeting and recommendations subsequently published in the Journal are products of both the general consensus of the participants in the final plenary session and contributions of all the coauthors.2

Our article states, “In adults with a baseline calcium intake of 500–900 mg/day, increasing or supplementing this intake by a further 500–1000 mg/day has a beneficial effect on BMD [bone mineral density]”.2 In light of the evidence that we cited4 and more recent evidence,5,6 it is Nordin’s responsibility to highlight the potential risks of excessive calcium intake, from dietary sources plus supplements, in a population that is at high risk of cardiovascular disease.7 Moreover, we are not alone in raising this concern — a recent statement from the American Society for Bone and Mineral Research has expressed similar concern.8

In addition, Nordin cites the seminal work of Chapuy and colleagues; although this study was carried out in nursing homes and apartments for older people, it only looked at independent, ambulatory older people.9 Furthermore, the statement regarding calcium compliance is again supported by a study performed in ambulatory populations, in which compliance is likely to differ from that in our population of interest.

Finally, Nordin asserts that our article promotes the use of bisphosphonates, particularly the intravenous variety, and makes the unfounded suggestion that the recommendation of bisphosphonates was due to the relationship between the sponsor and some of the coauthors. This is inaccurate. The University of Sydney, funded by a medical education grant, organised the Consensus Conference. Also, both the ANZBMS and Osteoporosis Australia endorsed the meeting and the integrity of the funding process. Indeed, maintaining independence from the sponsor was a major goal of the Consensus Conference, which was attested to by the feedback from participants.

In conclusion, a basic knowledge of geriatric pharmacology and a good understanding of the current literature on geriatric medicine are enough to value the recommendations presented in our article.

Author

  • Gustavo Duque1
  • 1. Ageing Bone Research Program, Sydney Medical School — Nepean Campus, University of Sydney, Sydney, NSW.

Correspondence: gustavo.duque@sydney.edu.au

Competing interests

Competing interests relevant to this letter are declared in the original position statement.2 In addition, Gustavo Duque has received honoraria from Servier, Novartis and Sanofi-Aventis; payment for development of educational presentations from Servier; and support for travel and accommodation from Sanofi-Aventis. His employing institution has received a research grant from Merck. Charles Inderjeeth has received payment for board membership from Amgen, Novartis and Sanofi-Aventis; payment for consultancy from Sanofi-Aventis and Novartis; honoraria from Sanofi-Aventis, Servier and Novartis; payment for development of educational presentations from Sanofi-Aventis and Novartis; and support for travel and accommodation from Sanofi-Aventis and Novartis. His employing institution has received grants from Sanofi-Aventis, Servier and Merck Sharpe and Dohme.

References

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