• Research published in MJA questions the role of calcium and vitamin D supplementation for older adults in the general population.

  The findings state that supplementation alone provides little benefit to those who are not overtly deficient in either nutrient. The authors concede, however, that both have an important role to play in supporting specific at-risk groups and certain health conditions.

  Fast facts
  

• A food first approach – including calcium-containing foods, weight-bearing exercise and safe sun – is essential for healthy bones. Those who cannot consume enough or whose lifestyle is restrictive, a calcium supplement may be helpful. The advice of a GP is recommended.
• A calcium supplement of around 600mg is considered safe and effective.,
• Calcium intake significantly above the recommended level is unlikely to achieve additional benefit for bone health.
• The quoted study says: “Calcium supplements in healthy individuals are not needed, nor are they required in most people receiving treatment for osteoporosis.” However, the latter is inconclusive.
• People need fewer calories as they get older so obtaining all the nutrients – consuming all of the wide variety of foods needed for optimal health –  can be difficult.
• Older people often have several conditions for which they are being treated for and the treatments may well affect calcium status.
• When taken at the recommended dose, help supports healthy bone and muscle and may help prevent osteoporosis.
• There are specific conditions for which these supplements are useful, such as osteomalacia (a condition similar to rickets that causes soft, weak bones).
• People with kidney disease and other conditions should only take calcium supplements after recommendation by their GP.
• The door is not closed to calcium and vitamin D supplements just yet.

Background

Without doubt, a healthy mixed diet, including calcium-rich foods such as dairy and non-dairy equivalents, leafy greens and canned fish, together with regular weight-bearing exercise and safe sun exposure are all essential in supporting optimal bone health.

 

People with a family history of osteoporosis, or who are interested in understanding more about their bone health, should speak to their health professional to determine a health care plan personalised to their specific needs.

 

More about calcium and vitamin D

The mineral calcium is essential for building and maintaining healthy bones, as well as organ and muscle function and more.
 

Vitamin D is also vital for building and maintaining healthy bones; it aids calcium absorption. It is made when the skin is exposed to sunlight (lack of safe sun exposure is the major cause of D deficiency among most people who are deficient, such as the elderly and housebound). It is also found naturally in small amounts in fatty fish including tuna, mackerel, and salmon, as well as beef liver, cheese and egg yolks.

 

Calcium-rich and calcium added (‘calcium-fortified’) foods as well as dairy and non-dairy equivalents, canned salmon and sardines, broccoli, mustard cabbage, bok choy, and silverbeet are calcium-rich. Regular weight-bearing exercise is also important for healthy bones.

 

Calcium intake in the population

According to HealthDirect, nearly half of Australians don’t get the recommended dietary intake of calcium putting people, and the elderly housebound at risk of osteoporosis and fractures. Diet may become more restricted with age and the ability to absorb nutrients also declines with advancing age. Plus, the use of multiple medications may interfere with healthy absorption. A calcium supplement may be prescribed to bridge the calcium gap.

 

Heart disease and kidney stones

The study acknowledges that calcium supplements may be linked with heart disease and kidney stones. Generally, results are taken from combined data from smaller studies where doses of calcium supplements were, on average, well above 600mg (1000–1300mg), “Some researchers found a small increase in these risks, but others have not.” says Professor Mark Cooper, an endocrinologist and Deputy Chair of the Medical and Scientific Committee at Osteoporosis Australia. “Some researchers found a small increase in these risks, but others have not,” he says.

 

Anyone who is concerned about their bone health should consult their health professional who may suggest a bone mineral density test. Low density can increase the risk of fractures.

 

If extra calcium is required, taking 500mg to 600mg of supplements per day is considered safe and effective. These should be used with caution by people with a history of a kidney stone or some other kidney problems.

 

As far as older adults are concerned, an intake of 1300 mg calcium is recommended for women 51 and over. If calcium intake is not adequate, the mineral is leached from the bones leading to loss of bone density predisposing the individual to conditions such as osteoporosis.

 

This is common in Australia especially in the over 60s, those who don’t get out in the sun (the sun is the primary source of vitamin D), those who drink a lot of alcohol and caffeinated drinks, people with kidney disease and those who regularly take corticosteroids.

 

Adequate Vitamin D status is essential for active calcium absorption from the gut and for bone development and remodelling. Diet is the best source of calcium. If anyone is concerned in any way, it is important to seek advice of a health professional, especially if aged over 50; a bone density scan may be recommended.

 

While a healthy mixed diet is essential, so is activity. But lifestyle and appetite can change with age affecting diet.

 

Decreasing appetite or reduced ability to buy and prepare healthy foods can mean that many older people don’t get enough essential vitamins and minerals. Plus, the need for fewer calories adds to this difficulty.

 

Calcium deficiency is common in Australia. Professor Peter Ebeling, Medical Director of Osteoporosis Australia, says: “The average calcium intake in Australia is around 700–800mg per day.” (The RDI is 1000–1300mg.)

Groups at particularly high risk include adolescents (especially girls) and post-menopausal women. The calcium requirements for both these groups are higher than other age and gender groups, at 1300mg per day (four to five serves of dairy or calcium-fortified equivalent), compared to 1000mg for most adults.

 

Plus, there are specific conditions for which calcium and vitamin D supplements may be useful, such as osteomalacia (a condition similar to rickets that causes soft, weak bones).

 

The study says, “Calcium supplements in healthy individuals are not needed, nor are they required in most people receiving treatment for osteoporosis.” However, the latter is inconclusive.

 

Without doubt, a healthy mixed diet, including calcium-rich foods such as dairy and non-dairy equivalents, leafy greens and canned fish together with regular weight-bearing exercise and safe sun exposure is essential in supporting bone health.

 

People with a family history of osteoporosis, or are concerned about their bone health, should speak to their health professional to determine a health care plan personalised to their specific needs.

 

While a food first approach is recommended, the door is not closed to calcium and vitamin D supplements just yet.

 

Calcium and vitamin D

The mineral calcium is vital for healthy bones, as well as organ and muscle function.

 

Vitamin D is also vital for building and maintaining healthy bones, and it aids calcium absorption. It is made in the skin when on exposure to sunlight (lack of exposure is the cause among most people who are deficient, such as the elderly). It is also found naturally in fatty fish, like tuna, mackerel, and salmon, as well as beef liver, cheese and egg yolks. The safe sun is important so people who are housebound may be at risk. Regular weight-bearing exercise is also important for healthy bones – again, something which may become more difficult with age.

 

Look for calcium added (‘calcium-fortified’) and find calcium in dairy and non-dairy equivalents, canned salmon and sardines, broccoli, mustard cabbage, bok choy, silverbeet.

 

According to HealthDirect, nearly half of Australians don’t get the recommended dietary intake of calcium; this can put many people, and the elderly housebound at risk of osteoporosis and fractures. With age, diet may become more restricted, and the ability to absorb nutrients also declines. To absorb calcium, vitamin D is essential, so regardless of how much calcium is consumed, it may not be absorbed effectively. A calcium supplement may be prescribed to bridge the calcium gap.

 

Heart disease and kidney stones

The study says that calcium supplements may be linked with heart disease and kidney stones. Generally, the study combined data from smaller studies where doses of calcium supplements were, on average, well above 600mg, “Some researchers found a small increase in these risks, but others have not.” says an endocrinologist and Deputy Chair of the Medical and Scientific Committee at Osteoporosis Australia. The risk of this happening is very low. But calcium supplements should be used cautiously in people with a history of a kidney stone or some other kidney problems,” says Professor Cooper.

 

If a supplement is recommended by a doctor, 500mg to 600mg of supplements per day is considered safe and effective, says Professor Mark Cooper,

 

As always, before starting to take or stop taking any supplement, it is advisable to consult your doctor first.

 

Safe at the recommended dose

If extra calcium is required, taking 500mg to 600mg of supplements per day is considered safe and effective. These should be used with caution by people with a history of a kidney stone or some other kidney problems.

 

The standard Australian diet

The 2016 CSIRO Healthy Diet Score canvassed the dietary habits of more than 86,500 Australian adults over 12-months surveying more than double the amount of people studies the previous year. The nation scored 61 points out of 100 but with almost 47,000 additional surveys completed recently, the score has slipped to just 59 out of 100.

Experts urge us all to protect against the growing rates of obesity and lifestyle diseases such as heart disease, type 2 diabetes and a third of all cancers by doubling the intake of healthy food and cutting unhealthy food intake by half. This is very important for older adults and quality is vital over quantity.

 

Older adults

As far as older adults are concerned, an intake of 1300 mg is recommended for woman 51 and over.  Calcium deficiency is common in Australia. Professor Peter Ebeling, Medical Director of Osteoporosis Australia, says: “The average calcium intake in Australia is around 700–800mg per day.” (The RDI is 1000–1300mg.) This is equivalent to four to five serves of dairy or calcium-fortified equivalent), compared to 1000mg for most adults.

 

If calcium intake is not adequate, calcium is leached from the bones leading to loss of bone density predisposing the individual to conditions such as osteoporosis.

 

This is common in Australia especially in the over 60s, those who don’t get out in the sun, those who drink a lot of alcohol and caffeinated drinks, people with kidney disease and those who regularly take corticosteroids. Plus, older people often have a number of conditions for which they are being treated for and the treatments may affect calcium status.

 

For those who are concerned about bone health, they should seek advice from a GP especially if are over 50 and consider whether a bone density scan is appropriate.

 

Decreasing appetite or reduced ability to buy and prepare healthy foods can mean that many older people don’t get enough essential vitamins and minerals.

 

There are specific conditions for which these supplements are useful, like osteomalacia (a condition similar to rickets that causes soft, weak bones).

For more information, email Ravinder.lilly@cmaustralia.org.au