Calcium Supplements: Helpful or Not?

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DIRECTLY CONTRADICTORY advice on calcium and vitamin D supplements appeared on facing pages in last week’s New York Times Science Times.

Meanwhile last year, a U.S. government-appointed panel of physicians recommended “against daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium for the primary prevention of fractures” in postmenopausal women.

In April of 2014, my post on supplements and bone health described annual checkups with both my internist and my gynecologist, mistakenly scheduled within a few weeks of one another.  Because my blood levels were good, my internist advised me to stop taking both supplements, while my gynecologist reminded me that, because of my mother’s severe osteoporosis, I should be taking the maximum doses.

Five years later, not much has changed. On the left-hand page of the Science Times spread, research linked the commonly recommended daily amounts of calcium and vitamin D respectively (1,000 or more mg and 400 IU or more) with “an increased risk of death from cancer” and “increased cancer death and death from any cause.”

The same study—referred to as NHANES, involving more than 30,000 American adults—linked other vitamins and minerals with reductions in mortality but “only when the substances came from food, not supplements.” In fact, most studies showing benefits of calcium/vitamin D supplements are observational, failing to consider diet, exercise and other important variables.

On the right-hand page of the Science Times spread, Jane Brody characterized vitamin D and calcium supplements as providing “nutrients critical to forming healthy bones.”

An osteoporosis diagnosis begins with a DEXA or DXA scan that measures the mineral content of bones as an indication of bone strength. Those with bone density scores T-scores of -2.5 or below, as a group, have a 33% chance of fracturing a hip compared with a 16% risk with a score of -1.  These scores, along with a history of fracture, can help determine individual risk.  For those with borderline scores, urine testing can help determine the need for drug treatment.

Decreasing bone density occurs over time when bone resorption exceeds bone formation, which is controlled by hormones, such as estrogen and parathyroid hormone, as well as by specific proteins in the bone.

Bisphosphonate drugs can inhibit bone resorption by blocking the osteoclasts that cause breakdown, in turn allowing osteoblasts to create more new bone.  Other osteoporosis drugs affect parathyroid hormone levels or create antibodies to proteins in the bone to encourage bone growth.

Side effects of these drugs, however, include gastrointestinal problems as well as increased risk of stress fractures and deterioration of specific bones.  The numbers of osteoporosis patients and their doctors who “have turned their backs on bone-protecting medicine” have led to a plateauing of hip fractures since 2012, following 10 years of declining rates, Brody noted.  One study of 126,188 women, all of whom had Medicare Part D drug coverage, found fewer than one-third started drug therapy within a year of diagnosis.

In her 2015 article,“12 Minutes of Yoga for Bone Health,” Brody described research by Columbia University physiatrist Loren Fishman that found yoga increased bone density in the spine and femur.  “Yoga puts more pressure on bone than gravity,” Fishman told her.  “By opposing one group of muscles against another, it stimulates osteocytes, the bone-making cells.”

“Yoga for osteoporosis,” offered at Circle Yoga off Chevy Chase Circle and elsewhere, concentrates on the 12 poses used in Fishman’s study, with the recommendation to hold each pose for 30 seconds—a routine that takes closer to 20 minutes than 12—and poses are adjusted for individual bodies.

The worst outcomes for osteoporosis sufferers come, not from brittle bones themselves, but from the increased risk of falling for which the best protection is good balance.  Yoga for osteoporosis focuses on balance in most of the poses—not just tree pose (standing on one leg).

In Northwest Washington, a “forum” of four friends—after comparing DXA scan results, diagnoses of osteoporosis and prescriptions for osteoporosis drugs—determined to find ways to strengthen their bones without taking drugs or relying on supplements.

They wanted to avoid the side effects. Even calcium/vitamin D supplements can cause gas and bloating, as well as constipation.  Also supplements may increase the risk of serrated polyps, precursors to colon cancer.  These concerns aside, there is abundant medical research and professional statements advising against supplements.

The group started when two friends broke bones—one her wrist, the other her hip.  Calling themselves Gimpy and Limpy, the two commiserated and, with two others, began sharing research on bone health.  While some take small amounts of supplements, they try to get most of their calcium from diet—notably dark, leafy greens and bone broth.

One member, MH (Limpy), continues with a low-inflammation diet, which includes less dairy, sugar and processed foods, and more vegetables, fruits and grains.

Exercise choices varied.  For the first time ever, MH, a former runner, signed up for twice-weekly personal training sessions for almost four months. The sessions worked on strength and flexibility, with a particular focus on her feet.  Because she had already been doing Gyrotonics—exercises involving a series of circular, flowing movements—MH added Gyrotonics-related PT, which includes weights, all at Elements Center in Georgetown.

In the three years since they began, several members have not just leveled off but improved their DEXA scores.  It may help that they have each other to compare notes and scores, and even egg each other on.  But their success in improving bone strength is enough to inspire someone like me, wavering between opposing doctors’ recommendations, finally to let go of calcium supplements and see what I can do for myself—with diet, exercise, and yoga whenever possible.

—Mary Carpenter

Every Tuesday in this space, well-being editor Mary Carpenter reports on health news you can use.