Sunday, 5 June 2011

The New Controversy Calcium Intake

Researchers found that patients who underwent bariatric surgery appear to have a 2.3-fold increased risk for fracture compared with the general population. The finding from the final analysis is higher than the 1.8-fold increased fracture risk reported 2 years ago in this study population.

Minnesota Images
This photo of Minnesota is courtesy of TripAdvisor

But the study was done in Minnesota, so the population would be predominantly White or European descent, a group susceptible to osteoporosis and Fractures
But this study said, osteoporosis was not the reason for the fractures, but something else that was in the bone metabolism or structure that increased the fractures. They suggest calcium and vitamin D optimization ..
Measures to optimize bone health
Kennel said the link between bone health and bariatric surgery is not a new issue. However, “the problem is that lately we see evidence in the literature that people who are trying to get enough vitamin D and calcium still show signs that their bones are changing in a negative way,” he said at the press conference.
Of note, patients who developed fractures did not necessarily develop osteoporosis, the researchers said.
“We need to start looking at the skeleton as one of the key issues for long-term follow-up [of bariatric surgery],” Kennel said. Clinicians may also need to consider other measures to improve post-surgery bone health, such as proper calcium and vitamin D nutrition and fall prevention, he added.

But a study from New Zealand throws some light on Calcium and Vitamin D supplementation, it increases your rate of Heart Attacks..
For women the choice has been broken bones or broken hearts?
A new study from New Zealand now extends the increased cardiovascular risk (CVR) linked to calcium supplements to include people who are also taking vitamin D. The study, published in the British Medical Journal this past month by Dr. Mark Bolland from the University of Auckland, New Zealand, observed that the combination of calcium and vitamin D — popular supplements taken by millions of patients to reduce the risk of bone fractures — may be associated with a20% increased risk of both MI and stroke.
A significant amount of controversy erupted last year when Bolland and colleagues reported on a meta-analysis of patients taking calcium alone compared to placebo, or people taking calcium/vitamin D combination compared with people taking vitamin D alone, and described a significant increase in myocardial infarction risk. This observation was at odds with a Women’s Health Initiative (WHI) study which had shown no adverse CVR in women taking this combination of supplements, as compared with those randomized to placebo.
As Dr. Russo and I have reported recently in this blog, Vitamin D is enjoying a wave of popularity as a CVR prevention strategy. This effect clearly was not seen in this analysis. As the authors pointed out, “This doesn’t rule out that possibility [that vitamin D may be protective], but what we’re saying here is that the calcium effect seems to be dominant when you give the two together.” I don’t think we are at the point where we need to tell patients to stop taking all dietary supplemental calcium. It seems prudent to recommend increased dietary calcium for patients with osteoporosis and recommend supplements to patients who are unable to get their dietary calcium intake. After all, suggestions that dietary calcium carries these same risks are not out there. In the end, I think that the most important recommendation at this point is to prompt physicians and patients to discuss the risks and other options for osteoporosis management/prevention. Please remember that there are other studies showing that the use of calcium and vitamin D with bisphosphonates for osteoporosis have been so far reassuring and appear safe from a cardiovascular standpoint. Clearly further studies are needed, and the debate remains ongoing.

Any correlation to the fact that the study was done in New Zealand where the calcium intake from dairy products may alredy be high?
The authors state that the effect of calcium overrides that of the addition of vitamin D, does it give us the idea that vitamin D increases calcium absorption and in new Zealand they are being overdosed with Calcium?
Obviously there is no blanket recommendations and there is more tricks to this than just calcium dosage
How much calcium?
In what form?
When to take it?
Gender and race differences?
Quality of calcium? Where it comes from?

This news is of great importance and I am sure you are going to hear more about it…