In 2008 the results of a small study were published reporting on the use of choline stabilized orthosilicic acid a form of silicon, or placebo in 184 women with low bone density. The women also received 1,000 mg of calcium in addition to vitamin D3 supplements. At 12 months 136 women had completed the study. There was wide variation in the markers of bone repair and renewal, a trend for higher markers of bone formation in the group receiving the orthosilicic acid. There was no significant change in the bone density at 12 months between the placebo group and the orthosilicic acid group.

There may be a potential benefit with this compound and it may warrant further research. However, at this time the research data available is extremely limited and has not confirmed that this product is of value in improving bone health and reducing the risk of fracture. Individuals with osteoporosis or low bone density should consult their physician regarding the best treatment options for them.

Prepared and reviewed by members of the Scientific Advisory Council of Osteoporosis Canada – Updated August 6, 2013

Calcitonin is a hormone found naturally in our bodies. A synthetic form of calcitonin (Miacalcin NS® or generic calcitonin) is used in a nasal spray It decreases the function of the osteoclast (bone-eroding cells) and can decrease bone loss and the risk of spine fractures. It has also been found to be helpful in decreasing bone pain after a spine fracture. Calcitonin is also approved for the treatment of Pagets bone disease as well as for the treatment of high blood calcium in those with cancer. In 2012, the European Medicines Agency (EMA) reviewed the benefits and risks of taking this medication and noted that a small increased risk of cancer has been seen with long term use of calcitonin. The EMA reviewed all available information including safety data following release of the drug on the market as well as information from experimental cancer studies. A 2.4% increased rate of cancer was seen in those taking nasal calcitonin long term. The concern regarding cancer risk did not appear to be present with short term use (≤6 months). At this time the increased risk of cancer has not been confirmed to be caused by calcitonin and may simply be an association.

In July 2013, Health Canada decided to withdraw all nasal spray calcitonin products from the market following a review of the safety and effectiveness data for synthetic calcitonin. Calcitonin does not have a very potent anti-osteoporosis effect, and does not decrease the risk of hip or nonspine fractures. For this reason, Osteoporosis Canada has previously advised that it not be used as a first line treatment for osteoporosis. People taking nasal calcitonin for osteoporosis should speak to their physician regarding a switch to an alternative product.

A recent report by the US Preventive Services Task Force (USPSTF) suggests that low doses of vitamin D up to 400 IU daily and calcium supplements up to 1000 mg daily are not effective in reducing the risk of fracture in healthy people (that is, people without osteoporosis or fractures).

The report expresses concerns that the use of calcium and vitamin D supplements may increase the risk of kidney stones in certain individuals and that for some, the potential benefit may not justify the potential harm.

Further research is needed to better determine the benefits and risks of calcium and vitamin D supplementation in healthy low risk adults. Based on all research to date, Osteoporosis Canada still recommends that those who are 50 years of age or more take 1200 mg of elemental calcium daily, preferably from dietary sources, and 800-2000 IU of a vitamin D supplement daily. Those who are under 50 and at high risk (with osteoporosis, multiple fractures, or conditions affecting vitamin D absorption) also require 800 – 2000 IU of a vitamin D supplement daily.

Along with exercise, good nutrition, and in some cases medication (for those who have an increased risk of fracture), dietary calcium and vitamin D supplementation are important components of a comprehensive plan to maintain your bone health.

Osteoporosis Canada urges all individuals to get the recommended amounts of calcium and vitamin D to protect their bone health.

It is important to talk to and work with your doctor to determine your fracture risk and to ensure that you have the bone health plan that is right for you.

Prepared and reviewed by members of the Scientific Advisory Council of Osteoporosis Canada

Calcium is essential for the achievement and maintenance of normal bone health. The current daily requirements for elemental calcium are approximately 1200 mg daily preferably from dietary sources and if this is not possible then supplements are recommended ideally in the form of calcium carbonate or calcium citrate. Recently concern has been raised regarding potential increased risk of coronary events in association with calcium supplements.

Research from New Zealand evaluated the results of 11 randomized controlled trials of calcium supplementation involving more than 12,000 patients. Ian Reid and his colleagues found an increase in the risk of heart attacks by 31% in the groups receiving calcium in comparison to placebo with 143 women experiencing a heart attack in the calcium groups and 111 women experiencing a heart attack in the placebo groups. This analysis however included studies in which women reported the presence of a heart attack based on their own opinion and the facts were not confirmed by medical records. In the review of the Women’s Health Initiative women who were taking calcium and vitamin D in addition to their own personal use of calcium did not have an increased risk of heart attacks or stroke. There was also no relationship between daily dose of personal calcium supplements and the risk of a heart attack or stroke

Li and colleagues evaluated 23,980 men and women from the European Prospective Investigation into Cancer and Nutrition cohort study (EPIC study). Participants completed questionnaires providing information on dietary calcium intake and the use of supplements. Those people with an increased intake of dietary calcium had a lower risk of heart attacks by approximately 31%. People using calcium supplements actually had an almost 2 fold increased risk of heart attacks. This study also has been criticized as the questionnaire simply asked the people if they took “vitamins” but did not ask which ones and the amounts taken. The presence of heart attacks was however confirmed by following medical records or reviewing the death certificates.

In summary the research studies which have been completed have been relatively small and have been of less than ideal design. Further research with large well designed studies is needed.

Osteoporosis Canada recommends that daily intake of calcium be obtained largely from dietary sources. If this is not possible then supplements may be used preferably calcium carbonate or calcium citrate following discussion with your doctor regarding the safe dose for each individual.

It is well known that calcium is a necessary nutrient because it plays an essential role in human health, not only for bone development but also for the heart, muscle and nerve functions. However, there have been some unsettling news reports this past week about a possible connection between excess calcium supplements and the risk of heart attacks. Some of us have been asking ourselves if it is time to reduce or even stop our calcium supplements. We therefore are happy to provide you with some information to help you get your calcium the best and healthiest way possible.

Osteoporosis Canada now recommends that everyone obtain their calcium through nutrition whenever possible. Even if you take excess calcium from your diet, that is not harmful. However, some individuals just can’t seem to get enough calcium in their diet. These persons may need to take a calcium supplement, but this should be discussed with a physician as calcium supplements can have some side effects and have been associated with some risks.

To know whether or not you need to take a calcium supplement, you really need to figure out how much calcium you are getting in your diet. Here is a very simple way to calculate this.

First, give yourself a baseline of 300 mg of calcium simply for eating anything at all. This is because there is a small amount of calcium in a variety of foods such as breads, muffins, oranges, etc. At the end of the day, even without eating any high calcium foods, you can’t help but get about 300 mg of calcium in your daily diet.

Now, add another 300 mg for any of the following high calcium foods: ฀

• 1 cup (250 ml) of cow’s milk or goat’s milk (including whole milk, 2%, skim or chocolate milk) ฀
• 1 cup (250 ml) of fortified soy, almond or rice beverage ฀
• 1 cup (250 ml) of fortified (or calcium rich) orange juice ฀
• ¾ cup of yogurt (175 ml) ฀
• 2 slices of cheese ฀
• one chunk of cheese (a 3 cm cube).

Three servings of any of the above will give you about 900 mg of calcium, and if you add the 300 mg of baseline calcium for eating anything at all, this will ensure the 1200 mg of calcium you need if you are over 50. Don’t forget to add in any calcium you might be getting from a multivitamin tablet.

If you are already getting close to the recommended amount of calcium for your age group, then you are doing great. Your body needs calcium and you are already getting the calcium you need from your diet.

Extra dietary calcium is not harmful. However, getting more calcium than you need from supplements can be harmful. Excess calcium from supplements has been associated with kidney stones, heart problems, prostate cancer, constipation and digestive problems. Do not take extra calcium from supplements if your diet is already giving you enough calcium.

If you are not getting or cannot get the recommended amount of calcium for your age group from your diet, or if you are not certain if your diet is giving you enough calcium, then you should discuss whether you need to take a low dose calcium supplement with your doctor. You should not just arbitrarily take a calcium supplement on your own.