Osteoporosis Canada

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Canadians Putting Themselves at Risk for Osteoporosis: Survey

New survey reveals Canadians are largely unaware about osteoporosis and the serious consequences it can have on their health

TORONTO, ON (February 2, 2016) – Snow and ice can make walking challenging, especially for those at risk of fractures due to osteoporosis. In fact, one in three Canadian women, and one in five Canadian men, will break a bone because of osteoporosis, a debilitating disease that can strike at any time, causing bones to become fragile and break. Each year in Canada, broken bones caused by osteoporosis are more common than heart attack, stroke and breast cancer combined for women over the age of 50, despite the fact that if simple steps are taken in your 30s, the risk can be reduced.

“Many people think that osteoporosis is a natural part of aging, but this is not the case,” said Dr. Famida Jiwa, President and CEO of Osteoporosis Canada. “Every year, thousands of Canadian women break bones due to undiagnosed osteoporosis, despite the fact that the disease can be effectively managed, and in some cases prevented. We strongly encourage everyone over 30 to speak to a healthcare professional about osteoporosis and the steps that they can take to protect themselves.”

Despite the severity and prevalence of osteoporosis, a new survey released today from Osteoporosis Canada, in partnership with Shoppers Drug Mart, reveals startling gaps in Canadians’ knowledge and understanding of the disease.2 The survey results show that half of those in their 30s don’t know the facts about osteoporosis and how to reduce their risk of developing this disease.2

Additional results and statistics include:

  • By 2035, it is estimated that almost 42,000 individuals per year will experience a broken hip, meaning that those in their 30s and 40s now are at risk3
  • 1.4 million Canadians have osteoporosis; however, only five per cent of respondents rated themselves as knowledgeable about the disease2, 4
  • When asked about key facts of the disease, the majority of Canadians admitted they are not aware of seven of eight key facts about osteoporosis and complications that are related to the disease2
  • Although guidelines recommend consumption of 1000-1200 mg of calcium per day, most women fail to reach this level with their dietary intake – many only getting 300 mg/day5
  • In Canada, among people over 50 years old, 80 per cent of broken bones are caused by osteoporosis, while 80 per cent of Canadians who break a bone are never assessed for possible underlying osteoporosis1
  • As of 2010, the overall yearly cost to the Canadian healthcare system for treating osteoporosis and the fractures it causes was over $2.3 billion6

“It’s never too early to start thinking about bone health and there are easy steps that Canadians can take, at every age, to help prevent osteoporosis,” said Bhavika Prajapati, pharmacist and Associate-Owner, Shoppers Drug Mart. “Ensuring your diet is rich with calcium, supplementing with vitamin D and adding regular exercise to your daily or weekly routine will help build bone strength and can make a difference in prevention of osteoporosis and fractures.”

As part of this effort for better bone health, Osteoporosis Canada has joined forces with Shoppers Drug Mart/Pharmaprix, whose pharmacists have received specialized training in the prevention, management and treatment of osteoporosis. Shoppers Drug Mart/Pharmaprix pharmacists are equipped to provide education and advice to patients about osteoporosis management and reducing the risk. In addition, Osteoporosis Canada is lending its endorsement to Life Brand Vitamin D and Calcium products, to help in the prevention and management of Osteoporosis.

Shoppers Drug Mart/Pharmaprix is committed to Putting Women’s Health First, which is why Shoppers Drug Mart launched SHOPPERS LOVE.YOU. program in 2015. SHOPPERS LOVE.YOU. is a program that helps women stay focused on making their own health a priority.

“Shoppers Drug Mart is thrilled to be working with Osteoporosis Canada, helping to further educate Canadian women about osteoporosis,” said Prajapati. ”Pharmacists’ expanded scope of practice offers further convenience to our customers and patients and, in this instance, knowledgeable information, to help reduce the risk of osteoporosis in Canadians.”

For more information about protecting your bones, visit your local Shoppers Drug Mart pharmacist or osteoporosis.ca.

About Osteoporosis Canada

Osteoporosis Canada, a registered charity, is the only national organization dedicated to serving people who have or are at risk of osteoporosis. In keeping with our vision of a Canada without osteoporosis fractures, the organization works to educate, empower and support individuals and communities in the risk reduction and treatment of osteoporosis by providing medically accurate information to patients, health professionals and the public.

At least 2 million Canadians are affected by osteoporosis. One in three women and one in 5 men will break a bone due to osteoporosis. There are approximately 30,000 hip fractures per year in Canada; data on spinal fractures is limited, but it is estimated that 65 per cent of vertebral fractures go undetected. For more information, visit www.osteoporosis.ca.

About Shoppers Drug Mart / Pharmaprix

Shoppers Drug Mart / Pharmaprix is one of the most recognized and trusted names in Canadian retailing. The Company is the licensor of full-service retail drug stores operating under the name Shoppers Drug Mart (Pharmaprix in Québec). With over 1,250 Shoppers Drug Mart and Pharmaprix stores operating in prime locations in each province and two territories, the Company is one of the most convenient retailers in Canada. The Company also licenses or owns 59 medical clinic pharmacies operating under the name Shoppers Simply Pharmacy (Pharmaprix Simplement Santé in Québec) and six luxury beauty destinations operating as Murale. As well, the Company owns and operates 62 Shoppers Home Health Care stores, making it the largest Canadian retailer of home healthcare products and services. In addition to its retail store network, the Company owns Shoppers Drug Mart Specialty Health Network Inc., a provider of specialty drug distribution, pharmacy and comprehensive patient support services, and MediSystem Technologies Inc., a provider of pharmaceutical products and services to long-term care facilities. Shoppers Drug Mart is a unique and independent operating division of Loblaw Companies Limited. For more information, visit www.shoppersdrugmart.ca.

References
1Osteoporosis Canada. Osteoporosis Facts and Statistics. https://osteoporosis.ca/osteoporosis-and-you/osteoporosis-facts-and-statistics/. Accessed February 1, 2016
2H+K Perspectives, Bone Health: A Survey of Canadians. June 4-14, 2015.
3Osteoporosis Canada. Fracture Liaison Services Toolkit, appendix B. https://osteoporosis.ca/fls/wp-content/uploads/FLS-TOOLKIT-App-B.pdf. Accessed February 1, 2016.
4Brown, Jacques P., Josse, Robert G., Canada and the OSC lead the way. Osteoporosis Update. 2003. https://osteoporosis.ca/local/files/health_professionals/pdfs/osteoupdate_special_e.pdf.  Accessed February 1, 2016
5Osteoporosis Canada. Calcium: An Important Nutrient that Builds Stronger Bones. https://osteoporosis.ca/osteoporosis-and-you/nutrition/calcium-requirements/. Accessed February 1, 2016.
6Tarride JE, Hopkins RB, Leslie WD, et al. The burden of illness of osteoporosis in Canada. Osteoporos Int.
Nov 2012;23(11):25912600.

SOURCE Osteoporosis Canada 

For further information: Emily Vear, Hill+Knowlton Strategies, Emily.vear@hkstrategies.ca, 416-413-4743

Public

New Study Suggests Association Between Intake of Dairy Milk with Greater Risk of Breast Cancer

A recent study from the US suggests women who drink as little as one cup /250 ml of cow’s milk per day could be increasing their risk of developing breast cancer by up to 50%. This study from Knutsen and colleagues is part of the Adventist Health Study-2, a large population-based study of Adventists from the US and Canada. The study assessed the relationship between risk of breast cancer and the intake of soy milk, other soy products, dairy milk, and other dairy foods.

This study followed nearly 53,000 women who were members of the Seventh Day Adventist Church for almost 8 years. The authors concluded that as dairy milk intake increased (regardless of fat content) so did the risk of breast cancer. No clear association was found between consumption of soy products and breast cancer.

It should be noted that this was an observational study. In this type of study, researchers observe what effect a risk factor (e.g., soy and dairy) has on health outcomes (e.g., breast cancer) over time. While this type of study can suggest a link (correlation or association) between a risk factor and an outcome, it cannot establish that the risk factor CAUSED the health outcome. In this study, dietary intake of soy and dairy was self-reported, leaving room for errors and omissions. In addition, diet was only assessed once, at the beginning of the study, meaning that possible changes in diet over the 8 years were not taken into account. The study also does not take into account other potential risk factors that could affect the outcome, such as quality of diet (fruit and vegetable intake was not measured); amount or intensity of physical activity; quantity of alcohol consumed; or amount smoked. Furthermore, Adventists diet may differ considerably from the general population as many follow a plant-based diet and exclude processed foods, alcohol, and caffeine, so it is difficult to know if these results can be applied to the general population.

The authors note that dairy milk has many positive nutritional qualities and suggest more research is needed to understand if there is a causal link between dairy intake or other closely related unidentified factors and breast cancer risk. Until then, a balanced and a varied diet including sources of calcium, regular physical activity, and avoiding smoking and excess alcohol make for a healthy lifestyle.

Osteoporosis Canada recommends that men and women over the age of 50 get 1000-1200 mg of calcium through all sources (diet and supplements). Information on non-dairy sources of calcium is available from the Calcium Calculator on the OC website.

https://osteoporosis.ca/bone-health-osteoporosis/calcium-calculator/#page-1

1. Dairy, soy, and risk of breast cancer: those confounded milks. Fraser GE, Jaceldo-Siegl K, Orlich M, Mashchak A, Sirirat R, Knutsen S. Int J Epidemiol. 2020 Feb 25. pii: dyaa007. doi: 10.1093/ije/dyaa007.

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Eating for Bone Health with the New Canada’s Food Guide

The new Canada’s Food Guide was released on Tuesday Jan 22nd. It is a modern approach to promoting healthy eating, making healthier eating choices easier for all Canadians. This new food guide focuses on what to eat and how to eat. It also includes updated recommendations on saturated fat, sodium, and sugars.

The food guide focuses on vegetables, fruits, proteins and whole grains. The new food guide encourages Canadians to choose plant-based proteins more often. According to the food guide, protein foods include legumes, nuts, seeds, tofu, fortified soy beverage, fish, shellfish, eggs, poultry, lean red meat including wild game, lower fat milk, lower fat yogurts, lower fat kefir, and cheeses lower in fat and sodium.

Canadians need adequate amounts of calcium, vitamin D and protein for optimal bone health. Milk products contain a high proportion of calcium per serving and are a great source of protein.  Calcium can also be found in other foods such as calcium-fortified food and drink, some vegetables and fruits, nuts and seeds, and legumes.  For suggestions regarding calcium containing foods, please click here.

Osteoporosis Canada continues to encourage adults who have osteoporosis or have risk factors for osteoporotic fractures, to get adequate vitamin D supplementation as it is difficult to obtain recommended levels through foods alone. Click here for more information on vitamin D.

Healthcare Professionals, Public

Increased Risk of Vertebral Fracture After Stopping Denosumab

Osteoporosis Canada advises individuals on denosumab therapy to discuss their treatment with their physician prior to delaying therapy, stopping therapy or missing a scheduled dose.  

Denosumab (Prolia) has been shown to reduce the risk of fractures in postmenopausal women and men aged 50 years or older with osteoporosis.  It has also been approved for steroid induced bone loss.

Individuals who were in the FREEDOM study, which evaluated denosumab in comparison to placebo, were followed, and those who stopped denosumab had a subsequent loss of bone mineral density (BMD) and an increase in the risk of fracture (Bone JCEM 2011).

Analysis of the data from the FREEDOM study as well as the Extension trial of denosumab (where treatment was continued up to a total of 10 years) confirmed that stopping denosumab was associated with an increase in the rate of bone loss, as measured by bone turnover markers, which rose 3 months after missing a scheduled dose. 12 months after missing a scheduled dose of denosumab, BMD decreased back to the baseline (pre-treatment) level (Cummings JBMR 2017).

Individuals who had received at least 2 doses of denosumab or placebo, and stopped treatment but remained in the study for at least 7 months after the last dose, were reviewed.  In the 1,001 patients who stopped denosumab, the rate of spine fractures increased from 1.2/100 patient-years (while on treatment) to 7.1/100 patient-years, a similar rate to the placebo group. Patient years is a statistical measure used to express the time at risk. 7.1 spine fractures/100 patient-years means that if you followed 100 people for 1 year, on average you would see 7.1 spine fractures. Multiple (more than 1) spine fractures appeared to be more common in the group stopping denosumab than the group stopping placebo (3.4% vs 2.2%). The risk of having multiple (more than 1) spine fractures after stopping denosumab was higher in those people who had already experienced a spine fracture, and also in those who had rapid rates of bone loss. The rates of non-spine fractures were similar in those stopping denosumab and those stopping placebo (2.8% denosumab, 3.8% placebo) (Cummings et al JBMR 2017).

Due to the risk of BMD loss and spine fractures associated with denosumab discontinuation, it is important not to miss scheduled doses of denosumab once treatment has started. Patients need to be advised of the increased risk of bone loss and vertebral fracture when therapy is stopped.  If denosumab needs to be stopped, it should be replaced by an alternative osteoporosis medication to help prevent rapid bone loss and risk of fractures (Symonds CMAJ April 2018).

Osteoporosis Canada advises individuals on denosumab therapy to discuss their treatment with their physician prior to delaying therapy, stopping therapy or missing a scheduled dose.

  1. Bone HG et al JCEM 2011:96:972-980
  2. Cummings et al JBMR vol 33, No2, Feb 2018 pp 190-198
  3. Symonds C, Kline G CMAJ 2018 April 23:190 pp E485-486

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Vitamin D and Effects on Fractures, Falls and Bone Mineral Density

Osteoporosis Canada’s overall position statement in response to this study:

This study did not specifically address the vitamin D requirements of individuals with osteoporosis, those with risk factors for osteoporotic fractures, or those with risk factors for vitamin D deficiency. Vitamin D is needed for optimal calcium absorption from the gut, and plays an important role in calcium balance and bone mineralization. Osteoporosis Canada recommends that individuals with osteoporosis or with risk factors for fractures receive adequate vitamin D, as recommended at 800-2,000 IU per day.

A recent article on the effect of vitamin D supplementation on fractures, falls and bone mineral density was published in the journal Lancet Diabetes Endocrinology by Bolland and colleagues (October 4, 2018). This research reviewed the available literature as part of a systematic review and meta-analysis. A systematic review is a research method used to thoroughly locate and synthesize all the information (evidence) related to a specific topic. A meta-analysis uses statistical tools to combine data from the studies included in the review to provide an overall finding. During the systematic review process, it is important that the researchers combine studies that are clinically and statistically similar. This research summarized and combined the results of 81 randomized controlled trials, in which more than 50,000 people were enrolled.

There are some noteworthy characteristics of the included 81 studies. For example, the majority of studies were done in community-dwelling women age 65 years or older, and the only “intervention” was vitamin D in doses of more than 800 IU/day. There were also studies of higher dose vs. lower dose vitamin D, as well as studies that included calcium and vitamin D given together. The studies in the review were based on participants taking vitamin D for one year, or less. The main focus of the systematic review was to look at the effect of vitamin D on fractures and falls. However, there was also a summary of the effect of vitamin D on the change in bone mineral density [from the start of the study (baseline) to the final assessment] (1).

Based on the results of the meta-analysis, the authors reported that vitamin D supplementation did not have an effect on the risk of fractures or falls, and that there were no meaningful effects on participants’ bone mineral density. The authors also concluded that there were no differences between the effects of taking higher and lower doses of vitamin D (1) for these health outcomes.

There are several factors that should be considered when reviewing these results. First, in more than half of the studies, participants had a baseline vitamin D level (25OHD – the blood test used to measure Vitamin D levels in the blood) of less than 50 nmol/L (a cutoff considered by many (2) to indicate a low level of vitamin D). Almost all of the participants had a baseline 25OHD that was less than 75 nmol/L, which is considered an adequate level. Only four trials (6%) studied people with vitamin D deficiency (25OHD <25 nmol/L), in whom vitamin D supplementation may produce different results. In addition, there can be individual differences in how the body’s level of vitamin D responds to the administration of a fixed dose of Vitamin D. Most studies used 1,000 IU per day or less, and so the 25OHD levels after treatment (used as the intervention) may not have been high enough to make a difference in the health outcomes studied (fractures and falls).

Second, the finding that vitamin D alone (without calcium) may not prevent fractures, falls or improve bone mineral density is consistent with other published reviews. However, a review of studies of calcium and vitamin D for people living in long-term care showed benefit (3) but the current meta-analysis by Bolland and colleagues included only 20 trials (25%) that compared vitamin D and calcium to calcium alone. They also did not include studies that compared vitamin D and calcium with no treatment.

Third, although the major strength of the current review lies in the large number of studies included in the analysis, it is important to recognize there are potential limitations. For example, there were differences in the participants enrolled between studies, the study designs, and the results of the studies in the meta-analysis. Importantly, this review did not specifically address the vitamin D requirements of people with osteoporosis, those with risk factors for low trauma fractures, or those with risk factors for vitamin D deficiency. Although this systematic review suggests that routine vitamin D supplementation, in particular, high dose vitamin D, may not be necessary for healthy individuals in the general population, these findings cannot be applied to people with osteoporosis, or to those with risk factors for fractures or vitamin D deficiency.

Fourth, it must be highlighted that falls have many causes. Even specific fall prevention exercise programs are not always effective, and the relative benefit of any intervention on falls is individual.

It is important to remember that vitamin D is needed to optimize calcium absorption from the gut, and plays an important role in calcium balance and bone mineralization. Inadequate vitamin D can result in poor bone mineralization, as well as bone loss due to a rise in parathyroid hormone levels.

Osteoporosis Canada recommends that individuals with osteoporosis or with risk factors for fractures receive adequate vitamin D, as recommended at 800-2,000 IU per day (4); however, vitamin D dosing may require adjustment in order to achieve the adequate 25OHD level needed for optimal calcium homeostasis. Further studies are needed to clarify the optimal 25OHD level for those with osteoporosis or with risk factors for fracture. High dose vitamin D supplementation should be avoided due to potential harms (5). There are large randomized trials currently ongoing to help answer questions about effects of vitamin D supplementation on other aspects of health (6).

Appropriate osteoporosis medication may be required for those at high fracture risk. It is important to note that clinical trials showing the effectiveness of osteoporosis medications all included vitamin D and calcium as part of the treatment regimen.

References:

1. Bolland et al. Lancet Diabetes Endocrinol Oct 2018

2. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. Michael F. Holick et al. The Journal of Clinical Endocrinology & Metabolism, 2011 96 (7): 1911-1930.

3. Papaioannou et al. CMAJ 2015 187: 1-11.

4. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada by David A. Hanley MD et al CMAJ 2010

5. Smith et al. 2017 J Steroid Biochem Mol Biol173:317-22

6. Pradhan AD, Manson JE Update on the Vitamin D and OmegA-3 trial (VITAL). Study J Steroid Biochem Mol Biol. 2016 Jan;155(Pt B):252-6.

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Long-Term Use Of Bisphosphonates Increases the Risk of Fractures in Older Women

Bisphosphonate therapy – long term use

Recently a study published by Drieling et al in JAGS 2017 described the results of a cohort study of 5120 older women with an average age of 80 yrs and at high fracture risk . This observational study from the Womens Health Initiative included 5120 women who had been using oral BP for at least 2 years and had a FRAX score of 1.5% or higher for 5 yrs. Women who had been on PTH , calcitonin or aromatase inhibitors were excluded. The average follow up data was available for 4 yrs.

10-13 yrs of oral bisphosphonate use was associated with higher risk of any clinical fracture then 2 yrs of use HR =1.29 , 95% CI 1.07-1.57.

There was no association between intermediate use and fracture risk. There are a number of limitations to this observational data including the fact that this study did not include a group without bisphosphonate use also compliance was not evaluated.

Oral BPs have been shown to significantly reduce the risk of vertebral and non vertebral fracture in randomized controlled trials. The extension studies of these fracture trials unfortunately were not powered to evaluate impact on fracture risk and currently we do not have long term data consistently demonstrating reductions in non vertebral fracture risk with long term BP use.

It appears that the optimal period of use for oral or IV bisphosphonates is 3-5 yrs with published randomized controlled trial data confirming reductions in fracture risk for vertebral , non vertebral and hip fracture with use for this time period. After the first 5 years of bisphosphonate use the fracture risk should be re-evaluated and bisphosphonate therapy should also be re-evaluated.

Osteoporosis Canada advises that all patients should have their treatment strategy reviewed by their physicians particularly after 5 years of use as long term use of bisphosphonates may not have the same risk benefit ratio as seen with short term use of up to 5 yrs.

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How Does Calcium Affect Bone Health and Fracture Risk?

On September 29, 2015, two research articles were published online in the British Medical Journal (BMJ) concerning the effect of calcium intake on bone mineral density (BMD) and fracture reduction. These have been widely reported in the media.

The full text of the Osteoporosis Canada response can be found on the website at http://www.osteoporosis.ca/calcium-intake-and-effect-on-bone-health-and-fracture-risk-reduction/

The following is a summary of the OC response.

The first study published in the BMJ summarizes the results of 59 earlier studies to evaluate the effects of calcium intake on BMD in people over the age of 50. According to this study, both extra dietary calcium intake and the use of calcium supplements were associated with small increases in BMD. A small reduction in fractures was observed with calcium supplementation. The authors concluded that calcium intake from dietary sources and supplements increase BMD similarly, but that this is unlikely to reduce fractures.

The second study explored whether calcium could reduce fractures. This study did not show a significant reduction in fracture risk in the large randomized trials with calcium supplementation.

The two studies significantly differed in both the numbers of people evaluated and in the quality of the assessments. They also differed in how fractures were identified. As a result, in order to better determine the effects of calcium supplementation on bone health, additional research is needed using well-designed, large, controlled studies.

Every cell in our body requires calcium in order to function normally. Inadequate calcium intake results in the release of calcium from our bones in order to meet our daily requirements. Because of this, Osteoporosis Canada continues to recommend 1000-1200 mg of calcium daily, preferably from dietary sources, and to use supplements only if this is not possible (in the form of calcium carbonate or calcium citrate).

Click here for more detailed information on Osteoporosis Canada’s nutritional recommendations

However, in individuals with osteoporosis or high fracture risk, there is no research evidence supporting the use of calcium supplements alone as a treatment to prevent fractures. Such individuals may require medication in addition to adequate calcium intake and vitamin D supplementation in order to reduce their fracture risk.

Click here for more information on drug treatments for osteoporosis

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Swedish Milk Study

In a study published on Oct 28, 2014 by Dr. Michaelsson of Uppsala University, Sweden in the BMJ, high milk intake was associated with an increased rate of death in a large observational study completed in Sweden.

In this study 61,433 Women (39-74 years at baseline 1987-90) were followed for 20.1 years and 45,339 men (45-79 years at baseline 1997), were followed for 11.2 years. They completed food frequency questionnaires. During the follow-up of 20.1 years, 15,541 women died and 17,252 had a fracture, of whom 4259 had a hip fracture. Of the men being followed for an average of 11.2 years, 10,112 men died and 5,066 had a fracture, with 1,166 hip fracture cases. In women, the death rate was higher in those drinking three or more glasses of milk a day compared to those drinking just one glass a day (hazard ratio 1.93; 95% confidence interval 1.80 to 2.06). There did not appear to be a decrease in the risk of fracture with a higher intake of milk. Similar findings were seen in the men in this study. The researchers concluded that high milk intake was associated with a higher death rate and did not appear to protect from developing fractures.

This study design was not ideal however for determining cause and effect between the high intake of milk and the increased risk of death. Other researchers have actually observed a lower rate of heart attacks in those with a diet rich in dietary sources of calcium. In 2012, Li and colleagues evaluated a German cohort study of 23,980 people ages 35-64 followed over 11 years and found that a calcium enriched diet was associated with a lower rate of MI by 30%.

Clearly further research with well-designed studies is necessary before it can be concluded that high intake of milk is harmful. Osteoporosis Canada recommends that Canadians over 50 get 1200 mg of calcium daily through food and supplement, with food being the preferable source.

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Despite Recent Studies, Calcium and Vitamin D Remain Important Nutrients for Overall Bone Health

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.

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Calcium is Good – Are Calcium Supplements Bad?

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.

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