Is there need for calcium supplements?

» I’ve been taking calcium supplements for many years to strengthen my bones. I’m 74, weigh less than 95 pounds and stand

5 feet tall. I’m on the verge of osteoporosis, and have been getting Evenity injections for almost a year. Do calcium supplements help?

— H.

DEAR READER » Before I answer your question about calcium, I want to question why you are on medication therapy without having a diagnosis of osteoporosis. All osteoporosis medications — all medications, for that matter — have the potential for adverse effects. They should be used only when they clearly have more potential for benefit than potential for harm.

In your case, you may have had a high fracture risk due to other medical conditions. Being 95 pounds can be a risk factor in itself.

I’ve never discussed romosozumab (Evenity), which was approved in 2019 by the Food and Drug Administration after trials showed that it reduced fractures compared with placebo or alendronate (Fosamax). It works by increasing bone formation, but it also reduces bone resorption, so it greatly increases bone density. It is given by injection monthly or every three months. In one trial, women getting romosozumab had an increased risk of heart attacks and strokes, and until this possible risk is further evaluated, many doctors are reserving this treatment for women who have not done well or are not good candidates for other treatments.

Although many small trials have shown that calcium supplements alone increase bone density, there has been only inconsistent evidence that calcium supplementation, by itself, reduces fractures. The less calcium a person normally takes in, the more important it is to increase their consumption. In general, I recommend dietary calcium rather than supplements because of the risk of kidney stones from supplements (dietary calcium actually reduces kidney stone risk), and because there is controversy due to conflicting studies about whether calcium supplements increase heart disease risk. However, a theoretical risk of heart disease won’t stop me from recommending calcium supplements from a person who just can’t get enough from diet.

In the case of men and women taking medication, such as Fosamax or Evenity, for osteoporosis, adequate calcium intake is recommended, since the bone needs extra calcium to get stronger. All trials that showed effectiveness of the medication were done ensuring adequate intake of calcium and vitamin D.