Calcium supplements’ value in doubt

Dear Dr. Roach: I’ve been taking calcium supplements for many years to assist in strengthening 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. Now I’m hearing that calcium supplements may have no value. What’s the truth?

H.

Answer: Before I answer your question about calcium, I want to question why you are on medication therapy without having a diagnosis of osteoporosis. Too many people have serious side effects from osteoporosis medications when it wasn’t clear that the medication should have been prescribed in the first place. In your case, it may be that despite not having osteoporosis confirmed by a bone mineral density test, you nonetheless had a high fracture risk due to other medical conditions.

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. 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, and because there are conflicting studies about whether calcium supplements increase heart disease risk.

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.