Men's Osteoporosis Support Group

Calcium supplements needed with Fosamax?

Curr Med Res Opin. 2007 Jun;23(6):1341-9. Treatment with alendronate plus calcium, alendronate alone, or calcium alone for postmenopausal low bone mineral density. Bonnick S and others. PMID: 17594775. This is an interesting study that compared three differing regimens to placebo: 10-mg Fosmax/day, 10-mg Fosmax/day plus 1 gram of calcium/day, 1 gram of calcium/day alone, or placebo. This was a 2-year study involving 701 postmenopausal women. The important finding was that, "In postmenopausal women with a daily intake of > or =800 mg calcium and 400 IU vitamin D, 24-month treatment with alendronate 10 mg daily with or without calcium 1000 mg resulted in significantly greater increases in BMD and reduction of bone turnover than supplemental calcium alone. Addition of supplemental calcium to alendronate treatment had no effect on BMD and resulted in a small, though statistically significant, additional reduction in NTx."

Editor's comments. This is timely in that it provides some insights regarding an article in the BMJ this month concerning calcium supplements affecting heart disease. In the BMJ study by Bolland MJ and others, Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial, they reported increased myocardial infarctions in the older women who took calcium supplements when compared to the placebo group. This is a very complex study involving relatively small numbers of women making it hard to give it too much weight regarding cardiac events. Even the authors note that, "The present data do not permit definitive conclusions to be reached in this regard but do flag cardiac health as an area of concern in relation to calcium use and mandate that this is assessed carefully in future studies of calcium supplementation." Basically they appear to be saying that future studies should evaluate the potential effects of calcium supplements on cardiac health, but that this single study doesn't warrant our changing our lives. Another confounder for men is that none were included in the study, and we can't necessarily assume the results apply to us. But it is rational to assume that calcium metabolism is not particularly gender related.

Considering the Bonnick and others article, and keeping in mind our goals when treating osteoporosis, we want to rebuild bone mineral density (BMD). It appears that moderate intake of calcium when taking a bisphosphonate such as Fosamax, aldendronate, or Actonel, risedronate, is adequate to improve BMD and that supplementing further is not beneficial. Since there appears to be no need to overdose on calcium supplements to adequately treat osteoporosis, whether or not they might have cardiac risks, why do it? Certainly we need calcium in our diets daily, and studies have shown that vitamin D, either from sunshine or supplements is also helpful. My goal is to get the bulk of my calcium through diet and to strive for moderation, probably in the 1200 to 1500 mg daily dose. I don't however calculate every mg of calcium I ingest daily. I just drink some milk, eat some cheese or yogurt along with some green vegetables. I mainly take Rolaids (which contains magnesium, also beneficial for bone health) as a supplement when needed for acid reflux. That would appear to be adequate to build or maintain BMD, and very unlikely to add any risk, cardiac or otherwise. In short, the old adage of "all things in moderation" appears to apply here, too.

Return to Home