Medicine:Calcium supplement

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Short description: Dietary mineral supplement
Calcium supplement
500 mg calcium supplements with vitamin D.jpg
500 milligram calcium supplements made from calcium carbonate
Clinical data
Trade namesAlka-Mints, Calcet, Tums, others
AHFS/Drugs.comMonograph
License data
Pregnancy
category
  • US: A (No risk in human studies)
  • and C
Routes of
administration		by mouth, intravenous
ATC code
Identifiers
CAS Number
ChemSpider
  • none
UNII

Calcium supplements are salts of calcium used in a number of conditions.[1] Supplementation is generally only required when there is not enough calcium in the diet.[2][3] By mouth they are used to treat and prevent low blood calcium, osteoporosis, and rickets.[1] By injection into a vein they are used for low blood calcium that is resulting in muscle spasms and for high blood potassium or magnesium toxicity.[2][4]

Common side effects include constipation and nausea.[1] When taken by mouth high blood calcium is uncommon.[1] Calcium supplements, unlike calcium from dietary sources, appear to increase the risk of kidney stones.[1] Adults generally require about a gram of calcium a day.[1] Calcium is particularly important for bones, muscles, and nerves.[1]

The medical use of calcium supplements began in the 19th century.[5] It is on the World Health Organization's List of Essential Medicines.[6] It is available as a generic medication.[3] In 2020, it was the 204th most commonly prescribed medication in the United States, with more than 2 million prescriptions.[7][8] Versions are also sold together with vitamin D.[3] In 2020, the combination, calcium/vitamin D was the 215th most commonly prescribed medication in the United States, with more than 2 million prescriptions.[7][9]

Health effects

Bone health

In healthy people, calcium supplementation is not necessary for maintaining bone mineral density, and carries risks that outweigh any benefits.[10] Calcium intake is not significantly associated with hip fracture risk in either men or women.[11] The U.S. Preventive Service Task Force recommends against a daily supplement of calcium or vitamin D.[12] Although a slight increase in bone mineral density occurred in healthy children from calcium supplementation, using additional dietary calcium is not justified, according to a 2006 review.[13]

Cardiovascular impact

There is good evidence that 1,000 mg to 1,500 mg of daily calcium supplementation can effect a modest reduction in blood pressure in adults who do not have a blood pressure condition, suggesting that achieving adequate calcium levels may have role in preventing high blood pressure.[14]

Cancer

The US National Cancer Institute does not recommend the use of calcium supplements for lowering the risk of cancer.[15] There is weak evidence calcium supplementation might have a preventative effect against developing colorectal adenomatous polyps, but the evidence is not sufficient to recommend such supplementation.[16]

Side effects

Excessive consumption of calcium carbonate antacids/dietary supplements (such as Tums) over a period of weeks or months can cause milk-alkali syndrome, with symptoms ranging from hypercalcemia to potentially fatal kidney failure. What constitutes "excessive" consumption is not well known and, it is presumed, varies a great deal from person to person. Persons consuming more than 10 grams/day of CaCO3 (=4 g Ca) are at risk of developing milk-alkali syndrome,[17] but the condition has been reported in at least one person consuming only 2.5 grams/day of CaCO3 (=1 g Ca), an amount usually considered moderate and safe.[18]

A 2023 systematic review found that calcium supplementation is not associated with myocardial infarction, stroke, heart failure admission, and cardiovascular/all-cause mortality.[19]

Calcium supplements may contribute to the development of kidney stones.[1]

Acute calcium poisoning is rare, and difficult to achieve without administering calcium intravenously. For example, the oral median lethal dose (LD50) for rats for calcium carbonate and calcium chloride are 6.45[20] and 1.4 g/kg,[21] respectively.

Interactions

Calcium supplements by mouth diminish the absorption of thyroxine when taken within four to six hours of each other.[22] Thus, people taking both calcium and thyroxine run the risk of inadequate thyroid hormone replacement and thence hypothyroidism if they take them simultaneously or near-simultaneously.[23][unreliable medical source?]

Types

The intravenous formulations of calcium include calcium chloride and calcium gluconate.[1] The forms that are taken by mouth include calcium acetate, calcium carbonate, calcium citrate, calcium gluconate, calcium lactate, and calcium phosphate.[1]

  • The absorption of calcium from most food and commonly used dietary supplements is very similar.[24] This is contrary to what many calcium supplement manufacturers claim in their promotional materials.
  • Different kinds of juices boosted with calcium are widely available.
  • Calcium carbonate is the most common and least expensive calcium supplement. It should be taken with food, and depends on low pH levels (acidic) for proper absorption in the intestine.[25] Some studies suggests that the absorption of calcium from calcium carbonate is similar to the absorption of calcium from milk.[26][27]
  • Antacids frequently contain calcium carbonate, and are a commonly used, inexpensive calcium supplement.
  • Coral calcium is a salt of calcium derived from fossilized coral reefs. Coral calcium is composed of calcium carbonate and trace minerals. Claims for health benefits unique to coral calcium have been discredited.
  • Calcium citrate can be taken without food and is the supplement of choice for individuals with achlorhydria or who are taking histamine-2 blockers or proton-pump inhibitors.[28] Calcium citrate is about 21% elemental calcium. One thousand mg will provide 210 mg of calcium. It is more expensive than calcium carbonate and more of it must be taken to get the same amount of calcium.
  • Calcium phosphate costs more than calcium carbonate, but less than calcium citrate. microcrystalline hydroxyapatite (MH) is one of several forms of calcium phosphate used as a dietary supplement. Hydroxyapatite is about 40% calcium.
  • Calcium lactate has similar absorption as calcium carbonate,[29] but is more expensive. Calcium lactate and calcium gluconate are less concentrated forms of calcium and are not practical oral supplements.[28]

Vitamin D is added to some calcium supplements. Proper vitamin D status is important because vitamin D is converted to a hormone in the body, which then induces the synthesis of intestinal proteins responsible for calcium absorption.[30]

Labeling

For U.S. dietary supplement and food labeling purposes, the amount in a serving is expressed in milligrams and as a percent of Daily Value (%DV). The weight is for the calcium part of the compound – for example, calcium citrate – in the supplement. For calcium labeling purposes 100% of the Daily Value was 1000 mg, but in May 2016 it was revised to 1000–1300 mg.[31] A table of the pre-change adult Daily Values and references for the revision are provided at Reference Daily Intake. Food and supplement companies had until July 2018 to comply with the labeling change.[31]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 "Calcium Salts". The American Society of Health-System Pharmacists. https://www.drugs.com/monograph/calcium-salts.html. 
  2. ↑ 2.0 2.1 WHO Model Formulary 2008. World Health Organization. 2009. p. 497. ISBN 9789241547659. 
  3. ↑ 3.0 3.1 3.2 British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. pp. 694, 703. ISBN 9780857111562. 
  4. ↑ Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. 2015. pp. 215–216. ISBN 9781284057560. 
  5. ↑ (in en) Calcium Carbonate: From the Cretaceous Period into the 21st Century. Birkhäuser. 2012. p. 308. ISBN 9783034882453. https://books.google.com/books?id=eSMGCAAAQBAJ&pg=PA308. 
  6. ↑ World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. 2019. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO. 
  7. ↑ 7.0 7.1 "The Top 300 of 2020". https://clincalc.com/DrugStats/Top300Drugs.aspx. 
  8. ↑ "Calcium – Drug Usage Statistics". https://clincalc.com/DrugStats/Drugs/Calcium. 
  9. ↑ "Calcium; Vitamin D – Drug Usage Statistics". https://clincalc.com/DrugStats/Drugs/CalciumVitaminD. 
  10. ↑ "Calcium supplements: benefits and risks". Journal of Internal Medicine 278 (4): 354–368. October 2015. doi:10.1111/joim.12394. PMID 26174589. 
  11. ↑ "Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials". The American Journal of Clinical Nutrition 86 (6): 1780–1790. December 2007. doi:10.1093/ajcn/86.5.1780. PMID 18065599. 
  12. ↑ "Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement". Annals of Internal Medicine 158 (9): 691–696. May 2013. doi:10.7326/0003-4819-158-9-201305070-00603. PMID 23440163. 
  13. ↑ "Calcium supplementation for improving bone mineral density in children". The Cochrane Database of Systematic Reviews 2006 (2): CD005119. April 2006. doi:10.1002/14651858.CD005119.pub2. PMID 16625624. 
  14. ↑ "Calcium supplementation for prevention of primary hypertension". The Cochrane Database of Systematic Reviews 1 (1): CD010037. January 2022. doi:10.1002/14651858.CD010037.pub4. PMID 35014026. 
  15. ↑ "Calcium and Cancer Prevention: Strengths and Limits of the Evidence". National Cancer Institute. 4 May 2009. http://www.cancer.gov/cancertopics/factsheet/prevention/calcium. 
  16. ↑ "Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps". The Cochrane Database of Systematic Reviews 2008 (1): CD003548. January 2008. doi:10.1002/14651858.CD003548.pub4. PMID 18254022. 
  17. ↑ "Milk-alkali syndrome: a historical review and description of the modern version of the syndrome". The American Journal of the Medical Sciences 331 (5): 233–242. May 2006. doi:10.1097/00000441-200605000-00001. PMID 16702792. 
  18. ↑ "Calcium carbonate toxicity: the updated milk-alkali syndrome; report of 3 cases and review of the literature". Endocrine Practice 11 (4): 272–280. 2005. doi:10.4158/EP.11.4.272. PMID 16006300. 
  19. ↑ "Association Between Calcium Supplementation and the Risk of Cardiovascular Disease and Stroke: A Systematic Review and Meta-Analysis". Heart, Lung & Circulation 32 (10): S1443–9506(23)04281–6. September 2023. doi:10.1016/j.hlc.2023.07.008. PMID 37743221. 
  20. ↑ Sax's Dangerous Properties of Industrial Materials (9th ed.). New York, NY: Van Nostrand Reinhold. 1996. p. 635. ISBN 978-0-471-37858-7. https://archive.org/details/saxsdangerouspro0000lewi. 
  21. ↑ ITII. Toxic and Hazardous Industrial Chemicals Safety Manual. Tokyo, Japan: The International Technical Information Institute. 1988. p. 101. 
  22. ↑ "Effect of calcium carbonate on the absorption of levothyroxine". JAMA 283 (21): 2822–2825. June 2000. doi:10.1001/jama.283.21.2822. PMID 10838651. 
  23. ↑ "Calcium May Help With Weight Loss". http://www.rxalternativemedicine.com/headlines_news.php#headline77. 
  24. ↑ "29 Calcium". Present Knowledge in Nutrition. I (9th ed.). ILSI Press. 2006. p. 377. ISBN 978-1-57881-198-4. 
  25. ↑ Remington: The Science and Practice of Pharmacy. Lippincott Williams & Wilkins. 2005. p. 1338. ISBN 978-0-7817-4673-1. 
  26. ↑ "Calcium bioavailability of calcium carbonate fortified soymilk is equivalent to cow's milk in young women". The Journal of Nutrition 135 (10): 2379–2382. October 2005. doi:10.1093/jn/135.10.2379. PMID 16177199. http://jn.nutrition.org/content/135/10/2379.full.pdf. 
  27. ↑ "Relative bioavailability of calcium-rich dietary sources in the elderly". The American Journal of Clinical Nutrition 76 (6): 1345–1350. December 2002. doi:10.1093/ajcn/76.6.1345. PMID 12450902. 
  28. ↑ 28.0 28.1 "Calcium supplementation in clinical practice: a review of forms, doses, and indications". Nutrition in Clinical Practice 22 (3): 286–296. June 2007. doi:10.1177/0115426507022003286. PMID 17507729. 
  29. ↑ "Calcium absorption from three salts and CaSO(4)-fortified bread in premenopausal women". Journal of Agricultural and Food Chemistry 50 (13): 3874–3876. June 2002. doi:10.1021/jf020065g. PMID 12059174. 
  30. ↑ The Vitamins. Academic Press. 2008. p. 161. ISBN 978-0-12-183490-6. https://archive.org/details/vitaminsfundamen0000comb/page/161. 
  31. ↑ 31.0 31.1 "Regulations.gov". https://www.regulations.gov/document/FDA-2012-N-1210-0875. 

External links



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