ASMI reassures on use of calcium supplements

28 May 2012

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The Australian Self-Medication Industry (ASMI), the industry body representing evidence-based, non-prescription consumer healthcare products, said today that consumers can still take calcium supplements with confidence despite the results of one flawed survey.

The comments were in response to a new study by Li et al, published in the journal, Heart, assessing the link between calcium supplementation and the risk of stroke and cardiovascular disease1.

ASMI Regulatory and Scientific Affairs Director, Steven Scarff, said the study, while an important input into the debate, contained a number of deficiencies which place a question over the strength and validity of its conclusions.

Mr Scarff said that there was good evidence that calcium supplements reduced the risk of fractures and hence played a useful role in the treatment of osteoporosis2,3 and that the association with heart disease remained controversial4. In fact the conclusions of the study by Li et al are in stark contrast to the findings of other studies by Wang et al5 and by Lewis et al6.

Calcium supplementation is a well-tested and widely available option for increasing bone density and reducing the risk of fractures. This is particularly important for those patients who may be at risk of fracture, the elderly, or those whose dietary calcium intake is inadequate.

Mr Scarff said the study involved a single initial survey of diet and supplement intake, followed by an assessment of cardiovascular outcomes an average of 10 years later. This gap provides a considerable period of uncharted information about diet and behaviours which almost certainly impacted the results.

The design of the survey also means that known risk factors for cardiovascular disease (such as high blood pressure and high cholesterol) were not equally distributed across the study groups.

Many subjects who took supplements did not record what they were taking, and even those who did record the information, did not always advise the dose. This limitation further diminishes the value of the survey in assessing the risks associated with calcium supplements.

"Consumers should not stop using calcium supplements on the basis of this survey. Instead they should continue to aim for the recommended daily calcium intake of 1000-1300mg/day, depending on their age and sex7, and they should do this through eating a healthy diet or from supplements where their dietary intake was inadequate", Mr Scarff said.

A 2007 Australian study commissioned by ASMI found that calcium, and calcium in combination with Vitamin D, was associated with a 12% reduction in fractures of all types including hip, vertebrae and wrist. In instances where there was a higher compliance rate, the treatment was associated with a much higher 24% reduction in fractures8. This further evidence supports the positive role calcium supplements play.
About ASMI: The Australian Self-Medication Industry (ASMI) is the peak industry body for the Australian self care industry representing consumer healthcare products including over-the-counter medicines and complementary medicines. ASMI's mission is to promote better health through responsible self-care. This means ensuring that safe and effective self-care products are readily available to all Australians at a reasonable cost. ASMI works to encourage responsible use by consumers and an increasing role for cost-effective self-medication products as part of the broad national health strategy.
Media contact: Bob Bowden, Foresight Communications (02) 9241 2811, 0412 753 298



1 Kuanrong Li, Rudolf Kaaks, Jakob Linseisen, and Sabine Rohrmann. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study. Heart 2012;98:920e925, May 2012
2 Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007 Aug 25;370(9588):657-66.
3 Osteoporosis Australia. Calcium Supplements: latest debate - safety of calcium supplements.
4 Gustavo Duque, Jacqueline J Close, Julien P de Jager, Peter R Ebeling, Charles Inderjeeth, Stephen Lord, Andrew J McLachlan, Ian R Reid, Bruce R Troen and Philip N Sambrook. Treatment for osteoporosis in Australian residential aged care facilities: consensus recommendations for fracture prevention. MJA 2010; 193 (3): 173-179
5 Wang L, Manson JE, Song Y, Sesso HD. Systemic review : vitamin D and calcium supplementation in prevention of cardiovascular events. Ann Intern Med. 2010;152:315-323.
6 Lewis JR, Calver J, Zhu K, Flicker L, Prince RL. Calcium supplementation and the risks of atherosclerotic vascular disease in older women: results of a 5-year RCT and a 4.5-year follow-up. J Bone Miner Res. 2010v

7 Australian Government, DOHA, NHMRC Recommended Dietary Intakes
8 Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007 Aug 25;370(9588):657-66.