Calcium supplementation: cardiovascular risk?

Adequate dietary calcium intake and appropriate sunlight exposure ensuring adequate vitamin D availability are basic measures for the prevention of osteoporosis. Calcium and vitamin D supplementation increases bone density. Vitamin D plus calcium supplementation prevents hip fractures and other nonvertebral fractures in institutionalised persons 70 years of age or older. A meta-analysis of clinical trials showed an increase in myocardial infarction in patients taking calcium supplementation alone, with a relative risk of about 1.3. Epidemiological studies have not shown an increase in the cardiovascular risk. Conflicting results have also been reported in postmenopausal women taking both calcium and vitamin D. In an epidemiological study, hypercalcaemia was associated with increased mortality, particularly cardiovascular mortality. In practice, caution dictates that not all patients should routinely take calcium and vitamin D supplements. When calcium supplements are nonetheless used, the dose should be adjusted to dietary intake in order to avoid hypercalcaemia.