EditorialCalcium supplements: Good for the bone, bad for the heart? A systematic updated appraisal
Section snippets
Physiology of calcium homeostasis
In addition to conferring strength to the skeleton, the deposition of calcium in the bone represents a source of the cation when its serum concentration decreases: indeed, free calcium can be released through osteoclastic bone resorption. An unbalanced equilibrium between bone calcium deposition and resorption affects the bone mineral density (BMD) resulting in skeletal fragility. The leading actor in the regulation of this equilibrium and calcium homeostasis is vitamin D, which allows the
Impact of calcium supplements on the cardiovascular system
Although a balanced dietary intake of calcium and vitamin D is critical for our body in order to regulate critical mechanisms, the role of calcium and vitamin D supplementation in adults and elderly people remains not fully understood. In this issue of Atherosclerosis, Hulbert and colleagues show that calcium supplementation, but not dietary calcium, positively correlates with abdominal aorta calcification in postmenopausal women [3], suggesting that vascular calcification might contribute to
Effects of calcium supplementation on BMD: results frommeta-analyses
Several clinical trials have tested the efficacy of calcium supplementation in children and adolescents, overall showing a positive effect of calcium introduction on BMD [4]. Instead, it is not clear whether these effects are also detectable in the mature skeleton. One randomized clinical trial conducted in 354 females in the pubertal stage, examinated the long-time effects of calcium supplement on total-body BMD, from child to young adult [5]; the study revealed an increased BMD in the
Calcium and vitamin D: friends or foes?
As mentioned above, calcium supplementation alone seems to have a minimum clinical impact in terms of risk of fractures. This outcome is not surprising if we consider that, especially in aged populations, a key issue is calcium absorption, due to a defective vitamin D bioavailability and/or activity. Indeed, vitamin D is the key regulator of intestinal calcium absorption; with aging, an increase of the enzyme involved in vitamin D catabolism occurs, alongside with a vitamin D resistence.
Calcium and cardiovascular risk: controversy even in meta-analyses; do we need more cowbell?
Most recently, some investigators started raising their eyebrows on this topic, because of the potential detrimental effects of high calcium intake (with or without vitamin D) on cardiovascular risk [13]. One of the principal mechanisms triggering major concerns in some researchers is the acutely increased serum calcium levels observed after calcium supplement intake; in fact, calcium intake from dietary sources does not seem to increase cardiovascular risk, while calcium supplements might
Financial support
The Santulli's Lab is supported by the National Institutes of Health (R01-HL146691, R01-DK123259, R00-DK107895, P30-DK020541, and R01-DK033823 to Prof. Gaetano Santulli) and by the American Heart Association (AHA-20POST35211151 to Dr. Jessica Gambardella).
Declaration of competing interest
The authors declared that they do not have anything to disclose regarding conflict of interest with respect to this manuscript.
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