Are you advised to take calcium supplements or eating lots of milk and dairy to prevent osteoporosis or fracture risks? Let’s see what research suggests -
What is osteoporosis?
Bone is a living tissue which is constantly remodeling, that is, old bone is continually breaking down and replacing with new bone. Osteoporosis occurs when formation of new bone is slower than the destruction of old bone. Bone becomes so brittle that a fall or even mild stresses on bone, such as bending over may cause bone fractures. Osteoporotic fracture is common in hip, spine, and distal radius (wrist). Nearly 1 in every 5 patients with a hip fracture dies within six months, largely due to the immobility as well as increased metabolic demands because of fracture[1].
Osteopenia is the milder version of this disease that eventually develops into osteoporosis.
Why supplementing calcium?
Bone, by volume, comprised of 40% minerals (calcium, phosphorous, magnesium, potassium, zinc, copper, and some other trace minerals like boron), 35% protein (mostly collagen which provides structural framework of bone), and 25% water [2]. That means, calcium is not the only building block of bone.
However, calcium is the most abundant minerals in bone, hence it makes sense to take more calcium to protect bone; however, to date, there is no randomized, double-blinded, placebo-controlled study that shows calcium supplementation makes bone stronger, and thus fracture risks. Although, studies did show calcium supplementation increased bone mineral density by 0.6-1.8% over one to two years period that has negligible effects on bone fracture. And further supplementation did not improve bone mineral density [3]. Other studies found no link between calcium supplementation and low risk of fractures in older adults [4].
Calcium supplementation higher than 500mg daily also found to increase the risks of having kidney stones, arterial calcification, heart attack, and stroke [5].
How to strengthen bone?
Bone strength and bone density, although sounds similar, does not represent the same thing. The material and structural properties of bone determine its strength, in contrast bone density refers to the quantity of mineral in bone, which is just one component of bone strength [6]. Two cell types regulating bone heath are: osteoblasts that forms bone, and osteoclasts that breaks down old bone. Most medications for treating osteoporosis are based on inhibiting osteoclasts activity which stops resolving old bone, results in denser bone. Denser bones are brittle and hence, susceptible to break easily. Thus, having lots of calcium or medications to increase bone density doesn’t improve overall bone health, and requires accompanying lifestyle changes; some are –
-Having an active lifestyle: This is the most inexpensive and effective way to make bone stronger. Waking briskly, running, or weightlifting exercise causes stresses on bone; mechanical stress makes bone stronger by affecting the alignment of collagen during new bone formation [7]. Mechanical loading also increases new blood vessel formation in the bone, which is vital to maintain bone health [8]. Cumulative evidence suggests, exercise enhances bone mineral density, bone mass, as well as bone strength by directly or indirectly affecting all cell types in the bone and many features of bone remodeling process [7].
-Maintaining balance in bone minerals: Bone is not just a solitary entity of calcium; it’s a package of minerals, in which each one plays its own role to protect or build bone health.
-Having enough protein in diet: A significant portion of bone is made up of protein, especially collagen. Having fatty meats with skin along with Vitamin C rich foods will boost collagen synthesis.
-Having enough vitamin D from diet/sun/supplement: Taking vitamin D is way more important than taking calcium. Vitamin D is essential to help your body absorb calcium and phosphorous effectively. Without enough vitamin D, calcium and phosphorous leaves the body through the kidneys, in the urine.
-Avoid sugar or high carb diet: Glucose is structurally similar to vitamin C [9]. Having excess glucose in the body will reduce vitamin C content in the cells, as cells prefer glucose over vitamin C. Vitamin C is essential for collagen synthesis and our body cannot make vitamin C on its own. Thus, avoiding sugar or carb and eating more leafy greens will help improving bone strength.
-Avoid drinking milk: Accumulated research evidence strongly suggests that adults should avoid drinking milk as much as possible. By inducing chronic low-grade inflammation, milk makes bone health worse.
-Avoid anything that causes inflammation.
Takeaway
Calcium alone is not sufficient to increase bone strength. Indiscriminate calcium supplementation may raise the risks of having kidney stones, arterial calcification, heart attack, stroke, cancer, and gastrointestinal disorders. However, it may sometimes be necessary to take calcium supplementation if diet alone is not sufficient or a person has a malabsorption of calcium due to other medical conditions.
References
1. Price, C.T., J.R. Langford, and F.A. Liporace, Essential nutrients for bone health and a review of their availability in the average North American diet. The open orthopaedics journal, 2012. 6: p. 143.
2. Feng, X., Chemical and biochemical basis of cell-bone matrix interaction in health and disease. Current chemical biology, 2009. 3(2): p. 189-196.
3. Tai, V., et al., Calcium intake and bone mineral density: systematic review and meta-analysis. Bmj, 2015. 351.
4. Bolland, M.J., et al., Calcium intake and risk of fracture: systematic review. Bmj, 2015. 351.
5. Li, K., et al., The good, the bad, and the ugly of calcium supplementation: a review of calcium intake on human health. Clinical interventions in aging, 2018. 13: p. 2443.
6. Friedman, A.W., Important determinants of bone strength: beyond bone mineral density. JCR: Journal of Clinical Rheumatology, 2006. 12(2): p. 70-77.
7. Yuan, Y., et al., The roles of exercise in bone remodeling and in prevention and treatment of osteoporosis. Progress in Biophysics and Molecular Biology, 2016. 122(2): p. 122-130.
8. Tong, X., et al., The effect of exercise on the prevention of osteoporosis and bone angiogenesis. BioMed research international, 2019. 2019.
9. Dakhale, G.N., H.V. Chaudhari, and M. Shrivastava, Supplementation of vitamin C reduces blood glucose and improves glycosylated hemoglobin in type 2 diabetes mellitus: a randomized, double-blind study. Advances in pharmacological sciences, 2011. 2011.
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