Calcium and vitamin D supplements do not increase bone density in premenopausal women

A Cochrane Review showed no improvement in bone mineral density.

Not a surprise given that the two principal drivers of osteoporosis are inflammation and anabolic hormone deficiency.

Research recently published in the Cochrane Library showed no improvement in BMD (bone mineral density) in the hip and lumbar spine in premenopausal women and therefore no advantage for the prevention of fracture from supplementation.

The authors state that measures to prevent postmenopausal fractures should start at an early age but there has been no firm evidence that supplementation with calcium and vitamin D help

“Osteoporosis is a condition where bones become fragile due to low bone density and impaired bone quality. This results in fractures that lead to higher morbidity and reduced quality of life. Osteoporosis is considered a major public health concern worldwide. For this reason, preventive measurements need to be addressed throughout the life course. Exercise and a healthy diet are among the lifestyle factors that can help prevent the disease, the latter including intake of key micronutrients for bone, such as calcium and vitamin D. The evidence on whether supplementation with calcium and vitamin D improves bone mineral density (BMD) in premenopausal women is still inconclusive. In this age group, bone accrual is considered to be the goal of supplementation, so BMD is relevant for the future stages of life.”

Calcium, Vitamin D, and both compared to placebo

The authors analyzed seven RCTs (randomized controlled trials) with 941 participants with a mean age ranging from 18.1 to 42.1 years. Among them, 138 were randomized to calcium supplementation, 110 to vitamin D supplementation, 271 to vitamin D plus calcium supplementation, and 422 to placebo. Results were reported for for total hip or lumbar spine BMD, or both.

“Results for the reported outcomes are presented for the three comparisons: calcium versus placebo, vitamin D versus placebo, and calcium plus vitamin D versus placebo. In all comparisons, there was no clinical difference in outcomes...”

Bottom Line

The authors conclude:

“Our results do not support the isolated or combined use of calcium and vitamin D supplementation in healthy premenopausal women as a public health intervention to improve BMD in the total hip or lumbar spine, and therefore it is unlikely to have a benefit for the prevention of fractures (vertebral and non‐vertebral).

But while they have high confidence in these results for healthy premenopausal women, a wider net should be cast:

“The evidence found suggests that there is no need for future studies in the general population of premenopausal women; however, studies focused on populations with a predisposition to diseases related to bone metabolism, or with low bone mass or osteoporosis diagnosed BMD would be useful.”

For more information on calcium supplementation, see Calcium supplementation increases heart attack risk in large study.