Should All Women Take Calcium Supplements?
June 14th, 2012Calcium and Vitamin D supplement have long been the “backbone” of osteoporosis treatment and prevention. As reported by the New York Times this week, the USPTF issued a draft statement that there is insufficient evidence to show that healthy postmenopausal would benefit by taking supplements with Vitamin D or Calcium.
I strongly disagree with this statement, as there are many factors which must be considered. Bone health is not merely a factor of diet. Genetics, ethnicity (Caucasian or Asian), lack of exercise, alcohol intake, smoking, early menopause, and chronic illnesses are all factors that can cause worsening of bone density. How can we be sure that every “healthy” woman does not already have one of these risk factor or will not develop one of the risk factors later in life?
Calcium is an essential mineral that all humans must obtain from a diet rich in dairy, leafy greens, and soy products, among other items. There is a constant creation and destruction of bone at the cellular level happening all the time. We also lose some calcium in the urine. It doesn’t take complicated math to see that if you do not replace the calcium in your diet, you will end up with less calcium in the bones than when you started. After menopause, the destruction increases as estrogen, which is responsible for building bones, is lost.
Over the years, I have rarely seen women with adequate dietary intake of calcium. In order to get the recommended daily allowance of 1200 mg for a post menopausal woman, one would have to consume 4 cups of skim milk or 3 cups of yogurt or 6 cups of spinach per day! I don’t really know where the USPTF obtained the data for their studies, but it must be somewhere in Wisconsin or Switzerland with all the dairy products those women are consuming. Imagine if you were lactose intolerant, and not surprisingly so, 60% of Americans are lacking the enzyme that helps digest the sugars in dairy products, how much calcium would you be getting daily? To make a blanket statement that all “healthy” women are getting adequate intake of calcium is negligent.
As I mentioned earlier, bone health is also dependent on weight bearing exercise. When you do a workout that involves weights or running, the bones strengthen and more resistant to the destruction. As our country is becoming more sedentary and spending more time on the computer, iPad, or on the phone, and less time in the gym, we are certainly going to see a rise in osteoporosis. Excessive weight can lead to osteoarthritis of the knees and hips, which are also known to cause osteoporosis of those joints. A woman’s peak bone density is reached before menopause, which means all women will lose bone throughout the rest of their lives thereafter. Not having adequate calcium intake is certainly not a good idea for any woman. The USPTF should revise their statement to include a clause that all healthy women should have their dietary intake of calcium assessed by a healthcare professional and if it is inadequate, supplementation should be considered.
Regarding Vitamin D, all healthcare providers in the U.S. are seeing a widespread epidemic of low Vitamin D. Vitamin D is found in dairy products and requires sunlight to become activated. Vitamin D is essential for processing calcium so that it can be made into bone. You can imagine in the northern latitudes where it is cold 6 months out of the year how much people are lacking this vitamin. Again, this is where supplementation is a necessity and another place where the USPSTF is making an error.
I understand the USPSTF’s motivation in it’s recent rage against doctors doing too much, in terms of PSA screening, Cervical cancer screening, and mammograms, but they must make a distinction between treating statistical numbers and individuals. I shudder to think how many women who may have several risk factors for osteoporosis, but consider themselves “healthy” reading the guideline and throwing out their calcium and vitamin D pills only to realize 20 years later after falling and sustaining a hip fracture that they should’ve continued them.
