Calcium Supplementation Significantly Improves Bone Mass in Young Adults

by | Dec 22, 2022 | 2022, Bone Health, Calcium, Minerals

Written by Taylor Woosley, Staff Writer. Subgroup analyses of 13 RCTs show that calcium supplementation demonstrated a statistically significant effect on femoral neck and total body BMD in the lower dose subgroup receiving <1000 mg/day (0.717, 95%CI: 0.349-1.085; p<0.001 and 0.392, 95%CI: 0.161-0.624; p=0.001, respectively). 

calciumBone is a dynamic organ and as we age bone homeostasis undergoes deregulation1. Osteoporosis is an age-related bone disease characterized by deterioration of bone density and architecture2. It is caused by an imbalance between bone formation and resorption, leading to skeletal structure deterioration and an increased risk of fractures3. It is estimated that more than 40 million American citizens over 50 years of age are at risk of osteoporotic fractures4.

Calcium is a mineral involved in a variety of vital functions, such as constituting the signaling transduction system and mediating cellular functions and is essential for maintaining bone health5. Therefore, calcium deficiency is a major risk factor for osteoporosis development6. Previous research on calcium supplementation has found that higher serum calcium levels improve overall bone mineral density and reduce the risk of fracture in the general population7.

Liu Yupeng et al. conducted a systemic review and meta-analysis to assess the effectiveness of calcium supplementation to improve bone mineral density (BMD) or bone mineral content (BMC) in young people under age 35. Additionally, the study analyzed whether any effect would vary by sex, baseline calcium intake, ethnicity, age or calcium source, duration, and doses of calcium supplementation. Only randomized controlled trials (RCTs) were included in the study. Inclusion criteria consisted of RCTs comparing calcium or calcium plus vitamin D supplements with a placebo, trials with participants aged under 35 years at baseline, and trials with BMD or BMC data measurements by dual energy X-ray absorptiometry as estimates of bone mass.

Primary outcomes extracted from the studies included absolute changes in BMD or BMC at the lumbar spine, femoral neck, total hip, and total body. Predesigned subgroup analyses based on sex (female vs. male) and age at baseline (<20 vs. ≥20 years) were performed, representing the prepeak and peripeak subgroups, respectively. All analyzed trials were divided into two groups by the age of achieving PBM, regions, sources of calcium supplementation, and bias risk of each individual trial. Sensitivity analyses included evaluations using fixed-effect models and omitting low-quality trials. Meta-regression was performed for sample, size, age, sex, and supplementation differences to explain the heterogeneity between studies.

43 eligible RCTs involving 7382 subjects were included in the final analysis. In 20 studies dietary sources of calcium were used, while 23 studies used calcium supplements. The average baseline dietary calcium intake was 714 mg/day. Study duration of calcium supplementation did not exceed 2 years in most trials. Significant findings of the systemic review and meta-analysis are as follows:

  • Changes for total body show moderate evidence that calcium supplementation significantly improved BMC levels with an SMD of 0.330 (95%CI: 0.163-0.496, p < 0.001) and slightly improved BMC levels with an SMD of 0.149 (95%CI: 0.006-0.291, p < 0.001).
  • Changes at the femoral neck show a stronger and moderate protective effect on BMD (0.627, 95%CI: 0.338-0.915, p < 0.001) and a small improvement effect on BMC (0.364, 95%CI: 0.134-0.595, p = 0.002).
  • Subgroup analyses dividing subjects into two groups: prepeak (<20 years) and peripeak (≥20-35 years) show that the improvement effect on both BMD and BMC at the femoral neck appeared to be stronger in the peripeak subjects than in the prepeak subjects (0.852, 95%CI: 0.257-1.446 vs. 0.600, 95%CI: 0.292-0.909 [for BMD] and 1.045, 95%CI: 0.701-1.39 vs. 0.249, 95%CI: 0.043-0.454 [for BMC], respectively).

Results of the systemic review and metanalysis of 13 RCTs show that calcium supplementation significantly improved both BMD and BMC in young subjects. Further research should continue to explore the role of calcium supplementation on bone health, particularly in older adults who are more prone to osteoporosis. Study limitations include substantial heterogeneity in the present analysis and the inability to compare differences between male and females due to the limitation of existing data.

Source: Liu, Yupeng, Siyu Le, Yi Liu, Huinan Jiang, Binye Ruan, Yufeng Huang, Xuemei Ao, Xudong Shi, Xiaoyi Fu, and Shuran Wang. “The effect of calcium supplementation in people under 35 years old: A systematic review and meta-analysis of randomized controlled trials.” medRxiv (2022).

© Liu, Le et al. This article is distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use and redistribution provided that the original author and source are credited.

Click here to read the full text study.

Posted December 22, 2022.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

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