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As calcium supplements are widely used these modest increases in risk
of cardiovascular disease might translate into a large burden of
disease in the population. A reassessment of the role of calcium
supplements in the management of osteoporosis is
warranted.IntroductionOsteoporosis is a major cause of morbidity and
mortality in older people.1 Calcium supplements marginally reduce the
risk of fracture,2 3 and most guidelines recommend adequate calcium
intake as an integral part of the prevention or treatment of
osteoporosis.4 5 Consequently, calcium supplements are commonly used by
people over the age of 50. Observational studies suggest that high
calcium intake might protect against vascular disease,6 7 8 and the
findings are consistent with those of interventional studies of calcium
supplements that show improvement in some vascular risk factors.9 10 11
In contrast, calcium supplements accelerate vascular calcification and
increase mortality in patients with renal failure, in both dialysis and
predialysis populations.12 13 14 Furthermore, a five year randomised
controlled trial of calcium supplements in healthy older women, in which
cardiovascular events were prespecified as secondary end points,
recently reported possible increases in rates of myocardial infarction
and cardiovascular events in women allocated to calcium.15 16 We carried
out a meta analysis of cardiovascular events in randomised trials of
calcium supplements.

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