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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\n      \u003Ch2\u003ESummary\u003C\/h2\u003E\n      \u003Cp id=\u0022p-1\u0022\u003EThe benefits of calcium intake for bone health are very clear, but the risks\u2014cardiovascular (CV), in particular\u2014have become controversial. This article discusses calcium metabolism and the results of recent studies on calcium supplementation and CV health.\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Emetabolic bone disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n      \u003Cp id=\u0022p-2\u0022\u003EThe benefits of calcium intake for bone health are very clear, but the risks\u2014cardiovascular (CV), in particular\u2014have become controversial. Richard Bockman, MD, PhD, Weill Cornell Medical College and Hospital for Special Surgery, New York, New York, USA, discussed calcium metabolism and the results of recent studies on calcium supplementation and CV health.\u003C\/p\u003E\n      \u003Cp id=\u0022p-3\u0022\u003EAccording to Dr. Bockman, calcium is anything but a solitary player in nutrient metabolism. \u201cIt isn\u0027t about Ca, D, P, PTH (parathyroid hormone), or FGF 23 (fibroblast growth factor 23),\u201d he said. \u201cIt\u0027s about all of them interacting\u201d (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Dr. Bockman reports that when vitamin D status is sufficient, absorption of dietary calcium is approximately 30% to 40%. As vitamin D status declines, absorption of dietary calcium drops to approximately 10% to 15% (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E). Low levels of calcium and vitamin D lead to increased release of PTH. This raises bone resorption and decreases bone mass.\u003C\/p\u003E\n      \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\n         \u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\n            \n               \u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/13\/28.2\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Calcium Metabolism.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1549033319\u0022 data-figure-caption=\u0022Calcium Metabolism.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/13\/28.2\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\n            \n            \n         \u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/13\/28.2\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/13\/28.2\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12626\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\n         \u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\n            \u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003ECalcium Metabolism.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from R. Bochman, MD, PhD.\u003C\/q\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\n      \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\n         \u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\n            \n               \u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/13\/28.2\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Interaction of Calcium, Vitamin D, and PTH with Bone and Kidney.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1549033319\u0022 data-figure-caption=\u0022Interaction of Calcium, Vitamin D, and PTH with Bone and Kidney.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/13\/28.2\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\n            \n            \n         \u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/13\/28.2\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/13\/28.2\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12627\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\n         \u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\n            \u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EInteraction of Calcium, Vitamin D, and PTH with Bone and Kidney.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from R. Bochman, MD, PhD.\u003C\/q\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\n      \u003Cp id=\u0022p-6\u0022\u003EGiven its effect on calcium absorption, vitamin D and calcium insufficiency are associated with bone loss and increased fracture risk. Excessive P alters D, FGF, and intact PTH and increases bone loss.\u003C\/p\u003E\n      \u003Cp id=\u0022p-7\u0022\u003ERecently, the safety of calcium intake has become controversial, based on reports of increased risk of CV events that are associated with calcium supplementation (143 vs 111; HR, 1.31; 95% CI, 1.02 to 1.67; p=0.035) [Bolland MJ et al. \u003Cem\u003EBMJ\u003C\/em\u003E 2010; Bolland MJ et al. \u003Cem\u003EBMJ\u003C\/em\u003E 2011]. Bolland\u0027s meta-analysis from 2010 included novel datasets that were obtained from the principal investigators after the published reports, with CV outcomes obtained from self-reports, hospital admissions, and death certificates. Fifteen randomized controlled trials were eligible for inclusion\u2014five with patient-level data and six with partially complete trial-level data.\u003C\/p\u003E\n      \u003Cp id=\u0022p-8\u0022\u003EThe opposing view that calcium supplementation does not increase CV risk has also been published recently [Lewis et al. \u003Cem\u003EJBMR 2010\u003C\/em\u003E]. A systematic review and meta-analysis by Wang et al. [\u003Cem\u003EAnn Intern Med\u003C\/em\u003E 2010] found no increased CV risk that was associated with calcium supplementation. The authors excluded ecological, cross-sectional, and retrospective case control studies, as well as studies that did not ascertain cardiovascular disease (CVD) events (including CVD death, nonfatal coronary heart disease, myocardial infarction, and nonfatal stroke). The meta-analysis included only original study data, in which compliance was \u0026gt;80% and outcomes were formally collected.\u003C\/p\u003E\n      \u003Cp id=\u0022p-9\u0022\u003EAccording to the Institute of Medicine\u0027s review of calcium supplementation and CV risk, most studies in the meta-analyses were small and did not report dietary calcium. Vascular events were not studied as a primary outcome and were not always adjudicated. In many cases of CV events, the confidence intervals included the null association value of one. In addition, renal function was not considered a covariate in the studies, which is a well-known risk factor for CVD [Institute of Medicine: Dietary reference intakes for calcium and vitamin D. In: Washington, DC. The National Academies Press 2011].\u003C\/p\u003E\n      \u003Cp id=\u0022p-10\u0022\u003EA true placebo-controlled, randomized trial of a single, readily available nutrient, such as calcium, is often difficult to achieve. Compliance with study parameters must be maintained at levels well above 80% to provide confidence in a verifiable outcome. Clear, definable endpoints that can be validated must be used, and the most stringent methods of statistical analysis must be applied in order to provide a final answer to this complex question. Until then, the preponderance of evidence does not point to a definite conclusion regarding calcium supplementation as a cause of CV events.\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/13\/28.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmwop\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmwop\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}