Clarity needed on calcium supplements
Medical science is constantly changing and it can become a full-time job trying to keep up to date with all the newly published literature. It is important that we stay aware of some of the major changes happening in clinical research, but on occasion this can leave us unsure what the findings mean for our own clinical practice.
One such piece of research that I came across was highlighted in a report in the univadis GP News recently (click here). The study's take-home message was that calcium supplements with or without vitamin D modestly increase the risk for cardiovascular events and the full paper - published online in the British Medical Journal (BMJ) - is well worth a read (click here). In a related editorial published at the same time (click here), the conclusion that there is "as yet insufficient evidence available to support or refute the association" is no great surprise. But if the study's claim is substantiated then the role of calcium in therapeutics will have to be critically re-examined, particularly when it comes to the management of osteoporosis.
The study authors note that although the impact may be modest, calcium and/or vitamin D are relatively commonly prescribed drugs so the actual numbers of people involved could be significant - in which case we could have a therapeutic dilemma. We are keen to manage osteoporosis, but not at the expense of an increased burden of cardiovascular disease and we need some clarity on this as a matter of urgency. I accept that the definitive evidence on the risks and benefits of calcium and vitamin D supplements may take some time to come through, but if the doubt seeps through to the front line, then we will need some sort of guidance from a respected body.
Royal Colleges, learned academic societies and of course NICE will all hopefully have something to say and give updated guidance to clinicians as well as to the public at large. After all, thanks to the internet and media with a strong interest in health, this kind of information is widely available. The public will be asking us what we think and we should be in a position to give a balanced opinion, based on the currently available evidence.
For the time being it looks like we will have to share the uncertainty with our patients and healthcare professionals will have to stay alert to the current thinking on this important debate. This means following the massive volume of medical literature published every day. Not an easy task - but who said it was easy being a doctor?
Dr Harry Brown, editor-in-chief
By Dr Harry Brown