Calcium2026-07

Dietary and supplemental calcium intake and bone changes during antiresorptive osteoporosis treatment in older women: a longitudinal observational study.

Papageorgiou Maria, Gugler Yvan, Ferrari Serge, Rizzoli René et al. — Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA

Summary

This study looked at how calcium and protein intake affect bone health in older women taking medication for osteoporosis. It suggests that if women already get enough calcium from their diet, extra calcium supplements might not provide additional benefits. Instead, ensuring adequate protein intake appears to be more crucial for the effectiveness of osteoporosis treatments in strengthening bones.

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Key points

For older women on osteoporosis medication, getting enough protein may be more important than extra calcium supplements if their dietary calcium is already sufficient.
Routine calcium supplementation might not be necessary for those already meeting recommended calcium intake levels through diet.
Low protein intake could reduce the benefits of osteoporosis medications on bone strength.
Optimizing overall nutrition, especially protein, is key for effective osteoporosis management.

What the study looked at

What question the study asked: This study investigated whether calcium intake (from diet or supplements) or protein intake influences how effectively osteoporosis medications improve bone health in older women who are already getting enough calcium. How it was studied (design/participants): Researchers followed nearly 600 older women, with a median age of 67, from a long-term study in Geneva for approximately 3.5 years. They assessed annual changes in hip bone density and strength, and recorded participants' calcium and protein intake using food frequency questionnaires. Some women were taking osteoporosis medication, others menopausal hormone therapy, and some no medication. What it found: The study revealed that for women already consuming sufficient calcium, taking additional calcium supplements did not significantly enhance the bone benefits from osteoporosis medication. However, women with low protein intake (less than 0.8 grams per kilogram of body weight per day) experienced reduced improvements in bone strength from their osteoporosis treatments. This indicates that adequate protein intake is vital for these medications to work optimally, potentially more so than extra calcium supplements when dietary calcium is already sufficient.

Dietary takeaway

This study suggests that if you're an older woman taking osteoporosis medication and already getting enough calcium from your diet, focusing on adequate protein intake might be more beneficial than adding extra calcium supplements. Good sources of protein include lean meats, poultry, fish, dairy products, beans, and lentils. Remember, this is one study, and individual needs can vary, so always discuss your diet and supplement use with your doctor or a registered dietitian.

Abstract

UNLABELLED: Calcium supplements are often prescribed with osteoporosis medications without considering dietary adequacy. In calcium-replete older women, calcium supplements had little effect on the response to antiresorptives, whereas low protein intake blunted their benefits. Calcium supplementation may be unnecessary when intake is adequate, and nutrition should be optimized for osteoporosis treatment. PURPOSE: Osteoporosis medications (OM) are commonly prescribed with calcium supplements (CaS) without considering dietary adequacy. We investigated whether calcium and protein intakes influence the effect of OM on total hip bone mineral density (BMD) and strength in calcium-replete women. METHODS: Data from 586 women (median age 67 years) from the Geneva Retirees Cohort were analyzed: 101 on menopausal hormone therapy (MHT), 67 on antiresorptives (AR) (bisphosphonates, denosumab or raloxifene), and 418 without OM. Annual changes in total hip BMD, strength, and structure were assessed over a median 3.5 years using 2D/3D-DXA and finite element analysis. Calcium and protein intakes were assessed by food frequency questionnaire; CaS use was recorded at baseline and follow-up. RESULTS: Total calcium intake (diet + supplements) was 1503 mg/day; 71% women met recommendations (≥ 1200 mg/day), 51% used CaS, and 70% vitamin D. MHT or AR increased total hip BMD and strength versus no OM. Neither total calcium intake (above or below 1200 mg/day) nor CaS use significantly affected bone outcomes. However, in women with low calcium intake (< 800 mg/day), no difference in changes of BMD or bone strength was observed between women with and without OM in the absence of CaS. In women with protein intake < 0.8 g/kg/day, AR effects were blunted, with reduced improvements in trabecular BMD (P = 0.009) and total hip strength (P = 0.040). CONCLUSION: In calcium-replete older women, protein intake rather than CaS influences total hip bone changes with OM. These findings question routine CaS in women with adequate calcium intake and emphasize the importance of sufficient protein intake for optimal osteoporosis management. CLINICAL TRIAL REGISTRATION: GERICO http://www.isrctn.com/ISRCTN11865958.

View on PubMed →DOI: 10.1007/s00198-026-08154-8