Are more trials of calcium supplements really needed? A response to Bolland et al.

Are more trials of calcium supplements really needed? A response to Bolland et al. Osteoporos Int (2017) 28:2731 DOI 10.1007/s00198-017-4123-z LETTER Are more trials of calcium supplements really needed? A response to Bolland et al. 1,2 1,2,3 N. C. Harvey & C. Cooper & on behalf of the IOF-ESCEO Working Group Received: 5 June 2017 /Accepted: 8 June 2017 /Published online: 7 July 2017 International Osteoporosis Foundation and National Osteoporosis Foundation 2017 We agree with the assertion by Bolland et al., in their recent et al., in discounting the one route to a definitive answer, letter [1] commenting on our review of calcium/ vitamin D without providing an alternative solution, does little to ad- supplementation and health [2], that concerns regarding pre- vance the field. viously suggested links between these supplements and car- diovascular events will not be settled by further debate. The Compliance with ethical standards response to this position should, one might suppose, be to suggest what might offer a more appropriate way forward. Disclosure statement N. Harvey has received consultancy, lecture fees, Our proposal is that, in order to definitively understand the and honoraria from Alliance for Better Bone Health, AMGEN, MSD, Eli benefits and risks associated with calcium/ vitamin D supple- Lilly, Servier, Shire, Consilient Healthcare, and Internis Pharma. C. Cooper has received consultancy, lecture fees, and honoraria from mentation, a suitably powered trial, with relevant validated AMGEN, GSK, Alliance for Better Bone Health, MSD, Eli Lilly, endpoints, would be required. We of course accept that it is Pfizer, Novartis, Servier, Medtronic, and Roche. unlikely that such a trial will be undertaken, and we clearly recognize that there would be methodological and ethical is- sues which would require very careful thought: we are certain- References ly not indiscriminately Bcalling for more large randomized trials of calcium supplements^ as Bolland et al. seem to sug- 1. Bolland MJ, Grey A, Reid IR (2017) Are more trials of calcium gest. Notwithstanding the authors’ rather simplistic illustration supplements really needed? Osteoporos Int. doi:10.1007/s00198- of risk-benefit ratio (by comparing numbers of fractures 017-3988-1 prevented with numbers of selected adverse events, which 2. Harvey NC, Biver E, Kaufman JM et al (2017) The role of calcium ignores the magnitude of associated morbidity etc.), it is supplementation in healthy musculoskeletal ageing: an expert con- sensus meeting of the European Society for Clinical and Economic self-evident, from the existence of this debate, that the current Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal literature does not answer these questions. Our interpretation Diseases (ESCEO) and the International Foundation for of the evidence base is that the support for cardiovascular Osteoporosis (IOF). Osteoporos Int 28:447–462. doi:10.1007/ adverse effects is tenuous at best; the approach of Bolland s00198-016-3773-6 * C. Cooper cc@mrc.soton.ac.uk MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK NIHR Biomedical Research Centre, University of Oxford, Oxford, UK http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Osteoporosis International Springer Journals

Are more trials of calcium supplements really needed? A response to Bolland et al.

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Publisher
Springer London
Copyright
Copyright © 2017 by International Osteoporosis Foundation and National Osteoporosis Foundation
Subject
Medicine & Public Health; Orthopedics; Endocrinology; Rheumatology
ISSN
0937-941X
eISSN
1433-2965
D.O.I.
10.1007/s00198-017-4123-z
Publisher site
See Article on Publisher Site

Abstract

Osteoporos Int (2017) 28:2731 DOI 10.1007/s00198-017-4123-z LETTER Are more trials of calcium supplements really needed? A response to Bolland et al. 1,2 1,2,3 N. C. Harvey & C. Cooper & on behalf of the IOF-ESCEO Working Group Received: 5 June 2017 /Accepted: 8 June 2017 /Published online: 7 July 2017 International Osteoporosis Foundation and National Osteoporosis Foundation 2017 We agree with the assertion by Bolland et al., in their recent et al., in discounting the one route to a definitive answer, letter [1] commenting on our review of calcium/ vitamin D without providing an alternative solution, does little to ad- supplementation and health [2], that concerns regarding pre- vance the field. viously suggested links between these supplements and car- diovascular events will not be settled by further debate. The Compliance with ethical standards response to this position should, one might suppose, be to suggest what might offer a more appropriate way forward. Disclosure statement N. Harvey has received consultancy, lecture fees, Our proposal is that, in order to definitively understand the and honoraria from Alliance for Better Bone Health, AMGEN, MSD, Eli benefits and risks associated with calcium/ vitamin D supple- Lilly, Servier, Shire, Consilient Healthcare, and Internis Pharma. C. Cooper has received consultancy, lecture fees, and honoraria from mentation, a suitably powered trial, with relevant validated AMGEN, GSK, Alliance for Better Bone Health, MSD, Eli Lilly, endpoints, would be required. We of course accept that it is Pfizer, Novartis, Servier, Medtronic, and Roche. unlikely that such a trial will be undertaken, and we clearly recognize that there would be methodological and ethical is- sues which would require very careful thought: we are certain- References ly not indiscriminately Bcalling for more large randomized trials of calcium supplements^ as Bolland et al. seem to sug- 1. Bolland MJ, Grey A, Reid IR (2017) Are more trials of calcium gest. Notwithstanding the authors’ rather simplistic illustration supplements really needed? Osteoporos Int. doi:10.1007/s00198- of risk-benefit ratio (by comparing numbers of fractures 017-3988-1 prevented with numbers of selected adverse events, which 2. Harvey NC, Biver E, Kaufman JM et al (2017) The role of calcium ignores the magnitude of associated morbidity etc.), it is supplementation in healthy musculoskeletal ageing: an expert con- sensus meeting of the European Society for Clinical and Economic self-evident, from the existence of this debate, that the current Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal literature does not answer these questions. Our interpretation Diseases (ESCEO) and the International Foundation for of the evidence base is that the support for cardiovascular Osteoporosis (IOF). Osteoporos Int 28:447–462. doi:10.1007/ adverse effects is tenuous at best; the approach of Bolland s00198-016-3773-6 * C. Cooper cc@mrc.soton.ac.uk MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK NIHR Biomedical Research Centre, University of Oxford, Oxford, UK

Journal

Osteoporosis InternationalSpringer Journals

Published: Jul 7, 2017

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