Calcium supplementation for adults under 35 may improve bone health

• Calcium plays an important role in bone health; deficiencies can result in reduced bone density and cause conditions such as osteoporosis.
• Calcium supplementation later in life only slightly decreases the risk of osteoporosis or fracture.
• Previous research on the effect of supplemental calcium on bone mineral growth in young people (35 years or younger) was limited.
• Recently, researchers completed a systematic review to summarize the evidence of the effect of calcium supplementation in younger age groups, finding that supplementation does, in fact, improve bone mass.

Osteoporosis, where bones become porous and weaker due to loss of bone density, is an important health concern during aging.

The condition increases the risk of fractures, especially in the hip, spinal vertebrae, and wrists. Osteoporosis particularly affects older women and typically occurs as a result of hormonal changes or deficiencies of calcium or vitamin D.

In a new study recently published in eLife, researchers from Wenzhou Medical University, China, searched for randomized controlled trials that compared calcium or calcium plus vitamin D with a placebo or no treatment in participants under the age of 35. Specifically, the researchers examined bone mineral density or bone mineral content.

Their analysis included more than 7,300 participants across 43 studies and examined changes in bone mineral density and bone mineral content in the lumbar spine, femoral neck, total hip, and total body.

Measuring bone health

Tests for bone mineral density can provide a snapshot of a person’s bone health.

Bone mass changes occur naturally over time, with peak bone mass occurring in our 20s — although there is a difference between males and females.

In the new study, researchers found that calcium supplements in people under 35 could significantly improve the bone mineral density levels of both the total body and femoral neck and slightly increase the bone mineral density of the femoral neck, total body, and lumbar spine.

This improvement was most pronounced in people ages 20 to 35 years (the peri–peak bone mass age, where the bone mass plateaus) compared with those younger than 20 years (the pre-peak bone mass age).

Professor Joan Marie Lappe, Ph.D., RN, associate dean at the College of Nursing Research at the Osteoporosis Research Center at Creighton University in Omaha, NE, not involved in the study, explained the findings to Medical News Today:

“Younger persons need adequate calcium intake to build and maintain strong bones. In the analysis, both calcium supplement and dietary calcium studies were included. Dietary calcium is the best source, but supplements should be taken as needed to achieve the recommended intake level.”

Building stronger bones with additional calcium

The researchers found that both dietary sources of calcium and calcium supplementation had positive effects on overall bone mineral density, but bone mineral density measurements of the femoral neck and lumbar spine were only improved following calcium supplementation.

Prof. Lappe noted, “previous research and human calcium physiology inform us that without adequate calcium intake, the body takes calcium from the bone to be used for other vital functions.”

Research also shows that peak bone mass (reached between ages 25 and 30) is the best predictor of osteoporotic fractures in older adults. Thus, attaining the maximum peak mass provides protection against osteoporosis.

– Professor Joan Marie Lappe, Ph.D., RN

Lily Chapman, BSc., MSc., performance coach and sport and exercise nutritionist, not involved in the research, highlighted to MNT that “studies have shown consistently that either increasing dietary calcium intake or including calcium supplementation can help to increase peak bone mass/content/density and reduce bone loss.”

However, Chapman pointed out that most studies to date tended to include older participants.

“Age leads to accelerated bone density loss, accompanied with microstructural alterations. Knowing the current strain on healthcare systems and the growing importance of a proactive and preventative approach to [the] health and fitness industry, this research plays an important part in being the first meta-analysis I am aware of to focus on age before achieving peak bone mass.”

– Lily Chapman BSc., MSc.

On reviewing the study’s results, Chapman said:

“Significant improvement effects of calcium supplements were found on both bone mineral density and bone mineral content, especially at the femoral neck. This is a promising find, as people who develop a higher peak bone mass when younger are likely to be better protected against issues such as osteoporosis and related fractures later in life.”

Recommended guidelines for calcium differ between country and age

Prof. Lappe noted that “there is no specific age recommended to start supplements. Guidelines [in the United States] recommend calcium intake by age group, 1000 milligrams per day for those ages 19 to 50 years and 1200 mg per day for those over 50. Supplements should be used at any age if adequate calcium is not obtained from food.”

• dairy products
• plant-based milks
• edamame
• canned sardines
• almonds
• leafy greens

Limitations to the research

The researchers noted several limitations in their publication.

For instance the researchers did not clearly compare the difference between males and females due to the limitations of the existing data (some studies provided merged data of males and females without males alone). They also noted that few of the studies they included in the analysis focused on the 20- to 35-year-old age group.

Chapman noted this in her review. “Only three studies met the inclusion criteria for the age range between 20–35, meaning a high percentage of participants were adolescents,” Chapman said.

“With this, it is therefore warranted for more studies to investigate the age group of 20–35 to help consolidate these findings, as this is a period of life where bone mineral density peaks. But overall, a promising area of research that poses several strengths, mainly due to it being one of the first meta-analyses of its kind!”

The researchers highlight that although the number of studies in the 20–35 age group was small, their evidence was of high quality, and the results were stable, especially in the femoral neck.

Based on this research, people older than 35 may wonder if it’s too late to start calcium supplements. In answer to this important question, Prof. Lappe noted, “it is never too late.”

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