Calcium citrate supplements
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Calcium Citrate Supplements: Efficacy, Safety, and Clinical Applications
Introduction to Calcium Citrate Supplements
Calcium citrate is a commonly used form of calcium supplement, particularly beneficial for individuals who do not achieve adequate calcium intake through diet alone. It is often compared with other calcium salts like calcium carbonate for its efficacy and safety in various health conditions.
Efficacy in Bone Health and Osteoporosis
Calcium Citrate and Bone Turnover
Calcium citrate has been shown to be effective in managing bone health, particularly in postmenopausal women and individuals with osteoporosis. Studies indicate that calcium citrate supplementation can attenuate the increase in bone resorption markers such as C-telopeptide of type 1 collagen (CTX) during acute citrate loads, which mimic conditions like citrate anticoagulation during apheresis procedures2. Additionally, calcium citrate is more bioavailable than calcium carbonate, leading to greater increases in serum calcium and more significant reductions in parathyroid hormone levels, which are crucial for bone health7.
Long-term Benefits and Safety
Long-term studies suggest that calcium citrate supplementation does not increase the risk of kidney stone formation in healthy postmenopausal women. In fact, when combined with potassium citrate, it may even reduce the risk of uric acid and calcium oxalate stones4. This makes calcium citrate a safer option for long-term use in individuals at risk of nephrolithiasis.
Clinical Applications Beyond Bone Health
Hypoparathyroidism Management
In patients with chronic hypoparathyroidism, calcium citrate has shown potential advantages over calcium carbonate. It is associated with a significant reduction in urinary oxalate excretion, which could lower the risk of nephrolithiasis, a common complication in these patients5. Moreover, calcium citrate is effective in maintaining desirable serum calcium levels without increasing the risk of kidney stones5.
Impact on Lipid Profiles
Calcium citrate supplementation has also been linked to beneficial changes in lipid profiles. A study involving older women found that calcium citrate increased high-density lipoprotein (HDL) cholesterol levels and improved the HDL to low-density lipoprotein (LDL) cholesterol ratio, suggesting a potential cardiovascular benefit6.
Comparative Efficacy with Other Supplements
Potassium Citrate and Calcium Balance
Potassium citrate, another supplement often used in conjunction with calcium citrate, has been shown to improve calcium balance and reduce bone resorption markers in older adults. This combination can neutralize dietary acid loads, which are detrimental to bone health, thereby enhancing the overall efficacy of calcium supplementation3 10.
Acute Effects on Calcium and Bone Metabolism
Comparative studies have demonstrated that both calcium citrate and calcium carbonate effectively reduce serum parathyroid hormone levels and bone resorption markers. However, calcium citrate is absorbed more efficiently and has a more pronounced effect on increasing serum calcium levels8 9.
Conclusion
Calcium citrate is a highly effective and safe supplement for improving bone health, particularly in individuals with osteoporosis, chronic hypoparathyroidism, and those at risk of nephrolithiasis. Its superior bioavailability and beneficial effects on lipid profiles further enhance its clinical utility. When combined with potassium citrate, it offers additional benefits in calcium balance and bone metabolism, making it a valuable option for long-term supplementation.
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Most relevant research papers on this topic
Calcium citrate: from biochemistry and physiology to clinical applications
Calcium citrate supplementation may be beneficial for managing chronic conditions like osteoporosis, bariatric patients, and achloridria, as well as preventing kidney stone formation and recurrence.
Literature ReviewCalcium supplementation attenuates citrate-related changes in bone metabolism: a placebo-controlled crossover study in healthy volunteers.
Calcium supplementation effectively reduces short-term bone resorption related to acute citrate load in healthy volunteers.
RCT
Rigorous JournalPotassium citrate supplementation results in sustained improvement in calcium balance in older men and women
Potassium citrate supplementation improves calcium balance and reduces urinary calcium levels in older men and women, potentially improving skeletal health.
RCT
Very Rigorous Journal
Highly CitedStone forming risk of calcium citrate supplementation in healthy postmenopausal women.
Calcium citrate supplementation does not increase the risk of stone formation in healthy postmenopausal women, and co-administering potassium citrate may provide additional protection against uric acid and calcium oxalate stones.
RCTCalcium Citrate Versus Calcium Carbonate in the Management of Chronic Hypoparathyroidism: A Randomized, Double‐Blind, Crossover Clinical Trial
Calcium citrate may reduce nephrolithiasis risk in chronic hypoparathyroidism patients by reducing urinary oxalate excretion, but does not significantly differ in serum calcium and phosphorus levels.
RCTVery Rigorous JournalEffects of calcium supplementation on serum lipid concentrations in normal older women: a randomized controlled trial.
Calcium citrate supplementation improves HDL cholesterol levels and the HDL/LDL cholesterol ratio in postmenopausal women, suggesting its cost-effectiveness may be underestimated.
RCTHighly CitedPharmacokinetic and Pharmacodynamic Comparison of Two Calcium Supplements in Postmenopausal Women
Calcium citrate is more bioavailable than calcium carbonate when given with a meal in postmenopausal women.
RCTHighly CitedAcute effects of calcium carbonate, calcium citrate and potassium citrate on markers of calcium and bone metabolism in young women.
Potassium citrate reduces bone resorption and increases calcium retention in young women, while both calcium carbonate and calcium citrate decrease serum parathyroid hormone levels.
RCTVery Rigorous JournalAcute and 3-month effects of microcrystalline hydroxyapatite, calcium citrate and calcium carbonate on serum calcium and markers of bone turnover: a randomised controlled trial in postmenopausal women.
Microcrystalline hydroxyapatite (MCH) and calcium citrate-carbonate supplements both have similar effects on serum calcium concentrations and suppress bone turnover in postmenopausal women.
RCTVery Rigorous JournalPotassium Citrate Supplementation Decreases the Biochemical Markers of Bone Loss in a Group of Osteopenic Women: The Results of a Randomized, Double-Blind, Placebo-Controlled Pilot Study
Potassium citrate supplementation improves the beneficial effects of calcium and vitamin D in osteopenic women with a documented potassium and citrate deficit and low-grade acidosis.
RCTVery Rigorous Journal