Doesn’t apply to most calcium prescriptionsBMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c5003 (Published 15 September 2010) Cite this as: BMJ 2010;341:c5003
- Matthew L Grove, consultant rheumatologist1,
- David Cook, lead pharmacist—procurement, formulary, and business information1
- 1Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear NE29 8NH
Bolland and colleagues have followed-up their 2008 paper on calcium supplementation and cardiac risk with a better constructed meta-analysis supporting their original conclusions.1 2 However, by excluding trials of calcium and vitamin D supplements, they have drastically limited the generalisability of their findings.
In our trust (population 550 000; three district general hospitals; no renal unit, so limited use of calcium supplements as phosphate binders) our pharmacy records 4074 transactions for calcium supplements during 2009-10. Of these, 146 were for calcium supplements alone and 3928 were for calcium with vitamin D in one form or another (around 2500 for Adcal D3, the preferred local brand, around 900 for Calcichew D3 forte, and around 450 for Calfovit D3 sachets, a calcium citrate preparation).
In other words, only 3.5% of the prescriptions were for calcium supplements not containing vitamin D. This isn’t surprising as the local osteoporosis guidelines recommend routine supplementation with vitamin D,3 and we have long been suspicious of the value of calcium supplementation in isolation.
Our concern is that Bolland and colleagues’ paper will dissuade our local patient population from taking their calcium supplements when 96.5% of them would have been excluded from the meta-analysis. A better title would have been “Effect of calcium supplements without vitamin D on risk of myocardial infarction . . ..”
Cite this as: BMJ 2010;341:c5003
Competing interests: None declared.