Prevalence, determinants, and inappropriateness of calcium supplementation among men and women in a Spanish Mediterranean area: Cross-sectional data from the ESOSVAL cohort

Authors

  • Gabriel Sanfélix-Gimeno,

    Corresponding author
    1. Center for Public Health Research (CSISP), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain
    2. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
    3. Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
    4. Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
    • Address correspondence to: Gabriel Sanfélix-Gimeno, PhD, Health Services Research Area, Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Avda. de Cataluña 21, 46020 Valencia, Spain. E-mail: sanfelix_gab@gva.es

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  • José Sanfélix-Genovés,

    1. Center for Public Health Research (CSISP), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain
    2. Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
    3. Fundación de Investigación del Hospital Clínico Universitario-Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
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  • Clara L Rodriguez-Bernal,

    1. Center for Public Health Research (CSISP), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain
    2. Ciber en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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  • Salvador Peiró,

    1. Center for Public Health Research (CSISP), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain
    2. Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
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  • Isabel Hurtado

    1. Center for Public Health Research (CSISP), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain
    2. Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
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ABSTRACT

Recently, safety concerns about calcium supplementation have arisen. In this situation, ensuring appropriateness of use is highly important. We aimed to describe the use of calcium and vitamin D supplements, the factors related to it, and to assess the appropriateness of calcium prescription among men and women aged 50 years or older. We performed a cross-sectional study in 2009–2010 including 11,035 adults who belong to the ESOSVAL cohort and attend 272 primary healthcare centers in the Valencia region of Spain. Criteria for the inappropriateness of calcium prescription, based on guidelines and recent evidence, were: excessive or insufficient daily total intake (diet plus supplements), excessive single doses of supplements, excessive or insufficient association with vitamin D, and overall inappropriateness. Calcium and/or vitamin D were prescribed to about 17% of the population. Older age, antiosteoporotic treatment, use of glucocorticoids, and a diagnosis of osteoporosis were related to prescription. The presence of other secondary causes of osteoporosis determined supplementation only in men. Calcium dietary intake was not related to the prescription of supplements. Among calcium users, 85.8% met at least one criterion of inappropriate prescription; 29% had an inappropriate daily total intake mainly resulting from excessive consumption (>2000 mg/day); 53.8% of patients were given calcium supplements in quantities higher than 500 mg per dose; and 38.9% of individuals receiving calcium supplements had inappropriate (absent or below 800 UI/day) vitamin D supplementation (all of them at high risk). In conclusion, we found high inappropriateness of calcium supplementation, mainly because of calcium overdosing, and also to undertreatment and underdosing of vitamin D in high-risk patients. Physicians should be encouraged to assess calcium dietary intakes before supplementation, recommending intake from food whenever possible, and to prescribe low calcium doses and high vitamin D doses when given in fixed-dose combinations, or vitamin D alone when calcium is not necessary. © 2013 American Society for Bone and Mineral Research

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