Expert opinion on the clinical use of calcium and vitamin D supplements in osteoporosis in Indian settings


  • Manjula S. Department of Medical Services, Micro Labs Limited, Bangalore, Karnataka, India
  • Krishna Kumar M. Department of Medical Services, Micro Labs Limited, Bangalore, Karnataka, India



Osteoporosis, Calcium, Vitamin D, Fracture, Calcium aspartate anhydrous


Background: Several clinical studies demonstrated that calcium intake decreases the risk of osteoporosis and osteoporotic fractures. However, understanding the prescription practice of calcium supplements employed in Indian contexts may help in improving patient management and developing evidence-based recommendations for optimizing the treatment. So, this study aimed to gather clinicians’ perspective regarding the use of calcium and vitamin D supplements for the management of osteoporosis in Indian settings.

Methods: The current survey involved 17 questions pertaining to current feedback, clinical observations, and clinical experience of specialists on osteoporosis management and the use of calcium and vitamin D supplements.

Results: According to 30%, 26%, 25%, and 19% of the experts, higher dietary sodium (salt) intake was generally associated with negative calcium balance and bone mineral loss, increased risk of fracture, decreased calcium excretion in the urine and decreased dietary calcium absorption. Calcium and vitamin D were recommended by 78% of the respondents for the management of osteoporosis. Approximately 72% of the respondents stated calcium aspartate anhydrous as the preferred calcium supplement to manage osteoporosis. Around 49% of the respondents reported a reduced risk of bone fractures among those who consume more calcium than the average amount. Further 48%, 30%, and 25% of the respondents indicated that calcium aspartate anhydrous have better absorption, better bioavailability, and better gastrointestinal tolerability.

Conclusions: According to the expert’s opinion, both calcium and vitamin D administration in conjunction with maintaining a balanced sodium intake were recommended for managing osteoporosis.



Sözen T, Özışık L, Başaran NÇ. An overview and management of osteoporosis. Eur J Rheumatol. 2017;4(1):46-56.

Babhulkar S, Seth S. Prevalence of osteoporosis in India: an observation of 31238 adults. International Journal of Research in Orthopaedics. 2021;7(2):362-8.

Bhadada SK, Chadha M, Sriram U, Pal R, Paul TV, Khadgawat R, et al. The Indian Society for Bone and Mineral Research (ISBMR) position statement for the diagnosis and treatment of osteoporosis in adults. Arch Osteoporos. 2021;16(1):102.

Khinda R, Valecha S, Kumar N, Walia JPS, Singh K, Sethi S, et al. Prevalence and Predictors of Osteoporosis and Osteopenia in Postmenopausal Women of Punjab, India. Int J Environ Res Public Health. 2022;19(5):2999.

Voulgaridou G, Papadopoulou SK, Detopoulou P, Tsoumana D, Giaginis C, Kondyli FS, et al. Vitamin D and Calcium in Osteoporosis, and the Role of Bone Turnover Markers: A Narrative Review of Recent Data from RCTs. Diseases. 2023;11(1):29.

Chadha M, Chaddha R, Divakar H, Kalyan H, Seth S, Shah P. Osteoporosis: Epidemiology, Pathogenesis, Evaluation and Treatment. Open J Orthop. 2022;12(4):153-82.

Holroyd C, Cooper C, Dennison E. Epidemiology of osteoporosis. Best Pract Res Clin Endocrinol Metabolism. 2008;22(5):671-85.

Reid IR, Mason B, Horne A, Ames R, Reid HE, Bava U, et al. Randomized controlled trial of calcium in healthy older women. Am J Med. 2006;119(9):777-85.

Cumming RG, Nevitt MC. Calcium for prevention of osteoporotic fractures in postmenopausal women. J Bone Miner Res. 1997;12(9):1321-9.

Karpouzos A, Diamantis E, Farmaki P, Savvanis S, Troupis T. Nutritional Aspects of Bone Health and Fracture Healing. J Osteoporosis. 2017;2017:e4218472.

Carbone L, Johnson KC, Huang Y, Pettinger M, Thomas F, Cauley J, et al. Sodium Intake and Osteoporosis. Findings From the Women’s Health Initiative. J Clin Endocrinol Metab. 2016;101(4):1414-21.

Teucher B, Dainty JR, Spinks CA, Majsak-Newman G, Berry DJ, Hoogewerff JA, et al. Sodium and bone health: impact of moderately high and low salt intakes on calcium metabolism in postmenopausal women. J Bone Miner Res. 2008;23(9):1477-85.

Park SM, Jee J, Joung JY, Cho YY, Sohn SY, Jin SM, et al. High Dietary Sodium Intake Assessed by 24-hour Urine Specimen Increase Urinary Calcium Excretion and Bone Resorption Marker. J Bone Metab. 2014;21(3):189-94.

Sheth B, Akil Prabhakar S, Pawar P, Ganwir H, Panchal S, Jain A. Calcium prescription by Indian orthopaedic surgeons: A survey and a review of literature. J Clin Orthop Trauma. 2021;16:292-8.

Weaver CM, Alexander DD, Boushey CJ, Dawson-Hughes B, Lappe JM, LeBoff MS, et al. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int. 2016;27:367-76.

Yao P, Bennett D, Mafham M, Lin X, Chen Z, Armitage J, et al. Vitamin D and Calcium for the Prevention of Fracture: A Systematic Review and Meta-analysis. JAMA Netw Open. 2019;2(12):e1917789.

Eleni A, Panagiotis P. A systematic review and meta-analysis of vitamin D and calcium in preventing osteoporotic fractures. Clin Rheumatol. 2020;39(12):3571-9.

Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. 1997;337(10):670-6.

Advanced Alternatives Centre. Effects of Calcium Aspartate Anhydrous on Treatment of Osteoporosis. Available at: Accessed on 30 December 2023.






Original Research Articles