Calcium Supplementation in the Indian Context: A Consensus Statement by the Endocrine Society of India Skeletal Health Taskforce

Abstract

Optimum intake of calcium is fundamental for skeletal health and additionally plays a role in cardiovascular health, haemostasis, synaptic transmission, and several enzyme-driven metabolic reactions. In several countries, including India, dietary calcium intake is poor, and it is necessary to ensure adequate calcium intake for optimizing musculoskeletal health. Not many guidelines focus on regions where calcium in the diet is suboptimal, and supplementing calcium may be specially relevant. In view of this, the Endocrine Society of India (ESI) Skeletal Task Force has developed clinical practice guidelines on calcium supplementation. The statement emphasizes that food sources should be the preferred modality of meeting calcium needs, and supplements should be used when dietary intake is insufficient or when physiological demands are higher, such as in pregnancy, lactation, or after menopause. Additionally, calcium should be supplemented in bone mineral disorders, such as osteoporosis, osteomalacia, hypocalcaemic rickets, and hypoparathyroidism. Special precautions are necessary in chronic kidney disease and in the presence of renal stone disease, but safety in cardiovascular disease is reinforced unless the total intake crosses the recommended daily intake. The statement recommends ensuring vitamin D sufficiency but strongly recommends against supplementing activated forms of vitamin D except in special situations. This ESI statement aims to provide rationalized guidance to ensure adequate calcium supplementation while avoiding the risks associated with injudicious use.