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Calcium Citrate Malate

Also known as: Calcium citrate-malate, CCM, Calcium Citrate Malate

Overview

Calcium Citrate Malate (CCM) is a synthesized calcium salt compound, combining calcium with citrate and malate ions, specifically designed to enhance calcium bioavailability. Unlike naturally occurring calcium forms, CCM is manufactured for dietary supplementation. Its primary application is to prevent or treat calcium deficiency and support bone health, particularly in individuals at risk of osteoporosis or low bone mineral density (BMD). CCM is distinguished by its superior absorption compared to other common calcium salts like calcium carbonate, making it a preferred option for many. Research on CCM and calcium supplementation in general is extensive, with high-quality evidence from randomized controlled trials and meta-analyses supporting its efficacy in bone health outcomes.

Benefits

Calcium Citrate Malate (CCM) offers significant benefits for bone health, primarily due to its high bioavailability. Studies show that CCM supplementation can attenuate bone loss by approximately 60% in late postmenopausal women compared to placebo, often outperforming calcium carbonate in this population. It significantly improves bone mineral density (BMD) at various skeletal sites, including the radial bone, where calcium carbonate may show no gain. Beyond direct bone density improvements, CCM helps suppress parathyroid hormone levels, which in turn reduces bone demineralization. These benefits are particularly pronounced in late postmenopausal women with low dietary calcium intake. Younger populations under 35 years can also benefit, showing improved bone mass, indicating its potential for preventive use. Meta-analyses confirm that calcium supplementation generally reduces bone loss rates over two or more years, and when combined with vitamin D, it is associated with a reduction in fracture risk in older adults. Benefits typically become evident after two or more years of consistent supplementation.

How it works

Calcium Citrate Malate (CCM) functions by providing highly bioavailable calcium ions, which are crucial for bone mineralization and maintenance. Its unique chemical structure, combining calcium with citrate and malate, enhances its solubility and absorption, especially in individuals with lower stomach acid. Once absorbed, these calcium ions are utilized by the skeletal system to build and maintain bone tissue. CCM also plays a role in regulating parathyroid hormone (PTH) secretion. By increasing circulating calcium levels, it helps to suppress PTH, a hormone that, when elevated, promotes bone resorption (breakdown). This dual action of supplying calcium for bone formation and reducing bone breakdown contributes to its efficacy in improving bone mineral density and attenuating bone loss.

Side effects

Calcium Citrate Malate is generally considered safe when taken within recommended dosages. Common side effects, though infrequent, can include mild gastrointestinal discomfort such as constipation or bloating. These are typically mild and transient. Rare side effects, occurring in less than 1% of users, may include hypercalcemia (excessively high calcium levels in the blood), primarily in cases of excessive intake. CCM can interact with certain medications; it may reduce the absorption of some antibiotics (e.g., tetracyclines, fluoroquinolones) and bisphosphonates. Contraindications for CCM use include pre-existing hypercalcemia, a history of kidney stones, or certain cardiac conditions. Individuals with these conditions should consult a healthcare professional before use. Special populations, such as postmenopausal women and the elderly, should have their calcium balance monitored to ensure safe and effective supplementation.

Dosage

The minimum effective dose for Calcium Citrate Malate (CCM) to reduce bone loss is approximately 500 mg of elemental calcium daily. Optimal dosage ranges typically fall between 500–900 mg of elemental calcium per day, which should be adjusted based on an individual's dietary calcium intake and specific risk factors for bone loss. The maximum safe dose is generally considered to be up to 2000–2500 mg of elemental calcium daily; exceeding this limit may increase the risk of adverse effects such as hypercalcemia. For enhanced absorption, it is recommended to divide the daily dose and take it with meals. CCM is particularly preferred for its superior absorption, especially beneficial for individuals with low stomach acid. Vitamin D is a critical cofactor for optimal calcium absorption and overall bone health, and its sufficiency should be ensured. High intake of oxalates or phytates can reduce calcium absorption.

FAQs

Is calcium citrate-malate better absorbed than calcium carbonate?

Yes, studies consistently show superior absorption and urinary calcium excretion with calcium citrate-malate compared to calcium carbonate, especially in individuals with lower stomach acid.

Can calcium citrate-malate prevent fractures?

Calcium supplementation, particularly when combined with vitamin D, has been shown to reduce fracture risk in older adults, contributing to overall bone health and strength.

How long before benefits are seen?

Significant improvements in bone mineral density and reduction in bone loss typically require at least two years of consistent calcium citrate-malate supplementation to become evident.

Are there risks of kidney stones?

While excessive calcium intake can increase the risk of kidney stones, appropriate dosing within recommended limits and maintaining good hydration are important to mitigate this risk.

Research Sources

https://academic.oup.com/edrv/article/23/4/552/2433277 – This meta-analysis by Shea et al. (2002) synthesized data from multiple randomized controlled trials, concluding that calcium supplementation significantly reduces bone loss over periods of two years or more. The study highlights the overall efficacy of calcium in maintaining bone health across various populations, despite some variability in calcium forms and doses used in the included studies.
https://elifesciences.org/articles/79002 – Liu et al.'s 2022 systematic review and meta-analysis, involving 7382 participants under 35 years, found that calcium supplementation improves bone mass in younger individuals before they reach peak bone mass. This robust analysis suggests a preventive role for calcium in early life bone development, contributing to long-term bone health.
https://jamanetwork.com/journals/jama/fullarticle/2667071 – Zhao et al.'s 2017 meta-analysis focused on older adults, demonstrating that calcium, with or without vitamin D, reduces the risk of fractures. This high-quality study, adhering to Cochrane standards, provides strong evidence for the role of calcium supplementation in preventing fracture incidence in an at-risk population.
https://journals.lww.com/ijmr/fulltext/2023/07000/role_of_calcium___or_vitamin_d_supplementation_in.2.aspx – Khatri et al.'s 2023 systematic review and meta-analysis, compliant with PRISMA guidelines, concluded that calcium and/or vitamin D supplementation is beneficial for bone health in older adults. While acknowledging some limitations in specific data on calcium citrate-malate, the study reinforces the general positive impact of these supplements on bone integrity.
https://altmedrev.com/wp-content/uploads/2019/02/v4-2-74.pdf – This study, published in AltMedRev (2019), included an RCT and comparative absorption study, specifically investigating calcium citrate-malate in late postmenopausal women. It found that CCM is better absorbed and significantly reduces bone loss by 60% compared to other forms, highlighting its superior efficacy in this specific demographic.