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Calcium Citrate Malate Review

Calcium citrate malate or CCM is a paradox.  While bettter absorbed than calcium-citrate-malate | Articleother forms of calcium, CCM has not distinguished itself  in bone density improvement. This suggests that high bioavailability of calcium is only part of the dynamic that leads to impressive bone density increases.

CCM is a water-soluble calcium salt of citric acid and malic acid. It is different from calcium malate.  According to one Advancedinorganics.com, a company that sells the compound:

“Calcium citrate malate's bioavailability stems from its water-solubility and its method of dissolution. When dissolved, it releases calcium ions and a calcium citrate complex. Calcium ions are absorbed directly into intestinal cells, and the citrate complex enters the body through paracellular absorption. Calcium citrate malate plays a very important role in the body. It is necessary for normal functioning of nerves, cells, muscle, and bone. If there is not enough calcium in the blood, then the body will take calcium from bones, thereby weakening bones. If your product contains calcium citrate, then it may be taken with or without food. Follow all directions on the product package, or take as directed by your doctor…..Calcium citrate malate has been shown to support healthier bones in adolescents and adults. [Calcium] is the most abundant mineral in the body with 99% of it deposited in the bones and teeth. The remaining 1% of calcium is used for numerous functions including muscle contraction, blood clotting, vitamin D metabolism and nerve transmission. Calcium citrate malate is approximately 4-5% more absorbable than calcium carbonate and is well absorbed regardless of stomach acid. Studies have suggested that calcium citrate is better absorbed than calcium carbonates and that the citrate form might thus be more effective in helping to prevent or ameliorate bone loss. An analysis of 15 randomized trials concluded that calcium citrate was absorbed 22% to 27% better than calcium carbonate, whether taken on an empty stomach or with food. More research will be needed, however, to demonstrate conclusively that calcium citrate is more beneficial than calcium carbonate.”

Despite being better absorbed than calcium carbonate, CCM is less impressive on bone measures.  An article in the Journal of Nutrition (124: 1412S-1417S, 1994) summarized CCM research on adolescents.  In one study, bone density changes were the same between those taking CCM and a placebo. In another only those taking 1000 mg of CCM (but not 500mg) daily saw in an improvement in bone mineral content versus placebo.

In an article entitled: The health benefits of calcium citrate malate: a review of the supporting science (Adv Food Nutr Res. 2008;54:219-346), Reinwald et al note:

"In adults, [CCM] effectively promotes the consolidation and maintenance of bone mass. In conjunction with vitamin D, CCM also decreases bone fracture risk in the elderly, slows the rate of bone loss in old age."

calcium-citrate-malate | ArticleCCM without vitamin D has either not been tested or was shown not to be effective in elderly patients. This is in contrast to AdvaCAL calcium, which -- without vitamin D -- increased bone density in two studies with elderly women, one of which also showed reduced fracture risk.  That AdvaCAL fracture study was small and requires additional research. Despite better absorption, bone density benefits appear to be no better than less expensive forms of calciums with calcium citrate malate.