Osteoporosis: Taking calcium

Bone thinning occurs as part of the natural process of aging. If the thinning continues to the point that your bones become fragile and in danger of breaking, you have osteoporosis. However, osteoporosis is considered a preventable disease.

Key points

• After age 30, men and women naturally begin to lose bone mass. You can slow bone loss and possibly prevent osteoporosis by eating a diet rich in calcium and vitamin D.
• Getting enough calcium and vitamin D is especially critical for women in the first few years after menopause, when bone mass is lost more rapidly.
• Most Americans get only half the calcium they need from their diet. If you do not get enough calcium from the foods you eat, change your diet or take calcium and vitamin D supplements. Your body needs vitamin D to absorb calcium.
• If you are diagnosed with osteoporosis, you should take calcium and vitamin D supplements in addition to any other medicine prescribed by your doctor.
• Calcium is found in many foods, including dairy products such as milk or yogurt, fortified orange juice, and many vegetables.

 What is the recommended daily amount of calcium?
 Why is calcium used to treat or prevent osteoporosis?
 How can I get enough calcium in my daily diet?
 Where to go from here

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Calcium should always be taken with vitamin D, because vitamin D is necessary for the body to absorb calcium.

Pregnant or nursing women need the same amount of calcium as other women their age: 1,000 to 1,200 milligrams a day.

Most people do not get enough calcium through diet alone. You need to eat 3 to 4 servings a day of foods high in calcium to get the recommended daily amount.

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Calcium, combined with vitamin D and weight-bearing exercise, keeps bone loss from getting worse or helps reduce the rate of bone loss that occurs with osteoporosis. And one study showed that vitamin D may reduce an older person's risk for falling by 22%.²

Your bones need vitamin D to absorb calcium. Most doctors suggest daily vitamin D supplements for children and teens, starting by age 2 months. Talk with your doctor about how much and what sources of vitamin D are right for your child. The recommended daily intake is 400 to 800 IU for adults ages 19 to 50, and 800 to 1,000 IU a day for adults age 50 and older.³

If you live in a sunny climate, you can get enough vitamin D through 10 to 15 minutes per day of sun exposure a few days a week; however, older people may not get enough this way. You can also get vitamin D in foods such as egg yolks, liver, saltwater fish, and dairy products fortified with vitamin D. Taking a vitamin D supplement along with your calcium can help strengthen your bones.

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Many foods contain high amounts of calcium. It is important that you also get enough vitamin D and phosphorus along with calcium to help your body absorb the calcium. The following table shows some foods that contain calcium.

The best source of calcium is milk fortified with vitamin D. Four glasses a day provide about 1,200 mg of calcium. Other good sources of calcium include shrimp, blackstrap molasses, calcium-fortified tofu, and almonds. You can also buy foods that have been calcium-fortified, such as cereals, orange juice, and soy milk. Read the food label to know how much calcium was added.

Because most Americans get only half the calcium they need from their diet, many people need to take a calcium supplement. Everyone who has been diagnosed with osteoporosis should take calcium and vitamin D supplements in addition to eating a diet rich in these nutrients.

Types of calcium supplements include:

• Calcium carbonate, which is 40% elemental calcium.
• Calcium citrate, which is 21% elemental calcium. While lower in elemental calcium than calcium carbonate, calcium citrate is easier to digest and does not cause constipation as much as other types of calcium supplements.
• Calcium gluconate and calcium lactate, which contain a low amount of elemental calcium.

The following table shows examples of calcium supplements. Some of these products include vitamin D. Be sure to take vitamin D with calcium, either in combination or separately, to help your body absorb the calcium into your bones.

Each day take the number of tablets that satisfies your daily recommended amount of calcium based on your age and health condition. You should not get more than 2,500 mg a day of calcium, whether it is from supplements or food. Calcium supplements with vitamin D may slightly increase your risk of kidney stones.⁵

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Now that you have read this information, you can feel confident that you know how to get enough calcium daily to prevent or treat osteoporosis and reduce your risk for bone loss.

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Citations

1. Office of Dietary Supplements, National Institutes of Health (2005). Dietary Supplement Fact Sheet: Calcium. Available online: http://www.ods.od.nih.gov/factsheets/calcium_pf.asp.

2. Bischoff-Ferrari HA, et al. (2004). Effect of vitamin D on falls: A meta-analysis. JAMA, 291(16): 1999–2006.

3. National Osteoporosis Foundation (2008). Prevention. Available online: www.nof.org/prevention/index.htm.

4. Nieves J (2002). Nutrition. In SR Cummings et al., eds., Osteoporosis: An Evidence-Based Guide to Prevention and Management, pp. 85–108. Philadelphia: American College of Physicians–American Society of Internal Medicine.

5. Jackson RD, et al. (2006). Calcium plus vitamin D supplementation and the risk of fractures. New England Journal of Medicine, 354(7): 669–683.