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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.
Talk with your doctor
Calcium should always be taken with vitamin D, because vitamin D is necessary for the body to absorb calcium.
| Age | Recommended calcium intake (milligrams a day) |
|---|---|
| 1–3 years | 500 |
| 4–8 years | 800 |
| 9–18 years | 1,300 |
| 19–50 years | 1,000 |
| Older than 50 years | 1,200 |
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.
Test Your Knowledge
If I am a woman older than age 50, I need about 1,200 mg of calcium a day to keep my bones strong and healthy.
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.
Test Your Knowledge
Calcium increases bone mass and reduces the risk for developing osteoporosis.
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.
| Food | Serving size | Calcium (mg) per serving |
|---|---|---|
| Yogurt (plain, low-fat) | 8 oz |
415 |
| Yogurt (fruit, low-fat) | 8 oz |
245–384 |
| Sardines in oil, with bones | 3 oz |
324 |
| Cheddar cheese | 1 1/2 oz |
306 |
| Milk (skim, 2%, whole) | 1 cup |
291–302 |
| Tofu (firm, made with calcium sulfate) | 1/2 cup |
204 |
| Canned salmon (with bones) | 3 oz |
181 |
| Cottage cheese (1% milk fat) | 1 cup |
138 |
| Turnip greens (boiled) | 1/2 cup |
99 |
| Ice cream (vanilla) | 1/2 cup |
85 |
| Broccoli (raw) | 1/2 cup |
21 |
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.
| Product name | Calcium in each tablet |
|---|---|
| Caltrate (tablets or chewables) | 600 mg calcium carbonate |
| Citracal Ultradense Plus D, Coated Caplets | 315 mg calcium citrate |
| Oscal 500 | 500 mg calcium carbonate |
| Viactiv Soft Calcium Chews plus D | 500 mg calcium carbonate |
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
Test Your Knowledge
I am 35 years old and drink 2 glasses of milk a day. That's enough calcium to reduce my risk of bone loss.
I am a woman older than 65 and do not eat dairy products. I can get enough calcium by taking a good calcium supplement along with getting enough vitamin D to help my body absorb the calcium.
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.
Citations
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.
Bischoff-Ferrari HA, et al. (2004). Effect of vitamin D on falls: A meta-analysis. JAMA, 291(16): 1999–2006.
National Osteoporosis Foundation (2008). Prevention. Available online: www.nof.org/prevention/index.htm.
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.
Jackson RD, et al. (2006). Calcium plus vitamin D supplementation and the risk of fractures. New England Journal of Medicine, 354(7): 669–683.
WebMD Medical Reference from Healthwise
VIVELLE-DOT (estradiol transdermal system) IS AVAILABLE BY PRESCRPTION ONLY.
INDICATION
Vivelle-Dot is used after menopause to: reduce moderate to severe hot flashes; treat moderate to severe dryness, itching and burning in or around the vagina; help reduce your chances of getting osteoporosis (thin weak bones); and treat certain conditions in which a young woman's ovaries do not produce enough estrogens naturally. Vivelle-Dot 0.025 mg/day is only used to prevent osteoporosis from menopause. If you use Vivelle-Dot only to treat your dryness, itching, and burning in and around your vagina or if you use Vivelle-Dot only to prevent osteoporosis from menopause, talk with your healthcare professional about whether a different treatment or medicine without estrogens might be better for you.
IMPORTANT SAFETY INFORMATION
Estrogens increase the chances of getting cancer of the uterus (womb). Report any unusual vaginal bleeding right away while you are taking estrogens. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb).
Do not use estrogens with or without progestins to prevent heart disease, heart attacks, or strokes. Using estrogens with or without progestins may increase your chances of getting heart attacks, strokes, breast cancer, and blood clots. Using estrogens with progestins may increase your risk of dementia (decline in memory and thinking skills).
Vivelle-Dot should not be used if you have unusual vaginal bleeding; currently have or have had certain cancers, including cancer of the breast or uterus; had a stroke or heart attack in the recent past (for example, in the past year); currently have or have had blood clots; currently have or have had liver problems; or think you may be, or know that you are, pregnant.
The most common side effects that may occur with Vivelle-Dot are headache, breast tenderness, and back pain.
You and your healthcare professional should talk regularly about whether you still need treatment with Vivelle-Dot.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see Full Prescribing Information for Vivelle-Dot.
Taking Vitamin D and Calcium Together
Osteoporosis specialist Dr. Ethel Siris on why it's so important to take calcium with Vitamin D.
