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You are Here: Home Page > Osteoporosis > Commonly Asked Questions About Calcium Supplements  

Commonly Asked Questions About Calcium Supplements

Why is calcium important?

Calcium is a nutrient that is essential for strong bones and for supporting your body's critical functions such as controlling your blood pressure and maintaining your heart beat. Ninety-nine percent of your body's calcium is stored in your bones and teeth. This calcium makes up your bone bank. Throughout your lifetime, calcium is "deposited" in and "withdrawn" from your bone bank depending on your needs. When your dietary calcium intake is too low, your body will "withdraw" the calcium it needs from your bones. Over time, if more calcium is taken out of your bones than is put in, the result may be thin, weak bones that may break more easily.

How do I know if I am getting enough calcium in my diet?

Know your daily recommended calcium intake:

Age (years)	Calcium (mg*/day)
1-3	500
4-8	800
9-18	1300
19-50	1000
51 or older	1200
*mg=milligram Dietary Reference Intakes, National Academy of Sciences, 1997

The preferred way to get adequate calcium is through a healthy, well-balanced diet. The first step is to determine the amount of calcium you consume in your typical daily diet. The "Estimating Your Total Daily Calcium Intake" will help you determine whether you are getting your recommended daily intake for calcium.

If I am not getting enough calcium, what should I do?

• Most individuals can easily get at least half of the calcium they need from food. If your typical calcium intake is too low, first try to increase the calcium in your diet. There are many calcium-rich foods to help you meet your calcium needs through diet alone. See "Using the Food Pyramid Guide to Help You Get Enough Calcium".
• If you are unable to modify your diet to get enough calcium on a daily basis, speak to your healthcare provider about taking a calcium supplement.
• If you need a supplement, it is important to select one that contains the proper amount of calcium. Your daily recommended calcium intake minus the estimated daily calcium in your diet will determine how much calcium to take from a supplement.

Is more calcium better?

• If you consume more calcium than recommended, there is no proof that it will benefit your bones.
• High calcium intakes consumed on a regular basis may be harmful. It is important to get your daily recommended daily calcium and not to consume more than 2500 milligrams of calcium per day. The adverse effects of excessive calcium intake may include high blood calcium levels, kidney stone formation and kidney complications.

How do I choose a calcium supplement?

• A USP (United States Pharmacopeia) symbol means that the calcium supplement is pure from lead and other metals. The application for the USP symbol is voluntary so many acceptable products do not display this symbol. According to a recent laboratory analysis, calcium supplements, in the dosage prescribed for prevention and treatment of osteoporosis, contain much less than the safe level of lead. A further safeguard is that lead in calcium supplements will not be well absorbed because calcium blocks lead absorption.
• Calcium must dissolve in your stomach before it can be absorbed in your intestines and then used by your body. A USP symbol on the label of a calcium supplement means that is it will dissolve in your stomach. If your supplement does not have a USP symbol, you can easily test it to find out if it will dissolve. Simply put the supplement into a glass of clear vinegar. This creates an acidic environment much like that of your stomach. Stir the solution occasionally. If the calcium supplement disintegrates within 30 minutes, it should dissolve in your stomach, too. If the supplement does not completely dissolve, choose an alternative calcium supplement. Be sure to discard the calcium/vinegar solution after the test.
• If you are taking acid blockers for indigestion, reflux or other gastrointestinal conditions, your body may use calcium citrate better than other calcium compounds. Acid blockers reduce the acid in your gastrointestinal tract that is usually required for calcium absorption. However, unlike other calcium compounds, calcium citrate does not require an acid environment for calcium absorption.
• Read the supplement label to find out the calcium content in milligrams (mg) per serving. The label may refer to the calcium as elemental calcium. This distinguishes the weight (mg) of calcium alone from the weight (mg) of the calcium compound (such as calcium carbonate, calcium citrate, calcium phosphate, or others). It is also important for you to check the serving size to find out how many tablets or capsules provide a specific amount of calcium.
• Although vitamin D is readily available in combination with calcium supplements, supplemental vitamin D should only be taken when your daily requirement for vitamin D is not met. If you are over 70 or a homebound individual, you should discuss your risk of vitamin D deficiency with your doctor. For more information, see "Vitamin D and Bone Health".
• Magnesium supplements are not required for most healthy individuals. Magnesium is plentiful in a healthy, well-balanced diet. However, certain individuals may be at risk for magnesium deficiency including those with gastrointestinal diseases that cause poor absorption or increased losses of magnesium, frail elderly individuals eating poor diets, alcoholics, individuals receiving chemotherapy and those taking high dose diuretics (water pills) that deplete magnesium. Magnesium deficiency is easily diagnosed by a simple blood test. Your medical professional will prescribe a magnesium supplement if it is necessary or if you have a disease or condition that causes magnesium deficiency.
• A well-balanced diet following the food-pyramid approach to good nutrition including adequate calcium and vitamin D is what you need to achieve and maintain healthy bones. For most healthy individuals, additional vitamins or minerals (such as magnesium, boron, vitamin K, selenium or others) in the form of supplements are not required for bone health. In fact, many of these nutrients will be present in a diet with five or more servings of fruits and vegetables a day.

How do I take my calcium supplement?

• It is important to read supplement labels and follow the directions for use.
• When your calcium supplement is well absorbed, your body can easily use it. For best absorption, most calcium supplements should be taken with food. Calcium citrate is an exception; it can be taken with or without food.
• It is best to spread out the calcium you consume from diet and/or supplements throughout the day. In fact, for best absorption, it is recommended to consume 500mg of calcium or less at one time.

Are there any special considerations?

• If your medical professional recommends an iron supplement and you are also taking a calcium supplement, it is important that your body absorbs both nutrients. For the best absorption of both iron and calcium, it is recommended to take your calcium supplement 2 hours before or after your iron supplement. You should not take them at the same time.
• Calcium interferes with the body's ability to use certain antibiotics, tetracycline for example. If your doctor prescribes tetracycline, it is important for you to take it properly. Therefore, you should not take calcium supplements (or eat calcium-rich foods) at the same time as tetracycline. Your antibiotic will work best if you take your calcium supplement (or eat calcium-rich foods) 2 hours before or after taking tetracycline. It is always important to speak to your pharmacist about the proper way to take your medication.
• Some people who take calcium supplements complain about constipation. The best way to prevent constipation, is to eat more fiber in your diet from fruits, vegetables, and whole grain products as well as to drink 6 to 8 glasses of water each day. If these simple steps are not helpful enough, take a closer look at your diet to try to get more calcium from foods and less from supplements. Read the label for the amount of calcium in each dose. A lower dose calcium supplement may be better tolerated than a high dose supplement. In general, calcium carbonate has the highest amount of calcium per dose. Calcium citrate has less calcium per dose and calcium gluconate is one of the lowest dose options.

(c) Helen Hayes Hospital/NYS Department of Health - 11/03

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