Osteoporosis: Prevention With Calcium Treatment
What is calcium?
Calcium is a mineral that the body needs for good health. Calcium is found naturally in some foods and is added to others. It also is available as a nutrition supplement and is contained in some medicines like Tums®.
Why does the body need calcium?
Calcium is the healthy bone mineral. About 99% of the calcium in the body is stored in the bones and teeth. It’s the mineral that makes them hard and strong. The remaining 1% is needed for many activities that help keep the body functioning normally. Calcium helps blood vessels contract (narrow) and expand, makes muscles contract, helps send messages through the nervous system and helps glands secrete hormones.
Bones are constantly being remodeled every day, and calcium moves in and out of them. In children and adolescents, the body builds new bone faster than it breaks down old bone so total bone mass increases. This continues until about age 30, when new bone formation and old bone breakdown start occurring at about the same rate. In older adults, especially in post-menopausal women, bone is broken down at a faster rate than it’s built. If calcium intake is too low, this can contribute to osteoporosis.
How much calcium does an adult need to take in every day?
The amount of calcium needed for healthy bones and teeth is different by age. The National Institutes of Health suggests these levels of daily intake for adults:
Daily suggested calcium intake for adults
- Adults 19-50 years: 1,000 mg.
- Adult men 51-70 years: 1,000 mg.
- Adult women 51-70 years: 1,200 mg.
- Adults 71 years and older: 1,200 mg.
- Pregnant and breastfeeding teens: 1,300 mg.
- Pregnant and breastfeeding adults: 1,000 mg.
What are the best ways to get enough calcium?
The best way to get enough calcium every day is to eat a variety of healthy foods from all the different food groups. Getting enough vitamin D every day from foods like enriched milk or from natural sunlight is important to help the body absorb and use calcium from food.
Here are some easy guidelines for selecting foods high in calcium:
- Dairy products have the highest calcium content. Dairy products include milk, yogurt and cheese. A cup (8 ounces) of milk contains 300 mg of calcium. The calcium content is the same for skim, low fat and whole milk.
- Dark green, leafy vegetables contain high amounts of calcium. Broccoli, kale and collards are all good sources of calcium, especially when eaten raw or lightly steamed. (Boiling vegetables can take out much of their mineral content.)
- A serving of canned salmon or sardines has about 200 mg of calcium. It’s found in the soft bones of the fish.
- Cereal, pasta, breads and other food made with grains may add calcium to the diet. Look for cereals that are fortified with minerals, including calcium.
- Besides cereal, calcium is sometimes added to fruit juices, soy and rice beverages and tofu. Read product labels to find out if a food item has added calcium.
The U.S. Department of Agriculture recommends that everyone aged 9 years and older eat three servings of foods from the dairy group per day.
1 serving of dairy equals:
- 1 cup (8 ounces) milk.
- 1 cup yogurt.
- 1.5 ounces of natural cheese (such as cheddar).
- 2 ounces of processed cheese (such as American).
Should I take a calcium supplement?
Calcium is best absorbed through the foods we eat and the beverages we drink. For most healthy patients, it’s important to eat a well-balanced diet instead of relying on supplements alone.
For those who can’t get enough calcium from food and beverages each day, taking a calcium supplement may be necessary. People who have lactose intolerance might have difficulty getting enough calcium through their diet alone. In addition, those with absorption problems due to gastrointestinal illness may not absorb enough calcium. Those who follow a vegan diet, or consume large amounts of protein and sodium might also not get enough calcium.
What type of calcium supplement should I take?
The amount of calcium the body will absorb from supplements depends on the form of calcium in the supplement, how well the calcium dissolves in the intestines and the amount of calcium in the body. The two most commonly used calcium products are calcium carbonate and calcium citrate.
Calcium carbonate supplements dissolve better in an acid environment, so they should be taken with a meal. Calcium citrate supplements can be taken any time because they do not need acid to dissolve. For this reason, people who might have problems absorbing medications could consider using calcium citrate instead of calcium carbonate. This would include those who take medications to decrease stomach acid (such as over-the-counter and prescription heartburn medications). Also, those who have had intestinal bypass surgery, or perhaps even those 65 years and older, may benefit from calcium citrate instead of calcium carbonate.
Calcium supplements in the form of gluconate, lactate or phosphate are also available, but they generally contain less absorbable calcium. It’s helpful to look for supplements that have the United States Pharmacopeia (USP) or consumerlab.com (CL) abbreviation on the bottle. This indicates that the products have met voluntary industry standards for quality.
The higher the calcium dose, the less it’s absorbed. For the maximum absorption, no more than 500 mg of calcium should be taken in a single dose. If you need more than 500 mg as a supplement, take the doses at least four hours apart. If you think you need a calcium supplement, ask your doctor or a dietitian to recommend one.
What happens if I take too much calcium?
Adults ages 19 through 50 should not get more than 2,500 mg calcium total per day (including food and supplements). Adults over age 50 should not exceed 2,000 mg total per day. Dietary calcium is considered safe, but too much calcium in the form of supplements might have some health risks. Too much calcium has the potential to increase the risk of kidney stones, constipation or even calcium buildup in your blood vessels, along with difficulty absorbing iron and zinc.
Are there any medications that interact with calcium?
Calcium can reduce the absorption of these drugs if taken at the same time:
- Bisphosphonates (osteoporosis treatment).
- Thyroid medication.
- Certain seizure medications (phenytoin).
- Certain antibiotics.
- Iron supplements.
What happens when the body does not get enough calcium?
Children need calcium to build strong bones. Adults need calcium to maintain strong bones. Over time, inadequate calcium intake can cause osteoporosis, the brittle bone disease. People with osteoporosis are at high risk for broken bones, especially at the wrist, hip and spine. These fractures cause chronic (long-lasting) pain and disability, loss of independence, decreased quality of life and a higher risk of death.
Osteoporosis can cause the bones that make up the spine (the vertebrae) to break. This causes the spine to collapse in these areas, which leads to pain, difficulty in moving and gradual deformity. If the problem is severe enough, it causes a “dowager’s hump” to form, a curvature of the upper back.
Who develops osteoporosis?
According to the National Institutes of Health, half of all women over age 50 and a quarter of men older than age 50 will break a bone due to osteoporosis. Post-menopausal white and Asian women are at the highest risk for osteoporosis. About 25% of women with osteoporosis will develop a vertebral deformity, and 15% will break a hip. Osteoporosis also causes broken hips in men, although not as often as in women. Hip fractures are associated with an increased risk of death within the year after the bone break.
Risk factors for osteoporosis include:
- Not enough calcium in the diet.
- Age over 50.
- Small, thin body build.
- Family history of osteoporosis.
- Being a white or Asian woman.
- Use of certain medications such as breast cancer treatments, seizure medications, steroids.
What are the symptoms of osteoporosis?
Symptoms of bone loss do not occur until osteoporosis develops. Even then, in its early stages, osteoporosis may not cause any symptoms. Symptoms that develop as osteoporosis worsens may include:
- Breaking bones easily.
- Back pain.
- Stooped posture.
- Gradual loss of height.
How is osteoporosis diagnosed?
The outward signs of osteoporosis (height loss, easily broken bones, dowager’s hump) combined with a patient’s gender and age are strong signs that the patient has osteoporosis. A technology called dual X-ray absorptiometry (DXA) is the state-of-the-art technique for measuring bone mineral density (how much calcium is in the bones) and to diagnose osteoporosis.
How can osteoporosis be prevented?
To promote lifelong healthy bones and reduce calcium loss:
- Eat a diet rich in calcium and vitamin D throughout your life.
- Enjoy regular exercise, especially weight-bearing activity like walking or jogging.
- Don’t smoke.
- Go easy on the caffeine and alcohol.
The U.S. Preventive Services Task Force recommends a bone density screening by DXA in all women aged 65 years or older. They also recommended a screening test for women under the age of 65 who are at risk for fractures. This test shows the strength of the bones so that preventative measures against fractures can be started if necessary.
Calcium content of various foods
- Yogurt, plain, low fat, 8 ounces 415 mg per serving.
- Orange juice, calcium-fortified, 6 ounces 375 mg per serving.
- Yogurt, fruit, low fat, 8 ounces 338–384 mg per serving.
- Mozzarella, part skim, 1.5 ounces 333 mg per serving.
- Sardines, canned in oil, with bones, 3 ounces 325 mg per serving.
- Cheddar cheese, 1.5 ounces 307 mg per serving.
- Milk, nonfat, 8 ounces 299 mg per serving.
- Milk, reduced-fat (2% milk fat), 8 ounces 293 mg per serving.
- Milk, buttermilk, 8 ounces 282–350 mg per serving.
- Milk, whole (3.25% milk fat), 8 ounces 276 mg per serving.
- Tofu, firm, made with calcium sulfate, ½ cup 253 mg per serving.
- Salmon, pink, canned, solids with bone, 3 ounces 181 mg per serving.
- Cottage cheese, 1% milk fat, 1 cup 138 mg per serving.
- Instant breakfast drink, various flavors and brands, powder prepared with water, 8 ounces 105–250 mg per serving.
- Frozen yogurt, vanilla, soft serve, ½ cup 103 mg per serving.
- Ready-to-eat cereal, calcium-fortified, 1 cup 100–1,000 mg per serving.
- Turnip greens, fresh, boiled, ½ cup 99 mg per serving.
- Kale, fresh, cooked, 1 cup 94 mg per serving kale, raw, chopped, 1 cup 90 mg per serving
- Tofu, soft, made with calcium sulfate, ½ cup 138 mg per serving ice cream, vanilla, ½ cup 84 mg per serving.
- Soy beverage, calcium-fortified, 8 ounces 80–500 mg per serving.
- Chinese cabbage, bok choi, raw, shredded, 1 cup 74 mg per serving.
- Bread, white, 1 slice 73 mg per serving.
- Pudding, chocolate, ready to eat, refrigerated, 4 ounces 55 mg per serving.
- Tortilla, corn, ready-to-bake/fry, one 6″ diameter 46 mg per serving.
- Tortilla, flour, ready-to-bake/fry, one 6″ diameter 32 mg per serving.
- Sour cream, reduced fat, cultured, 2 tablespoons 31 mg per serving.
- Bread, whole-wheat, 1 slice 30 mg per serving.
- Broccoli, raw, ½ cup 21 mg per serving.
- Cheese, cream, regular, 1 tablespoon 14 mg per serving.
Nutrients for bone health
Many nutrients are involved in keeping bones healthy. Calcium and vitamin D are two of the most important.
Calcium is a mineral that’s essential to your body functioning properly and is stored in your bones. Your body needs vitamin D to absorb calcium. Not getting enough calcium in your diet can lead to fragile, brittle bones that are more prone to fractures and disease.
Vitamin K, vitamin C, magnesium, and phosphorus are other important nutrients for bone health.
Dark, leafy greens, such as kale, arugula, watercress, and collard greens, are perhaps the best nondairy sources of calcium. These greens are also high in magnesium, which is helpful for maintaining bone integrity, and vitamin K, which is needed for bone metabolism.
Although spinach is usually included in this group, it contains oxalic acid, which makes the human body unable to absorb its calcium.
The sun is our main source of vitamin D. However, eating fatty fish such as salmon is another great way to get vitamin D.
According to the National Institutes of Health (NIH)Trusted Source, one 3-ounce serving of salmon will provide you with 447 international units (IU) of vitamin D. The recommended minimum intake of vitamin D is 400 IU daily.
Canned salmon includes the softer (edible) bones of the fish, meaning it’s loaded with calcium.
Tuna is another fatty fish loaded with healthful vitamin D. It also contains high amounts of other beneficial nutrients like potassium, magnesium, and omega-3 fatty acids. And because it comes canned, it’s easy to find, easy on the wallet, and simple to add to your diet.
While we’re on fish, you can’t go wrong with catfish. It’s perhaps the least expensive variety of fish, and it’s also one of the highest in vitamin D, containing 425 IU in one 3-ounce filetTrusted Source.
It’s pretty simple: Cheese is made from milk. Milk has lots of calcium. Ergo, cheese has lots of calcium.
With a wide variety to choose from, mozzarella is particularly high in calcium. For a healthier option, try cheese made from skim milk.
Yogurt is an ancient culinary product, dating back as far as 2,000 B.C. Due to yogurt’s preparation process, this dietary staple actually contains significantly more calcium than the milk from which it’s made. One 8-ounce serving of low-fat yogurt provides a full 42 percent of your daily calcium needs, according to the NIHTrusted Source.
Good news for breakfast lovers: Eggs contain a nice amount of vitamin D and can improve bone health. Vitamin D is found in the yolks only, so if you tend to eat egg white omelets, you’ll have to get your vitamin D elsewhere.
Another breakfast item, orange juice, is often fortified with vitamin D and calcium.
Of all the nondairy sources of calcium out there, broccoli is second to dark, leafy greens. And broccoli isn’t only bone-healthy — it’s an excellent source of vitamin C, fiber, and nutrients that contain cancer-fighting properties.
So, what about milk?
One cup of milk has about 30 percent of the calcium you need daily, according to the NIHTrusted Source. On top of that, the milk that’s sold in stores is typically fortified with vitamin D, making it a double-whammy when it comes to bone health.
However, there has been some speculation that milk may actually deplete the bones of vital nutrients. A 2014 studyTrusted Source showed there was no correlation between milk consumption during teenage years and decreased risk of hip fractures in older adults.
However, one 2011 meta-analysisTrusted Source of cohort studies showed no association between milk intake and hip fracture in women, but stated more data needed to be done on men.
Research is mixed and more studies need to be done to find a concrete answer.
As you age, your body will continue to need calcium, vitamin D, and other nutrients to keep your bones strong and dense. Getting enough bone-supporting nutrients in your diet is perhaps the most important thing you can do to keep them strong and healthy.
But it’s not the only thing you can — or should — do. Check out these 10 tips to increase bone strength, and read about these 7 common osteoporosis myths so that you can be better informed about your bone health.
8 Fast Facts About Calcium
Calcium is an important nutrient that your body needs for many basic functions. Read on to learn more about this mineral and how much you should be getting.
Calcium plays a role in many of your body’s basic functions. Your body needs calcium in order to circulate blood, move muscles, and release hormones. Calcium also helps carry messages from your brain to other parts of your body.
Calcium is a major part of tooth and bone health as well. It makes your bones strong and dense. You can think of your bones as your body’s calcium reservoir. If you don’t get enough calcium in your diet, your body will take it from your bones.
Your body doesn’t produce calcium, so you have to rely on your diet to get the calcium you need. Foods that are high in calcium include:
- dairy products such as milk, cheese, and yogurt
- dark green vegetables such as a kale, spinach, and broccoli
- white beans
- calcium-fortified breads, cereals, soy products, and orange juices
Your body needs vitamin D in order to absorb calcium. That means you won’t fully benefit from a calcium-rich diet if you’re low on vitamin D.
You can get vitamin D from certain foods, such as salmon, eggs yolks, and some mushrooms. Like calcium, some food products have vitamin D added to them. For example, milk often has added vitamin D.
Sunshine is your best source of vitamin D. Your skin naturally produces vitamin D when exposed to the sun. Those with darker skin don’t produce vitamin D as well, so supplements may be necessary to avoid deficiency.
Several studies show that calcium may ease symptoms of premenstrual syndrome (PMS). This studyTrusted Source concluded that women with PMS have lower intakes of calcium and magnesium, and lower serum levels.
How do you know if you’re getting enough calcium? The National Institutes of Health (NIH)Trusted Source say that adults should get 1,000 mg every day. For women over 50 and during pregnancy and breast-feeding, NIH recommends 1,200 mg daily.
One cup of skim, low-fat, or whole milk contains about 300 mg of calcium. Check the UCSF’s helpful guide to see how much calcium is in many common foods.
A lack of calcium could lead to other health issues. For adults, too little calcium can increase your risk of developing osteoporosis, or frail and porous bones that easily fracture. Osteoporosis is especially common in older women, which is why the NIH recommends they consume more calcium than their male counterparts.
Calcium is essential for children as they grow and develop. Children who don’t get enough calcium may not grow to their full potential height, or develop other health issues.
Not everyone gets the calcium they need from diet alone. If you’re lactose intolerant, vegan, or just not a fan of dairy products, you may find it difficult to get enough calcium in your diet.
A calcium supplement can help add calcium to your diet. Calcium carbonate and calcium citrate are the two most recommended forms of calcium supplements.
Calcium carbonate is cheaper and more common. It can be found in most antacid medicines. It needs to be taken with food in order for it to work well.
Calcium citrate doesn’t need to be taken with food and may be better absorbed by older people with lower levels of stomach acid.
Take note that calcium supplements do have side effects. You may experience constipation, gas, and bloating. The supplements may also interfere with your body’s ability to absorb other nutrients or medications. Check with your doctor before starting any supplements.
With any mineral or nutrient, it’s important to get the right amount. Too much calcium can have negative side effects.
Symptoms such as constipation, gas, and bloating may indicate that you’re getting too much calcium.
Extra calcium may also increase your risk of kidney stones. In rare cases, too much calcium can cause deposits of calcium in your blood. This is called hypercalcemia.
Some doctors think that taking calcium supplements can increase your risk of heart disease, but others disagree. At the moment, more research is needed to understand how calcium supplements affect heart health.