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[Patient Adviser]

Banking on Strong Bones for Life

Do You Need Calcium Supplements?

Kimberly G. Harmon, MD

Practice Essentials Series Editors:
Kimberly G. Harmon, MD; Aaron Rubin, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 30 - NO. 3 - MARCH 2002


Calcium is important for building strong teeth and bones and for preventing osteoporosis. It is especially important that adolescents and young adults get adequate amounts of calcium. In women, bone density can increase until around age 30. After that, bone mass is maintained or lost at a slow rate until menopause, when the rate of bone loss increases.

Your bones are like a bank. You can deposit calcium until around age 30, and then for the rest of your life you have to withdraw the calcium that you have "saved." This is why it is critical to build strong bones when you are young!

Q. How much calcium do I need?

A. Women should get between 1,000 mg and 1,500 mg of calcium every day. That is typically three to five servings of dairy foods daily. The average American consumes less than 800 mg of calcium a day. It is especially important that women who do not have regular periods (at least 10 to 12 a year) or those using certain types of contraception (such as Depo-Provera shots) get adequate calcium. Irregular periods and Depo-Provera shots have been shown to deplete calcium in bones.

Q. What is the best way to get calcium?

A. The best way to get calcium is in your regular diet. The calcium content of some common foods is shown in table 1. Read food labels for more precise information.

TABLE 1. Calcium and Vitamin D in Common Foods and Selected Supplements

FoodAmountCalcium Content (mg)
Yogurt, plain, nonfat
Yogurt, plain, low fat
Yogurt, low fat with fruit
Milk, skim
Milk, 2%
1 cup
1 cup
1 cup
1 cup
1 cup
452
350-415
250-350
302-316
313
Cheddar cheese
Ricotta cheese, part skim
Mozzarella cheese, part skim
Swiss cheese
1 ounce
1 ounce
1 cup
1 ounce
204
207
337
272
Figs, dried
Orange juice, calcium fortified
Orange
Rhubarb, cooked with sugar
Spinach, cooked
Broccoli, cooked
10 figs
1 cup
1 medium
1/2 cup
1 cup
1 cup
269
250
56
174
138-244
178
Salmon, canned with bones
Sardines, canned with bones
31/2 ounce
31/2 ounce
237
240

SupplementElemental Calcium
per Tablet (mg)
Vitamin D
per Tablet (IU)
Calcium carbonate (generic)
Tums
Tums 500
Viactiv Soft Calcium chews
Citracal Caplets + D
600
200
500
500
315
200
0
0
100
200

If you can't get enough calcium from your diet, you should take a calcium supplement. Calcium supplements come in many forms. You need to look for the amount of elemental calcium in a supplement.

Many calcium supplements also contain Vitamin D to improve calcium absorption in the digestive tract. You should get between 400 and 800 IU of Vitamin D a day (see table 1). In general, there is little evidence that any one type of calcium supplement is more effective than another. Taking calcium with food in doses of 500 mg or less improves absorption. If you take two calcium supplements a day, you should take them at different meals, if possible.

Q. Are there side effects from taking too much calcium?

A. Calcium supplements are usually tolerated very well. Some people may have some problems with constipation, bloating, or excess gas. Switching calcium preparations or drinking more fluids may relieve these symptoms. Weight-bearing exercise, such as walking or using free weights, also helps build strong bones. Be sure to drink enough water to replace the fluids lost by sweating during exercise. A healthy lifestyle includes drinking eight glasses of water every day. Drinks that contain caffeine are not as beneficial as water or sports drinks for preventing dehydration.

Remember: This information is not intended as a substitute for medical treatment. If you have a medical concern, consult a physician.

Dr Harmon is a clinical assistant professor in the Department of Family Medicine and the Department of Orthopedics and Sports Medicine at the University of Washington in Seattle. She is an editorial board member of The Physician and Sportsmedicine.


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