Living With Osteoporosis

Boning Up on Calcium: Supplements for Bone Health

Popping calcium for better bone health? Get the most from that supplement with these tips.
You've probably heard that calcium is important for bone health and treating -- or preventing -osteoporosis. Happily, calcium seems to be everywhere these days. Not only is it naturally in dairy and other foods, but it now appears in many fortified products -- like oatmeal, cereal, protein bars, and orange juice. Calcium is also sold in countless supplements for bone health that line the aisles of your local drugstore. And yet, it's not enough. "Most people still aren't getting enough calcium in their diets," says Shreyasee Amin, MD, a rheumatologist at the Mayo Clinic in Rochester, Minn. Why? Part of the problem isn't just that we're not eating or taking enough calcium. For calcium to be absorbed and used, we need to have the right levels of other things, such as vitamin D. If we don't, the calcium we take in just doesn't do us much good. So some of us could be drinking milk by the bucket and yet still not get the calcium we need. So here's what you need to know about calcium supplements for bone health. Why Is Calcium Important for Bone Health? Calcium is key in the building of new bone. And bone development occurs every day of your life. Just as you shed skin cells and grow new ones to replace them, your body naturally removes old bone and replaces it with new. The pace of losing and growing bone differs depending on your age. When you were young, you made much more bone than you lost, which is why your bones got bigger and stronger. But the problems start when this balance tips too far in the other direction, and you start losing bone much faster than you can grow it. Gradual bone loss begins in adulthood and becomes more serious after age 50. In women, the hormonal changes of menopause -- and the drop in estrogen levels that occur with it -- can greatly worsen the imbalance. The bones naturally lose mass, becoming more brittle. Because calcium isn't produced by your body, the amount you have depends on the foods you eat. Here's a chart showing how much calcium -- measured in milligrams (mg) -- that you need based on your age. Age Birth to 6 months 6 months to 1 year 1-3 years 4-8 years 9-18 years 19-50 years 51-70 years Over 70 years Calcium (mg) 210 270 700 1,000 1,300 1,000 1,200 1,200

While 1,200 milligrams of calcium per day is sometimes considered the maximum, many osteoporosis experts think that higher levels are preferable. "A lot of rheumatologists will go up to 1,500 milligrams a day of calcium in people who are either over 70 or who have a high risk of osteoporosis," says John Schousboe, MD, director of the Park Nicollet Clinic Osteoporosis Center in St. Louis Park, Minn. However, more calcium isn't always better. Getting too much calcium -- 2,500 milligrams or above -- can increase your risk of some health problems, like kidney stones. Do I Need Calcium Supplements for Bone Health? Osteoporosis is often a silent disease -- you don't know your bones are weak until you break one. So what do you do? Start by seeing your doctor. Together, you can discuss your diet and work out a rough estimate of your calcium intake. If you're coming up short, then you either need to improve your diet or take a calcium supplement for bone health to bump you up to the recommended level. "Although some people with osteoporosis get enough calcium from their diets, I think most will wind up needing a calcium supplement," says Schousboe. Keep in mind that the numbers may not tell the whole story. Even if it looks like you're getting enough calcium, you might not be absorbing enough of this mineral. That can be due to many factors, like smoking, using certain medications, and many health conditions. So make sure to have a frank discussion with your doctor about any other factors that might increase your risk of osteoporosis. Vitamin D Supplements for Bone Health While calcium is crucial, taking it alone might not be enough. To actually get calcium into your bones, the body relies on other vitamins, minerals, and hormones. The most important may be vitamin D. Vitamin D helps your body absorb calcium from the kidneys and intestines -- calcium that would otherwise pass out of the body as waste. And according to osteoporosis experts, vitamin D deficiency is disturbingly common. "In the last few years, the focus for osteoporosis experts has really shifted from calcium deficiency to vitamin D deficiency," says Schousboe. Vitamin D is actually formed naturally in your body as a result of sun exposure. Usually just 10 to 15 minutes of sun a day will get you enough vitamin D. But your body becomes less efficient at making it as you age. Many of us should be using vitamin D supplements. But which kind of supplements? You might see different types of vitamin D on your drugstore shelves, like "vitamin D2" and "vitamin D3." What's the difference? "Vitamin D3 seems to be about three times as potent as vitamin D2," says Schousboe. While Amin agrees that vitamin D3 may be preferable, she notes that not all pharmacies carry vitamin D3 supplements. If you can't get it in your area, sticking with vitamin D2 is OK. "Some vitamin D is better than none," Amin says. How Much Vitamin D Do We Need for Bone Health? And how much vitamin D is necessary for good calcium absorption? Alas, the answer isn't simple. The National Institutes of Health still uses the traditional recommendations, which are: 600 IU (international units) for ages 1-70 800 IU for ages 70 or over

But as the widespread deficiencies of vitamin D have become more apparent, some osteoporosis experts think that those levels are not nearly high enough. How Much Vitamin D Do We Need for Bone Health? continued... "Most of us think that the traditional recommendations for vitamin D are inadequate," says Schousboe. "For anyone at risk of bone loss, I'd recommend at least 800 IU of vitamin D3 a day and more of D2." The National Osteoporosis Foundation now recommends 800 to 1,000 IU of vitamin D3a day for all adults over age 50. However, be careful. Never go above the recommended limits of vitamin D unless your doctor tells you too. Taking too much vitamin D -- above 2,000 IU a day -- can be toxic. Of course, you can't figure out if you have a deficiency of vitamin D on your own. So talk with your doctor. If your risk of osteoporosis seems high, he or she might want to do a special blood test to check your vitamin D levels. What Should I Look for in Supplements for Bone Health? Given the vast selection, choosing a supplement for bone health can be confusing. Again, the best advice is to start with your doctor. He or she may recommend a specific type of calcium for bone health. Here are a few other things to consider when choosing and using a supplement. Is it a brand name you recognize? Most brand name supplements should be fine, osteoporosis experts say. You can also look for the United States Pharmacopeia (USP) label, which indicates that the product has met the USP's purity requirements. What type of calcium is it? If you look on the ingredients of calcium supplements you might see different types, like calcium carbonate and calcium citrate. Does the variety you get make a big difference? Probably not much, although vitamin experts aren't sure. There is some evidence that calcium citrate might be more helpful for people who have low levels of stomach acid (because they take medicines for gastric reflux or other conditions.) Theoretically, calcium citrate might reduce the risk of kidney stones, Schousboe says, but he stresses that there's no real evidence to prove this so far. Is the calcium supplement easily absorbed? Any good calcium supplements for bone health should be easy for your body to absorb. But supplements that are liquid or chewable are often the easiest to take in, since they're broken down before you swallow them. Should you take your calcium supplement with food? Generally, calcium carbonate should be taken with food, while calcium citrate can be taken with or without food. Taking some calcium supplements on an empty stomach may increase the risk of kidney stones, Schousboe says. Does your calcium supplement cause side effects? Some people find that calcium supplements can cause side effects like gas or constipation. You may be able to control these problems by taking your supplement with more water, or upping the fiber in your diet. If this doesn't help, try a different supplement. Does your calcium supplement contain other ingredients? Many calcium supplements for bone health also include other vitamins and minerals, like vitamin

D. Is it better to get your vitamin D in the same pill as your calcium? It doesn't make any difference. Just keep track of what you're getting. If you're taking multiple supplements and aren't careful enough, you could get excessive doses of vitamin D. Will you need more than one supplement a day? In general, vitamin experts recommend taking no more than 500 milligrams of calcium at once. Why? Your body can only absorb so much calcium at one time. Going over 500 milligrams at once won't give you the full benefits of the calcium. So for instance, if you need to take 1,000 milligrams, your doctor might recommend splitting up the dose into 500 milligrams twice a day. As for other distinctions among calcium supplements, they don't really matter. Although some manufacturers claim that coral calcium -- made from exotic fossilized coral reefs -- has benefits over other formulas, the experts are unconvinced. "Many of us just think it's a clever marketing ploy and nothing more," says Schousboe. "But if people feel better taking coral calcium, that's fine. What's important is that they get enough calcium. If they waste a little money doing it, that's OK." What Else Do I Need to Know About Supplements for Bone Health? Of course, lots of other supplements are hawked as bone strength boosters for people battling osteoporosis. But do they work? "On the whole, there's just not a lot of good data on other supplements for bone health," says Amin. So far, the evidence isn't persuasive. While other minerals play a role in absorbing calcium, like magnesium and phosphorus, deficiencies are quite rare. So you probably don't need to worry about them. Schousboe is skeptical of other alternative bone-strengthening supplements, like cod liver oil. "There's no real evidence that the oils are important themselves," he tells WebMD. "The oil just contains vitamin D, and I think there are better ways to get it." While some phytoestrogens (plant compounds that have estrogen-like effects) -- found in soy, flaxseed, and other plants -- have shown some benefit in studies of bone health, their risks aren't clear yet. "Given the association between estrogen compounds and blood clots," says Schousboe, "I think we need to be very careful and wait for convincing data about phytoestrogens." For good bone health, go with the basics, say osteoporosis experts. "I usually just recommend that people stick to getting adequate calcium and vitamin D and eating a good, healthy diet," Amin tells WebMD. That simple advice can go a long way toward keeping your bones strong and your life healthy and active.