Lois Norberg, A.P.N./C.N.P.

Taking calcium plus vitamin D supplements, along with consuming dietary calcium, increases bone density and assists in preserving health and independence with aging. Approximately 250,000 Americans fracture a hip each year, with half of these remaining in a nursing home or dependent on others for care. Seventeen percent of all current 50-year-old women will fracture a hip during their remaining years. Obviously, this is a major public health concern.

Bones are constantly undergoing “osteoblastic” and “osteoclastic” changes (building up and breaking down), despite their solid feel. According to the National Osteoporosis Foundation, the greatest risk factors for fractures are fracture in a parent, weight less than 127 pounds, smoking, and any other fracture as an adult. Secondary risks include low calcium intake, Caucasian or Asian race, advanced age, menopause before age 45 (for men, low testosterone levels), high consumption of alcohol, and eating disorders. Although the factors for bone thinning are both modifiable and non-modifiable, calcium intake is one of the most important.

In most cases, 1,000 to 1,200 milligrams (mg) of elemental calcium are needed each day prior to age 50, 1,500 mg thereafter, to build and then preserve bone density. If bone thinning is present, measured by DEXA scan, then 1,800 mg are necessary.

Many people are amazed to learn that a cup of skim milk has more calcium (302 mg) than 2% or whole milk, although the difference is only 10 mg. That same fat free milk processed into yogurt yields 400 mg of calcium. Swiss tops the list of most calcium per ounce (272 mg) for cheeses, followed by cheddar and parmesan, with processed cheese the lowest (less than 100 mg). Salmon has up to 350 mg per 3 ounce serving, and one cup of cooked broccoli has 178 mg. Even an orange has 52 mg of elemental calcium.

Ingesting the right amount of calcium is tricky. The stomach can only absorb 600 mg of elemental calcium every 4 hours. If more is taken either in food and/or supplement, it simply passes out as waste. An iron supplement should be taken 4 hours apart from calcium, as both taken together means lower levels of both. A total of 2,000 mg of elemental calcium a day from food and supplements appears to be safe, but studies show no additional benefit with a greater amount. Higher amounts may cause drowsiness, impaired absorption of other minerals, and calcium deposits in tissue that may be mistaken for disease on x-rays.

Calcium carbonate is one type of supplement and is best absorbed when taken with food. Food stimulates stomach acid production, and with this type (Caltrate, Oscal, or Tums, for example), absorption is better in an acidic environment.

Calcium citrate is the supplement of choice when an individual is being treated for gastric reflux or other stomach ailments with a medication to lower stomach acid (Prevacid, Prilosec, or Ranitidine). Calcium citrate can be taken without regard to meals or snacks.

Pay attention to the total milligrams listed for strength per tablet compared to the actual elemental calcium amounts. Only the elemental amounts can be counted toward your total daily requirement. For example, extra strength Tums or Rolaids lists the active ingredient as 750 mg of calcium carbonate per tablet, but only 300 mg of that is elemental calcium. The label states that a serving size, 2 tablets, has 600 mg of elemental calcium. Calcium citrate usually lists only the elemental calcium.

Because swallowing large calcium tablets with vitamin D can be a challenge for some, consider these hints:

• Take calcium tablets alone, without the vitamin D, and take a separate smaller multivitamin that contains 400 IU of vitamin D.
• Although somewhat chalky, tablets that are meant to be swallowed whole, can be chewed.
• Obtain a chewable form of calcium (now in chocolate, lemon, or caramel flavors).

Keep in mind that medications to ensure that the building-up phase is longer than the breaking-down phase – Fosamax, Actonel, Boniva, and Miacadin – do not contain calcium. Calcium still needs to be ingested in adequate amounts.

To prevent bone thinning, make calcium-rich foods and/or supplements routine in your daily diet. Seventy-two million people in the U.S. will be age 65 or older by 2030. If you will be in that group, by taking calcium now, you may enjoy good bone health and independent living.