How Should I Take Calcium And Vitamin D Combination
Use exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.
Check the label of your calcium and vitamin D combination product to see if it should be taken with or without food.
Take the regular tablet with a full glass of water.
The chewable tablet must be chewed before you swallow it.
Do not crush, chew, or break an extended-release tablet. Swallow it whole.
Calcium and vitamin D may be only part of a complete program of treatment that also includes dietary changes. Learn about the foods that contain calcium and vitamin D.
Your supplement dose may need to be adjusted as you make changes to your diet. Follow your doctor’s instructions very closely.
Store at room temperature away from moisture and heat.
Getting Enough Calcium And Vitamin D
You can get enough calcium and vitamin D from foods and supplements. Food should be your primary source when possible.
When calcium or vitamin D is available in food, a food label will read percent daily value. The percent daily value is the percentage amount of a nutrient contained in that food. That percentage does not necessarily reflect the amount of that nutrient you should be getting.
It is much easier to look at the number of milligrams of calcium in food. For example, a glass of milk has around 300 mg of calcium. Most adults and children need around 1,000 mg per day so, that glass of milk means you need at least 700 more milligrams of calcium for the day to meet the daily recommended amount.
How Much Vitamin D Should You Supplement
To figure out how much vitamin D you need from a supplement, subtract the total amount of vitamin D you get each day from the recommended total daily amount for your age. For example, a 55-year-old woman who gets 400 IU of vitamin D from her calcium supplement should take between 400 and 600 additional IU of vitamin D to meet the 800 1,000 IU recommended for her age.
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Measurement Of Outcomes And Covariates
At enrollment, data were collected by trained research assistants ondemographics, medical history, family history medications and supplement use,health habits, and diet . Height and weight weredetermined by self-report or measurement, and used to calculate body mass index. During the trial, patients were contacted by a study coordinator every 6months to verify adherence, health status and adverse events, concomitantmedications and supplement use, and performance of colonoscopy or othercolorectal imaging. Blood levels of 25-hydroxyvitamin D, calcium, and creatininewere measured during the trial with standard assays as previouslydescribed.
Categorization of baseline specimens was based on abstraction ofpathology records at the clinical centers. All lesions found duringpost-randomization colonoscopies were reviewed centrally by an expert in GIpathology, specifically regarding serrated neoplasia . The studypathologist was blinded to treatment assignment. For this study, the outcome ofinterest included all SPs, subtyped as HPs , SSA/Ps , and TSAs, classified according to WHO criteria. In certain cases due to specimenfragmentation, orientation, or small size, it was not possible to make a cleardetermination of SP subtype, in which case lesions were labeled asâserrated polyp not subclassifiedâ. Polyp location was categorizedas right-sided if proximal to the splenic flexure, and lesions more distal werecategorized as left-sided.
Before Taking This Medicine
Ask a doctor or pharmacist if calcium and vitamin D combination is safe to use if you have:
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kidney disease
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high levels of calcium in your blood
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circulation problems or
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a parathyroid gland disorder.
Ask a doctor before using this product if you are pregnant or breast-feeding. Your dose needs may be different during pregnancy or while you are nursing.
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What Is The Takeaway
Well, simply, not much has changed. My advice to my healthy patients is still to get calcium from foods, and the best diet for this is a Mediterranean-style diet rich in colorful plants, plenty of legumes, and fish. This plus high-protein, low-fat, and low-sugar dairy can supply plenty of calcium. As far as vitamin D, well, vitamin D supplementation continues to be a topic of lively and livid debate among everyone, including competing guideline-authoring endocrine experts . I hesitate to wander into that minefield again. But here goes
How Much Vitamin D Do I Need
From about late March/early April to the end of September, the majority of people should be able to make all the vitamin D they need from sunlight on their skin.
Children from the age of 1 year and adults need 10 micrograms of vitamin D a day. This includes pregnant and breastfeeding women, and people at risk of vitamin D deficiency.
Babies up to the age of 1 year need 8.5 to 10 micrograms of vitamin D a day.
A microgram is 1,000 times smaller than a milligram . The word microgram is sometimes written with the Greek symbol followed by the letter g .
Sometimes the amount of vitamin D is expressed as International Units . 1 microgram of vitamin D is equal to 40 IU. So 10 micrograms of vitamin D is equal to 400 IU.
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Advice For Adults And Children Over 4 Years Old
During the autumn and winter, you need to get vitamin D from your diet because the sun is not strong enough for the body to make vitamin D.
But since it’s difficult for people to get enough vitamin D from food alone, everyone should consider taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter.
Between late March/early April to the end of September, most people can make all the vitamin D they need through sunlight on their skin and from a balanced diet.
You may choose not to take a vitamin D supplement during these months.
Calcium And Vitamin D Combination Side Effects
Get emergency medical help if you have signs of an allergic reaction: hives difficult breathing swelling of your face, lips, tongue, or throat.
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dry mouth, or a metallic taste in your mouth or
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muscle or bone pain.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
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Calcium Supplements: Evidence In Perspective
Although the meta-analyses of Bolland et al. constitute a safety signal that has to be taken seriously, some critical remarks have to be made.
First of all, the 31% increased risk of myocardial infarction in the first meta-analysis is a point estimate with a broad CI, compatible with either a 2% increase or a 67% increase in RR. The result was also only borderline significant , as was the case for the 21% increased risk of myocardial infarction in the second meta-analysis .
Secondly, the primary aim of the studies included in the meta-analyses was to examine the effects on bone strength and fracture risk. In none of these trials, cardiovascular events were registered in a standardised manner. These events were detected post hoc with varying criteria, which may have resulted in over- or under-reporting of myocardial infarction.
Finally, it is important to stress that an elevated risk of myocardial infarction with calcium supplements was only observed in the trials of Bolland et al. . Independent confirmation from other randomised clinical trials is lacking. In contrast, in a recent randomised placebo-controlled trial by Lewis et al. that was not included in the meta-analysis, the risk of death or first-time hospitalisation from atherosclerotic vascular disease was not higher in patients on calcium supplements. Further analysis even suggested that calcium supplements may reduce the cardiovascular risk in patients with pre-existing atherosclerotic cardiovascular disease .
What Are The Side Effects Of Calcium And Vitamin D Combination
Get emergency medical help if you have signs of an allergic reaction: hives difficult breathing swelling of your face, lips, tongue, or throat.
- nausea, vomiting, constipation
- muscle weakness, bone pain or
- confusion, lack of energy, or feeling tired.
Common side effects may include:
- an irregular heartbeat
- dry mouth, or a metallic taste in your mouth or
- muscle or bone pain.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
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Calcium / Vitamin D Dosage
Medically reviewed by Drugs.com. Last updated on May 23, 2022.
Applies to the following strengths: 600 mg-10 mcg 600 mg-20 mcg 250 mg-10 mcg 600 mg-5 mcg 232 mg-200 intl units 117 mg-3.325 mcg 250 mg-3.125 mcg 500 mg-3.125 mcg 500 mg-5 mcg 315 mg-6.25 mcg 200 mg-6.25 mcg 200 mg-6.25 mcg 250 mg-5 mcg 600 mg-3.125 mcg 500 mg-2.5 mcg 500 mg-15 mcg 500 mg-10 mcg 315 mg-5 mcg 600 mg-12.5 mcg 250 mg-6.25 mcg 250 mg-12.5 mcg 105 mg-3 mcg 100 mg-3 mcg 1000 mg-10 mcg/30 mL 500 mg-12.5 mcg/5 g
Literature Search And Study Inclusion
Flowchart for the selection of eligible studies
In addition to replicating and augmenting the 2011 Tufts EPC evidence reports literature search as described above, we conducted a second comprehensive search of all available literature without limits by year of publication. No additional studies were identified .
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What Other Drugs Will Affect Calcium And Vitamin D Combination
Calcium can make it harder for your body to absorb certain medicines, and some medicines can make it harder for your body to absorb vitamin D. If you take other medications, take them at least 2 hours before or 4 to 6 hours after you take calcium and vitamin D combination.
Other drugs may affect calcium and vitamin D combination, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.
Study Design And Participants
We analyzed the risk of serrated colorectal polyps among participants inthe Vitamin D/Calcium Polyp Prevention Study. This was a randomized,multicenter, double blind, placebo-controlled trial that took place at 11geographically diverse centers across the US. Participants were enrolled in thetrial between July 2004 and July 2008, and outcomes were collected up to June2016. Detailed methods regarding study design and procedures have beenpreviously published, including the study protocol. Briefly, patients between ages 45 and 75 who hada clearing colonoscopy with at least 1 adenomatous polyp detected and removedwithin the preceding 4 months, and who were scheduled for surveillancecolonoscopy at either 3 or 5 years were invited to participate. Exclusioncriteria included patients with known familial CRC syndromes , inflammatory bowel disease, other serious health conditions,contraindication or requirement for either agent, or abnormal blood creatinine,25-hydroxyvitamin D or calcium levels.
Study design and outcome measurement
Footnotes:
1Women could elect to be randomized to eithercalcium-containing group outside of factorial randomization .
2Interim colonoscopies taking place before 3 years wereincluded in the treatment interval analysis. In the absence of an anticipatedyear 3 or 5 colonoscopy, any colonoscopy taking place more than 1 year after thebaseline examination was accepted.
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Calcium And Vitamin D Combination Dosing Information
Usual Adult Dose for Osteoporosis:
Calcium – General Range: 1000 mg to 1300 mg dailyVitamin D – General Range: 200 international units to 800 international units dailyNote: While much larger vitamin D dosages have been recommended as a single agent, many calcium-vitamin D combination supplements will contain approximately 200 international units to 400 international units of vitamin D per dose.
Usual Adult Dose for Dietary Supplement:
Calcium – General Range: 1000 mg to 1300 mg dailyVitamin D – General Range: 200 international units to 800 international units dailyNote: While much larger vitamin D dosages have been recommended as a single agent, many calcium-vitamin D combination supplements will contain approximately 200 international units to 400 international units of vitamin D per dose.
Other Important And Effective Ways To Protect Your Bones
There are other methods that may be more effective at maintaining bone health and reducing fracture risk. One that we can likely all agree on is regular physical activity. Weight-bearing exercise like walking, jogging, tennis, and aerobics definitely strengthens bones. Core exercises like yoga and Pilates can improve balance. All of this can help reduce falls and fracture risk.
And so, in the end, I am recommending what I always end up recommending: a Mediterranean-style diet rich in colorful plants, plenty of legumes, fish, plus low-sugar, low-fat dairy and plenty of varied physical activity throughout your entire life and maybe calcium and/or vitamin D supplementation for certain people, following a discussion with their doctors.
About the Author
Monique Tello, MD, MPH, Contributor
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Effects Of Calcium And Vitamin D Supplementation
The effects of randomized calcium and vitamin D supplementation on riskof SPs during the treatment and observational phases are shown in Table 3. During the treatment phase, we found nostatistically significant effects of either calcium, vitamin D, or thecombination on occurrence of SPs overall or HP or SSA/P subtypes. During theobservational phase, there were no observed effects of calcium and/or Vitamin Don the risk of SPs overall or on HPs. There was also no statisticallysignificant effect of vitamin D supplementation on risk of SSA/Ps . However, among subjects randomized to calcium, weobserved an increased risk of SSA/Ps . Wealso observed an increased risk of SSA/Ps among those randomized to thecombination of vitamin D and calcium . Weperformed a sensitivity analysis excluding observational phase participants whohad prior SSA/Ps during the treatment phase. In this analysis, the risks ofincident SSA/P in the observational phase were similar to results of the fullcohort shown in Table 3 .
How Do You Get Vitamin D And Calcium
Your body makes Vitamin D when your skin is exposed to sun, but several factors limit its creation:
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Living anywhere in the country above latitude 33 degrees
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Wearing sunscreen to protect against melanoma
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Having naturally dark skin
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Aging, which changes absorption ability
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The amount of sun you would need to achieve normal blood vitamin D levels is probably more than is safe for your skin, so most people may need supplements to achieve a normal vitamin D level.
Either form of vitamin D benefits the body, but very few foods naturally contain the nutrient or are fortified with it. Thats why doctors recommend supplements to make up the difference. Foods containing vitamin D include:
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Cod liver oil: 400-1,000 IU per teaspoon
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Wild caught salmon: 600-1,000 IU per 3.5 oz
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Farmed salmon: 100-250 IU per 3.5 oz
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Canned salmon: 300-600 IU per 3.5 oz
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Canned sardines: 300 IU per 3.5 oz
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Canned mackerel: 250 IU per 3.5 oz
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Canned tuna: 236 IU per 3.5 oz
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Fresh shitake mushrooms: 100 IU per 3.5 oz
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Sundried shitake mushrooms: 1,600 IU per 3.5 oz
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Egg yolk: 20 IU per yolk
Milk, orange juice, infant formula, yogurt, margarine, butter, cheese and breakfast cereals are often fortified with vitamin D.
Calcium is found in:
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Talking To Your Healthcare Provider
While your bones need calcium and vitamin D, it is never a good idea to start taking any type of supplement without first talking to your healthcare provider. They can advise you how much calcium and vitamin D you should be taking daily and what to do if you experience side effects. Your practitioner can also advise on the types of supplements available and the ones they recommend for improving your bone health. One supplement used by alternative medicine proponents for better bone health is orthosilicic acid, a natural substance found in seafood, seawater, vegetables, and whole grains.
It can hard to achieve daily recommendations for calcium and vitamin D if certain circumstances apply to you, such as if you are a vegetarian who avoids dairy, are lactose intolerant, or if you have a health condition that keeps your body from absorbing vitamin D effectively. Your healthcare provider can also help you to determine how you can meet recommended daily levels through both diet and supplementation.
Supplements might be sold without a prescription, but your healthcare provider is always the best source of information on your bone health. These medications can interfere with other medications you are taking to treat other conditions.
It is important to be especially careful with supplements if you are pregnant or nursing, about to have a medical procedure, or have a serious medical condition. You should also be careful when giving supplements to children.
Practical Advice For Calcium And Vitamin D Supplementation
Based on guidelines, optimization of total calcium intake towards a total of 1,0001,200 mg calcium per day is considered necessary and sufficient in the context of osteoporosis and fracture prevention strategies with drug treatment. Calcium supplementation can be achieved by diet, mainly milk products or calcium-containing tablets. Dietary calcium intake is preferred and 34 portions of milk products per day should be advised. If this cannot be achieved, supplementation of calcium should be considered. If a patient consumes 12 portions of milk products per day, then the advice is to add 12 portions of milk products per day or 500 mg of calcium supplementation. If a patient does not take any milk products, supplementation of 1,000 mg calcium is needed. No adjustment is required if the patient consumes 34 portions of milk products per day. In the context of the concern about cardiovascular conditions, calcium supplementation should be individualized.
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Guidelines On Calcium And Vitamin D Supplements
In April 2018, the United States Preventive Services Task Force updated its recommendations on the use of calcium and vitamin D supplements. Based on its findings from a review of the current scientific evidence, the USPSTF does not recommend calcium or vitamin D supplements in healthy women without vitamin D deficiency. The task forces recommendations cite that studies do not show that supplements reduce the risk of fractures.
The USPSTF recommendations are not a blanket recommendation for everyone. They are suggesting that the evidence is not strong enough to suggest that all healthy adults take calcium and vitamin D supplements.
