How Much Calcium Do I Need
How much calcium you need daily is primarily based on your age and sex, but other health conditions and pregnancy may impact your needs. Most experts recommend that women and men under age 50 obtain 1,000 milligrams daily, and women over age 50 get 1,200 milligrams. For men over age 50, the recommended level is 1,000 milligrams. These amounts are available from a combination of foods and supplements.
What Foods Provide Calcium
Calcium is found in many foods. You can get recommended amounts of calcium by eating a variety of foods, including the following:
- Milk and milk alternatives such as yogurt, cheese, and fortified plant-based beverages
- Dark green vegetables such as broccoli, kale and spinach
- Fish with soft bones that are eaten, such as canned salmon or sardines.
How Much Vitamin D Should You Get
The amount you need depends on your age:
- 600 IU a day for people ages 1 to 70, including women who are pregnant or breastfeeding
- 800 IU a day for anyone over 70
Some experts think that these recommendations are too low, especially for people who are more likely to get the bone-thinning disease osteoporosis. Ask your doctor how much vitamin D is best for you.
It is possible to get too much vitamin D. Doses above 4,000 IU a day can be harmful for people ages 9 and older. Its hard to get that much from food, but it might happen if you take too many vitamin D supplements.
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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.
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
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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.
Vitamin K2 Mk7 Dosage Recommendations
The 2013 study in the Netherlands discussed above used a dosage of 0.18 mg/day of Vitamin K2 Mk7 supplements.
In his book, Vitamin K2: The Missing Nutrient for Heart and Bone Health, Dr. Dennis Goodman, a cardiologist in New York City, also recommends between 150 to 180 µg/day of MK-7 Vitamin K2 .
If you are not getting that level in your diet, you might consider supplementing. However, you should be cautious about the type of Vitamin K2 you take. Discuss your needs with your physician and take into account your health status and medical history.
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Whats The Difference Between Osteopenia And Osteoporosis
Osteopenia isnt as severe as osteoporosis, a disease that weakens bones so much that they can break more easily. Not everyone with osteopenia develops osteoporosis, but it can happen. People with osteopenia should try to strengthen and protect their bones. And their healthcare providers should monitor their bone mineral density.
Potential Concerns With Calcium Supplements
There are some concerns about taking large doses of calcium via supplements.
For example, calcium supplements have been associated with symptoms like constipation, kidney stones, and other digestive issues. There are also some concerns that they may be bad for heart health .
One review found an increased risk of heart attacks in those taking calcium supplements. That said, other studies have not shown a link between calcium supplements and negative outcomes for heart health .
As dietary intake of calcium has not been linked to these side effects, its best to focus on meeting your calcium needs through your diet and discussing the potential need for supplements with your healthcare provider.
Summary
While there are certain situations in which calcium supplements may be indicated, the current research doesnt support the use of calcium supplements to prevent or manage osteoporosis.
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Vitamin D Dosing Recommendations For People With Or At Risk For Osteoporosis
Patients with or at high risk for osteoporosis should take the lowest possible dosage of vitamin D3 with the shortest possible interval , according to study findings published in Joint Bone Spine.
Researchers presented new data and practices relevant to vitamin D levels in the general population in France to establish optimal vitamin D status and frequency of intermittent supplement dosing, and make recommendations for appropriate supplementation.
Previous literature has recommended a minimum serum 25-hydroxyvitamin D D) level of 30 ng/mL for patients who have osteoporosis or who are at high risk because of health conditions or receiving treatment that may have deleterious bone effects, as well as patients who have chronic kidney disease or are prone to falls. For a general population of healthy individuals, the literature contends that a level of at least 20 ng/mL is sufficient, but should not exceed 60 ng/mL. Approximately 50% of individuals in the general French population have serum 25D levels < 20 ng/mL.
The researchers recommend beginning supplementation with a loading phase consisting of 50,000 IU/wk of vitamin D3 for 8 weeks in patients with levels < 20 ng/mL and 50,000 IU/wk for 4 weeks in patients with levels between 20 and 30 ng/mL. Subsequently, long-term supplementation should be prescribed as 50,000 IU/mo.
Natural Treatments For Osteopenia
Your doctor may recommend medications if youâve already broken a bone. But many people try a number of nutritional supplements and herbs before they have a fracture to build stronger bones. The main ones are calcium and vitamin Dsupplements.
Most adults should get between 1,000 and 1,200 milligrams of calcium and 600 to 800 international units of vitamin D every day. If you aren’t getting enough of these nutrients in your diet and don’t spend much time in the sun, ask your doctor if you should take a supplement.
Other nutritional supplements may help strengthen bones, but so far, thereâs little research showing how well they work. These include:
- Boron
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Why Review The Dris For Vitamin D And Calcium
The DRIs for vitamin D and calcium were first published in 1997. Since that time, a significant amount of information has been published on vitamin D requirements and on the association of vitamin D with chronic diseases and conditions. Because of the availability of sufficient new and relevant scientific research to warrant a re-evaluation of the existing values, Health Canada, the Public Health Agency of Canada, and several U.S. government agencies co-sponsored a review of the DRIs for vitamin D and calcium.
The decision to commission the Institute of Medicine review reflects the government’s goal of ensuring that Canadians benefit from the most up-to-date health and nutritional advice.
Surprise In Randomized Trial: A Hint Of Actual Adverse Effect From Supplementation
This article is a collaboration between MedPage Today and:
Vitamin D might not be much help for strengthening bones among healthy adults without osteoporosis, Canadian researchers reported, even at doses far higher than recommended daily allowances.
In a clinical trial assessing three levels of daily vitamin D supplementation — 400 IU, 4,000 IU, and 10,000 IU — radial volumetric bone mineral density was significantly lower among those taking higher doses for 3 years, according to Steven Boyd, PhD, of the University of Calgary in Canada, and colleagues:
- 400 IU: reference
- 4,000 IU: -3.9 mg calcium hydroxyapatite /cm3
- 10,000 IU: -7.5 mg HA/cm3
No dose of vitamin D supplementation was able to prevent bone loss, as each dose saw a drop in the percentage of radial volumetric BMD over 3 years, they reported in JAMA:
- 400 IU: -1.2%
- 4,000 IU: -2.4%
- 10,000 IU: -3.5%
Boyd’s group explained that the findings were unexpected, and that the outcomes were in fact the opposite of what they were anticipating. But they cautioned that “this evidence of high-dose vitamin D having a negative effect on bone should be regarded as hypothesis generating, requiring confirmation with further research. Therefore, the appropriate interpretation of this study is that for maintenance of bone quality in healthy vitamin D-sufficient adults, these results do not support a skeletal benefit of vitamin D doses well above the recommended dietary allowance.”
Disclosures
Primary Source
JAMA
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What Is The Outlook For People With Osteopenia
If youre diagnosed with osteopenia, you will need regular bone density tests to monitor bone health, usually every two to three years.
Not everyone with osteopenia develops osteoporosis. Changes to your lifestyle can keep bone loss to a minimum. For those who do develop osteoporosis, some treatments can help protect and strengthen the bones.
How Much Vitamin D Do I Need
Many health experts recommend that adults take a vitamin D supplement throughout the year. Experts recommend that this supplement is at a level of 800 to 2000 IU every day if you are a man or woman over the age of 50, or if you have a risk of osteoporosis, or if you have osteopenia or osteoporosis. If you are under the age of 50, 400 to 800 IUs daily is the recommendation.
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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.
Vitamin K1 Vs Vitamin K2 For Osteoporosis
Vitamin K1 is processed in the liver and plays a larger role in the coagulation of our blood, whereas Vitamin K2, on the other hand, is processed in the intestine. This makes it more available to different tissues than Vitamin K1.
A large meta-analysis published in 2006 in the Archives of Internal Medicine demonstrated that while both Vitamin K1 and Vitamin K2 were beneficial for osteoporosis and bone health, Vitamin K2 was more effective than Vitamin K1.
The meta-analysis found that high levels of Vitamin K2 were associated with reduced:
- Hip fractures .
- Non-vertebral fractures .
As mentioned before, it has been shown that Vitamin K2 is also beneficial for your cardiovascular system.
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Vitamin D & Osteoporosis
Vitamin D3 helps to build strong bones and is essential for everyone throughout life. Vitamin D3 is very important to help protect our bones, your body to absorb calcium and supporting your muscles to help decrease falls, as well as helping your immune system. The lack of sunshine and the fact that only a few foods naturally contain vitamin D3 is an issue in Ireland. We usually have some sunny days in May, June, July, and August, so 15 minutes a day in the sun, then put sunblock on. If you burn easily, please do not try to get your Vitamin D from the sun. In Ireland, 74% of adults and 88% of primary school children, have less than half of the recommended daily amount of vitamin D. In the winter it is extremely important to make sure you are getting enough Vitamin D3. Vitamin D3 can only be found in a few foods: Oily fish such as salmon, tuna, sardines, mackerel, halibut, and herring, are all excellent sources of vitamin D3. Eating oily fish twice a week can help get your vitamin D3, depending on the portion size. Eggs contain Vitamin D3 and a lot of milk products and margarine are fortified with vitamin D3. Breakfast cereals, soya milk, and rice milk may also be fortified with vitamin D3. Low Vitamin D levels are very common in Ireland.
What Can I Do To Prevent Bone Loss
Several strategies can help you maintain bone strength and prevent bone loss:
- Avoid smoking.
- Eat a healthy, balanced diet with lots of fruits, vegetables, calcium and vitamins.
- Exercise every day. Walking, jogging and other activities that make you bear your own weight are particularly helpful, as is weight training.
- Get at least 1,200 mg of calcium daily.
- Get at least 800 to 1,000 IU of vitamin D daily.
- Go outside for exposure to the sun, which helps your body absorb vitamin D into the bloodstream.
- Limit alcohol.
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What Research Gaps Were Identified
The IOM expert committee identified areas where further research would help improve the determination of reference values in the future. A total of 22 major research needs were identified and are summarized in Table 9-1 of the report. The general categories of information gaps are:
- Data on the physiology and metabolism of calcium and vitamin D
- Data on health outcomes and adverse effects related to calcium and vitamin D
- Data on dose-response relationships between intakes of calcium and vitamin D and health outcomes
- Evidence to judge independent effects of calcium and vitamin D
- Information on the impact and role of sun exposure relative to vitamin D
- Standardized and consistent data on calcium and vitamin D intakes
- Exploration of methodologies for synthesizing evidence
Causes And Risk Factors Of Osteopenia And Osteoporosis
Your body is constantly making new bone and getting rid of old bone. Osteoporosis develops when the amount of bone that your body makes is less than the amount of bone that it gets rid of.
Lifestyle factors that can increase the risk of osteoporosis can include:
- Lack of exercise
Other things that can lead to bone loss include:
- Cancer and some cancer treatments
- Bone marrow or connective tissue disorders
- Diseases that affect levels of hormones, such as estrogen and testosterone
- Thyroid disorders
- Parathyroid disorders
- Conditions that create trouble absorbing food and nutrients, such as graft versus host disease in your digestive tract, Crohns disease, or ulcerative colitis
- Certain medications, such as corticosteroids, heparin, some anticonvulsants, and methotrexate
- Hormonal therapy for prostate and breast cancers
- Going through menopause or taking medications like leuprolide or goserelin , which stop your ovaries from making estrogen, or stop your testicles from making testosterone.
- Radiation therapy
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Calcium And Vitamin D Requirements
As new scientific research emerges, recommendations change. We are now rethinking how much calcium and vitamin D is needed for good bone health. There is increasing evidence that too much calcium from supplements is not likely to be a benefit and worse, can be harmful. This was underscored in the 2010 and 2018 reports from the US Preventive Services Task Force recommending that premenopausal women and men may not benefit from calcium supplements.
The recommended dietary allowances are goals established by the Institutes of Medicine the RDA varies with age, gender, and other factors. These amounts would be sufficient for 97% of the US population.
Mounting evidence shows that too little calcium in the diet is harmful, but too much calcium also may be harmful.
Talking To Your Doctor
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 doctor. 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 doctor can also advise on the types of supplements available and the ones they recommend for improving your bone health.
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 doctor 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 doctor 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.
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