Walk Talk Nutrition: calcium supplements

calcium supplements come in many forms

calcium supplements come in many shapes and sizes

Do post-menopausal women need calcium supplements?

Our interest in this topic is personal and professional.  After a recent DEXA scan, Kathy was told by her MD to start taking calcium.  She wondered why the doctor didn’t bother to ask about her intake of high calcium foods.  Why just automatically suggest supplements?  Similarly, after a DEXA scan, Donna’s doctor recommended drugs, didn’t even bother discussing calcium or any other dietary intervention.

And we’re probably not unique.  Most older women are automatically told to take drugs and/or calcium supplements.  Unfortunately, calcium isn’t the whole story when it comes to bone nutrition.  And lately, research has suggested that calcium supplements may increase risk for heart disease.  As Kathy notes, why take an expensive supplement to prevent one theoretical problem, when it increases you risk for another health problem.

As Donna points out in the podcast, bones aren’t just blocks of calcium.  They’re living tissue, made primarily of protein.  Calcium, phosphorus, potassium, magnesium and other trace minerals are important for structure.  If anything, most people have a poor intake of potassium and magnesium, which are abundant in plant foods.  So simply taking calcium to improve bone strength may not be helpful.  And of course, vitamin D has to be sufficient for calcium absorption.  Lately new research indicates vitamin K2 plays a role in bone health, directing calcium into bones.

The DEXA scan only measures calcification in bones, which doesn’t necessarily relate to bone strength.

Calcium supplements are available in a variety of forms:

  • Calcium carbonate: the cheapest, but least bioavailable.  Many people experience unpleasant digestive disturbance.  It’s the usual form found in fortified foods like soy milk, bars, juice and cereal.
  • Calcium citrate: a more expensive form, with a bigger molecule, making the supplement pills larger.  Kathy objects to that, as they’re hard to swallow.  But the calcium is absorbed better.
  • Liquid forms: these are less common, and more expensive.  The syrups may include magnesium or other minerals.
  • Chews: a newly popular form, and typically calcium carbonate.  Donna objects to these on principle: they’re like candy and can make it really easy to overdose on calcium, especially if a kid gets hold of them.  Kathy was impressed by how candy-like they were.

Again, whatever the form, recent research has linked calcium supplements to increased risk for heart disease.  So what should you do if you’re advised to take drugs and/or calcium by a doctor?  We agree, it’s a personal decision, dependent on your diet, your willingness to increase intake of high calcium foods (dairy foods are best), your willingness to adjust lifestyle to eat more bone nutrients and get more weight-bearing exercise, or how comfortable you are taking prescription drugs (which have their own side effects).  Keep in mind, doctors are not trained in nutrition, and don’t have the time or knowledge to assess your current dietary intake of calcium, vitamin D, or other bone nutrients.

As Kathy notes in the podcast, most food trackers can track calcium, so if you’re curious about your own calcium intake, it’s fairly easy to assess that with a food/diet tracker.  An intake of 1200 mg/day from food for a post-menopausal woman would be great.

The NIH has a Calcium Factsheet if you want more information.

Check out this handy Hip Fracture Risk Calculator from the Women’s Health Initiative Coordinating Center.  The key risk factors: age, smoking, exercise, family history of fractures, history of diabetes or use of certain medications.  Strangely, no questions about calcium intake or vitamin D status.


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