Calcium And Vitamin D Recommendations For Osteoporosis

Calcium And Vitamin D Recommendations For Osteoporosis

Calcium and vitamin D are essential to building strong, dense bones when you're young and to keeping them strong and healthy as you age. The information included here will help you learn all about calcium and vitamin D – the two most important nutrients for bone health.

What is Calcium and What Does it Do?

A calcium-rich diet (including dairy, nuts, leafy greens and fish) helps to build and protect your bones.

Calcium is a mineral that is necessary for life. In addition to building bones and keeping them healthy, calcium enables our blood to clot, our muscles to contract, and our heart to beat. About 99% of the calcium in our bodies is in our bones and teeth.

Every day, we lose calcium through our skin, nails, hair, sweat, urine and feces. Our bodies cannot produce its own calcium. That's why it's important to get enough calcium from the food we eat. When we don't get the calcium our body needs, it is taken from our bones. This is fine once in a while, but if it happens too often, bones get weak and easier to break.

Too many Americans fall short of getting the amount of calcium they need every day and that can lead to bone loss, low bone density and even broken bones.

How Much Calcium Do You Need?

The amount of calcium you need every day depends on your age and sex.

Women
Age 50 & younger	1,000 mg* daily
Age 51 & older	1,200 mg* daily

Men
Age 70 & younger	1,000 mg* daily
Age 71 & older	1,200 mg* daily

*This includes the total amount of calcium you get from food and supplements.

How Much Calcium Do You Eat?

Use the International Osteoporosis Foundation's Calcium Calculator to find out.

Sources of Calcium

Calcium-Rich Food Sources

Food is the best source of calcium. Dairy products, such as milk, yogurt, and cheese are high in calcium. Certain green vegetables and other foods contain calcium in smaller amounts. Some juices, breakfast foods, soymilk, cereals, snacks, breads and bottled water have added calcium. If you drink soymilk or another liquid that is fortified with calcium, be sure to shake the container well as calcium can settle to the bottom.

A simple way to add calcium to many foods is to add a single tablespoon of nonfat powdered milk, which contains about 50 mg of calcium. It is easy to add a few tablespoons to almost any recipe.

Reading Food Labels – How Much Calcium Am I Getting?

To determine how much calcium is in a particular food, check the nutrition facts panel for the daily value (DV). Food labels list calcium as a percentage of the DV. This amount is based on 1,000 mg of calcium per day. For example:

• 30% DV of calcium equals 300 mg of calcium.
• 20% DV of calcium equals 200 mg of calcium.
• 15% DV of calcium equals 150 mg of calcium.

Calcium Supplements

The amount of calcium you need from a supplement depends on how much you get from food. Try to get the daily amount recommended from food and only supplement as needed to make up any shortfall. In general, you shouldn't take supplements that you don't need. If you get enough calcium from foods, don't take a supplement. There is no added benefit to taking more calcium than you need. Doing so may even carry some risks.

Calcium supplements are available without a prescription in a wide range of preparations (including chewable and liquid) and in different amounts. The best supplement is the one that meets your needs for convenience, cost, and availability. When choosing a supplement, keep the following in mind:

• Choose brand-name supplements with proven reliability. Look for labels that state "purified" or have the USP (United States Pharmacopeia) symbol. The "USP Verified Mark" on the supplement label means that the USP has tested and found the calcium supplement to meet its standards for purity and quality.
• Read the product label carefully to determine the amount of elemental calcium , which is the actual amount of calcium in the supplement, as well as how many doses or pills you have to take. When reading the label, pay close attention to the "amount per serving" and "serving size."
• Calcium is absorbed best when taken in amounts of 500 – 600 mg or less. This is the case for both foods and supplements. Try to get your calcium-rich foods and/or supplements in small amounts throughout the day, preferably with a meal. While it's not recommended, taking your calcium all at once is better than not taking it at all.
• Take (most) calcium supplements with food. Eating food produces stomach acid that helps your body absorb most calcium supplements. The one exception to the rule is calcium citrate, which can absorb well when taken with or without food.
• When starting a new calcium supplement, start with a smaller amount to better tolerate it. When switching supplements, try starting with 200-300 mg every day for a week, and drink an extra 6-8 ounces of water with it. Then gradually add more calcium each week.
• Side effects from calcium supplements, such as gas or constipation may occur. If increasing fluids in your diet does not solve the problem, try another type or brand of calcium. It may require trial and error to find the right supplement for you, but fortunately there are many choices.
• Talk with your healthcare provider or pharmacist about possible interactions between prescription or over-the-counter medications and calcium supplements.

What is Vitamin D and What Does it Do?

Vitamin D plays an important role in protecting your bones, both by helping your body absorb calcium and by supporting muscles needed to avoid falls. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you don't get enough vitamin D, you're more likely to break bones as you age.

How Much Vitamin D Do You Need?

Women and Men
Under age 50	400-800 international units (IU) daily**
Age 50 and older	800-1,000 IU daily**

**Some people need more vitamin D. According to the Institute of Medicine (IOM), the safe upper limit of vitamin D is 4,000 IU per day for most adults.

Sources of Vitamin D

There are three ways to get vitamin D:

• Sunlight
• Food
• Supplements

Sunlight

Your skin makes vitamin D in reaction to sunlight and stores it in fat for later use. How much vitamin D your skin can produce depends on time of day, season, latitude, skin pigmentation, age, and other factors.

There are many reasons people do not have enough vitamin D. As we age, our skin loses its ability to generate vitamin D. People who live in cities or in institutional settings like nursing homes spend too little time outdoors. Even people who spend time outdoors often use sunscreen to prevent skin cancer. Sunscreen with an SPF as low as 8 reduces vitamin D production by 95 percent.

Vitamin D in Food

Vitamin D is found in very few foods. Sources include fatty fish like wild-caught mackerel, salmon, and tuna. Vitamin D is added to milk and other dairy products, orange juice, soymilk, and fortified cereals.

Check the food label to see if vitamin D has been added to a particular product. One eight-ounce serving of milk usually has 25% of the daily value (DV) of vitamin D. The DV is based on a total daily intake of 400 IU of vitamin D. So, a serving of milk with 25% of the DV of vitamin D contains 100 IU.

It is very difficult to get all the vitamin D you need from food alone. Most people must take vitamin D supplements to get enough to support bone health.

Vitamin D Supplements

If you aren't getting enough vitamin D from sunlight and food, consider taking a supplement. Before adding a vitamin D supplement, check to see if any of the other supplements, multivitamins, or medications you take contain vitamin D. Many calcium supplements also contain vitamin D.

There are two types of vitamin D supplements. They are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Both types are good for bone health.

Vitamin D supplements can be taken with or without food and the full amount can be taken at one time. While your body needs vitamin D to absorb calcium, you do not need to take vitamin D at the same time as a calcium supplement. If you need help choosing a vitamin D supplement, ask your healthcare provider or pharmacist to recommend one.

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 D Deficiency: Are You at Risk?

Vitamin D deficiency occurs when you are not getting the recommended level of vitamin D over time. Certain people are at higher risk for vitamin D deficiency, including:

• People who spend little time in the sun or those who regularly cover up when outdoors;
• People living in nursing homes or other institutions or who are homebound;
• People with certain medical conditions such as Celiac disease and inflammatory bowel disease;
• People taking medicines that affect vitamin D levels such as certain anti-seizure medicines;
• People with very dark skin;
• Obese or very overweight people; and
• Older adults with certain risk factors.

Talk to your healthcare provider if you have any of these risk factors. If you have osteoporosis and also have a vitamin D deficiency, your healthcare provider may temporarily prescribe a high dose of vitamin D to bring you up to a healthy level.

A Guide to Calcium-Rich Foods

We all know that milk is a great source of calcium, but you may be surprised by all the different foods you can work into your diet to reach your daily recommended amount of calcium. Use the guide below to get ideas of additional calcium-rich foods to add to your weekly shopping list.

Produce	Serving Size	Estimated Calcium*
Collard greens, frozen	8 oz	360 mg
Broccoli rabe	8 oz	200 mg
Kale, frozen	8 oz	180 mg
Soy Beans, green, boiled	8 oz	175 mg
Bok Choy, cooked, boiled	8 oz	160 mg
Figs, dried	2 figs	65 mg
Broccoli, fresh, cooked	8 oz	60 mg
Oranges	1 whole	55 mg
Seafood	Serving Size	Estimated Calcium*
Sardines, canned with bones	3 oz	325 mg
Salmon, canned with bones	3 oz	180 mg
Shrimp, canned	3 oz	125 mg
Dairy	Serving Size	Estimated Calcium*
Ricotta, part-skim	4 oz	335 mg
Yogurt, plain, low-fat	6 oz	310 mg
Milk, skim, low-fat, whole	8 oz	300 mg
Yogurt with fruit, low-fat	6 oz	260 mg
Mozzarella, part-skim	1 oz	210 mg
Cheddar	1 oz	205 mg
Yogurt, Greek	6 oz	200 mg
American Cheese	1 oz	195 mg
Feta Cheese	4 oz	140 mg
Cottage Cheese, 2%	4 oz	105 mg
Frozen yogurt, vanilla	8 oz	105 mg
Ice Cream, vanilla	8 oz	85 mg
Parmesan	1 tbsp	55 mg
Fortified Food	Serving Size	Estimated Calcium*
Almond milk, rice milk or soy milk, fortified	8 oz	300 mg
Orange juice and other fruit juices, fortified	8 oz	300 mg
Tofu, prepared with calcium	4 oz	205 mg
Waffle, frozen, fortified	2 pieces	200 mg
Oatmeal, fortified	1 packet	140 mg
English muffin, fortified	1 muffin	100 mg
Cereal, fortified 35	8 oz	100-1,000 mg
Other	Serving Size	Estimated Calcium*
Mac & cheese, frozen	1 package	325 mg
Pizza, cheese, frozen	1 serving	115 mg
Pudding, chocolate, prepared with 2% milk	4 oz	160 mg
Beans, baked, canned	4 oz	160 mg

*The calcium content listed for most foods is estimated and can vary due to multiple factors. Check the food label to determine how much calcium is in a particular product.

Last Reviewed 02/26/2018

Calcium And Vitamin D Recommendations For Osteoporosis

Source: https://www.bonehealthandosteoporosis.org/patients/treatment/calciumvitamin-d/

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