II. Indications: Osteoporosis Prevention
- Starting in childhood and adolescence preferable
- Begin at 35-40 years old if not already started
- Potentiates Estrogen Replacement Therapy
III. Contraindications
IV. Precautions
- Calcium Supplementation in Osteoporosis Prevention benefits may not outweigh cardiovascular and Nephrolithiasis risks
- Prevention of Hip Fracture with Calcium Supplementation Number Needed to Treat (NNT)
- Adults living in the community: 1000
- Older persons: 302
- Nursing Home resident: 111
- References
V. Adverse Effects
-
Nephrolithiasis
- Hypercalcemia does cause Nephrolithiasis
- However, Calcium Supplementation is often used in normocalcemic patients with Hypercalciuria
- Cardiovascular disease risk (mixed evidence)
- CAD Risk not increased at standard Calcium dose (but may be increased at high dose >1500-2000/day)
- Bolland (2008) BMJ 336(7638):262-6 [PubMed]
- Chung (2016) Ann Intern Med 165(12): 856-66 +PMID:27776363 [PubMed]
VI. Dosing: Calcium daily requirements
- Calcium is best absorbed in doses of 500 mg or less
- Dietary Calcium is better absorbed than Calcium in supplements
- Only one third of Oral Calcium supplements are absorbed, while Dietary Calcium aborption may approach 45%
- Calcium absorption varies considerably, and is highest in infants, and declines after age 40 years old
- Do not exceed Calcium 2500 mg/day in men or 2000 mg/day in women (Hypercalcemia risk)
- Daily dose of 1000 mg Calcium Indications
- Men and women ages 25 to 50 years
- Men 50 to 65 years
- Women on Estrogen Replacement ages 50-65 years
- Dose 1200 to 1500 mg Calcium Indications (some guidelines recommend 1000 mg daily for these groups)
- Ages 11 to 24 years
- Post-menopausal women not on Estrogen Replacement
- Age over 65 years
- Pregnancy
- Lactation
VII. Medications: Dietary Calcium Sources (300 mg elemental Calcium in each) - Preferred Source
- Yogurt or frozen yogurt 8 ounces
- Calcium-Fortified Orange Juice 8 ounces
- Milk 8 ounces
- Firm Cheese 1 to 1.5 ounces
- Canned Sardines 3 ounces
- Cooked greens, collards, or mustard 1-2 cups or 8 oz
VIII. Medications: Calcium Carbonate
- See Calcium Carbonate
- Advantages
- Disadvantages
- Only 35% of Calcium supplements are absorbed (contrast with much better Dietary Calcium absorption)
- Constipation
- Administration
- Take with meals or citrus juice
- Absorption reduced with Fasting or achlorhydria
- Preparations
- Tums 500 mg orall daily to three times daily
IX. Medications: Calcium Citrate
- Advantages
- No Constipation
- Better absorption than Calcium Carbonate by >20% especially in low gastric acid state
- Disadvantages
- Only 21% elemental Calcium
- Indications:
- Constipation or gas on Calcium Carbonate
- Calcium based Kidney Stones
- Gastric acid suppression medications (Proton Pump Inhibitors, H2 Blockers)
- Elderly patients
- Administration
- Take on an empty Stomach
X. Medications: Calcium Phosphate
- Advantages
- No Constipation
- Absorption: 39%
- Disadvantages
- Cost
XI. Preparations: Other Formulations
- Calcium Gluconate (9% elemental Calcium)
- Calcium lactate (13% elemental Calcium)