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)
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Related Studies
| Definition (CSP) | calcium salts containing the phosphate radical (PO4), frequently used as calcium supplements. |
| Concepts | Pharmacologic Substance (T121) , Inorganic Chemical (T197) |
| MSH | C020243 |
| SnomedCT | 259546007, 44044007, 419939009 |
| LNC | LP16847-3 |
| English | calcium phosphate, calcium (as phosphate), calcium phosphate [Chemical/Ingredient], calciums phosphates, calcium phosphate product, phosphate calcium, Calcium Phosphate, CALCIUM PHOSPHATE, Calcium phosphate, Calcium phosphate product, Calcium phosphate (substance), Calcium phosphate [dup] (substance), Calcium phosphate agent, Calcium phosphate (product) |
| Spanish | fosfato de calcio, fosfato de calcio (producto), fosfato cálcico (sustancia), fosfato cálcico |
Ontology: Calcium, Dietary (C0006726)
| Definition (MEDLINEPLUS) |
You have more calcium in your body than any other mineral. Calcium has many important jobs. The body stores more than 99 percent of its calcium in the bones and teeth to help make and keep them strong. The rest is throughout the body in blood, muscle and the fluid between cells. Your body needs calcium to help muscles and blood vessels contract and expand, to secrete hormones and enzymes and to send messages through the nervous system. It is important to get plenty of calcium in the foods you eat. Foods rich in calcium include dairy products such as milk, cheese and yogurt, and leafy, green vegetables. The exact amount of calcium you need depends on your age and other factors. Growing children and teenagers need more calcium than young adults. Older women need plenty of calcium to prevent osteoporosis. People who do not eat enough high-calcium foods should take a calcium supplement. NIH: National Institutes of Health Office of Dietary Supplements |
| Definition (NCI_CRCH) | Forms of the element calcium found in foods. |
| Definition (MSH) | Calcium compounds used as food supplements or in food to supply the body with calcium. Dietary calcium is needed during growth for bone development and for maintenance of skeletal integrity later in life to prevent osteoporosis. |
| Definition (CSP) | calcium compounds used as food supplements or in food to supply the body with calcium; dietary calcium is needed during growth for bone development and for maintenance of skeletal integrity later in life to prevent osteoporosis. |
| Concepts | Inorganic Chemical (T197) |
| MSH | D002136 |
| English | Dietary Calcium, Calcium, Dietary, Calcium, Dietary [Chemical/Ingredient], dietary calcium, calcium dietary, Calcium |
| Swedish | Kalcium i kosten |
| Czech | vápník dietní |
| Finnish | Ravinnon kalsium |
| Russian | KAL'TSII PISHCHEVOI, PISHCHEVOI KAL'TSII, КАЛЬЦИЙ ПИЩЕВОЙ, ПИЩЕВОЙ КАЛЬЦИЙ |
| Croatian | KALCIJ U HRANI |
| Polish | Wapń w pokarmach |
| Japanese | カルシウム-食品, 食品中のカルシウム, 食品カルシウム, 食物カルシウム, 食用カルシウム, 食品中のカルシウム成分 |
| French | Calcium alimentaire |
| German | Nahrungscalcium, Nahrungskalzium |
| Italian | Calcio alimentare |
| Portuguese | Cálcio na Dieta |
| Spanish | Calcio en la Dieta |
Ontology: Calcium Citrate (C0108101)
| Definition (NCI) | The citrate salt of calcium. An element necessary for normal nerve, muscle, and cardiac function, calcium as the citrate salt helps to maintain calcium balance and prevent bone loss when taken orally. This agent may also be chemopreventive for colon and other cancers. (NCI04) |
| Definition (MSH) | A colorless crystalline or white powdery organic, tricarboxylic acid occurring in plants, especially citrus fruits, and used as a flavoring agent, as an antioxidant in foods, and as a sequestrating agent. (McGraw-Hill Dictionary of Scientific and Technical Terms, 4th ed) |
| Definition (PDQ) | The citrate salt of calcium. An element necessary for normal nerve, muscle, and cardiac function, calcium as the citrate salt helps to maintain calcium balance and prevent bone loss when taken orally. This agent may also be chemopreventive for colon and other cancers. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=41817&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=41817&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C1355" NCI Thesaurus) |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D019355 |
| SnomedCT | 52209008 |
| English | Calcium Citrate, Citrate, Calcium, Calcium Citrates, Citrates, Calcium, TRICALCIUM CITRATE, 2-Hydroxy-1,2,3-propanetricarboxylic Acid, Calcium Salt (2:3), Tricalcium Citrate, calcium citrate (medication), mineral supplements calcium citrate, Calcium Citrate [Chemical/Ingredient], CALCIUM CITRATE, calcium citrates, citrate calcium, calcium citrated, calcium citrate, calcium (as citrate), Calcium citrate, Calcium citrate (substance), CALCIT, CALCIUM (AS CITRATE) |
| French | Citrate de calcium |
| Swedish | Kalciumcitrat |
| Czech | kalciumcitrát, citran vápenatý |
| Finnish | Kalsiumsitraatti |
| Russian | KAL'TSIIA TSITRAT, КАЛЬЦИЯ ЦИТРАТ |
| Polish | Cytrynian wapniowy |
| Norwegian | Kalsiumcitrat |
| Spanish | citrato de calcio (sustancia), citrato de calcio, Citrato de Calcio |
| German | Calciumcitrat, Kalziumcitrat |
| Italian | Calcio citrato |
| Dutch | Calciumcitraat |
| Portuguese | Citrato de Cálcio |
