Calcium supplements: Which one is the best

Q: My doctor says I need to take a calcium supplement. Which one is the best and how much of it do I need to take?
Your muscles, nerves and blood vessels depend on calcium to work properly. If there is not enough calcium in your blood for your muscles and nerves, your body will grab calcium right out of your bones to make it up. Over time, you lose more and more bone until something gives: your hip breaks or your backbone collapses.
How do you know if you are getting enough calcium to prevent this from happening to you? The Institute of Medicine recommends 1000mg daily of calcium for men and women up to age 50, and 1200mg for adults older than 50 years of age. The National Institutes of Health recommends more calcium for postmenopausal women: 1500mg daily for women who are postmenopausal but not taking an estrogen supplement, and 1500mg for all women age 65 and older. These recommended amounts of calcium refer to the actual amount of calcium mineral in each pill, also called elemental calcium. For example, each CitracalÆ tablet contains only 21% of elemental calcium, and CaltrateÆ has 40% elemental calcium in each tablet.
If you are taking a medicine to prevent or treat bone loss (such as FosamaxÆ or alendronate, ActonelÆ or risendronate, BonivaÆ, or calcitonin nose spray) it’s extra important to get plenty of calcium every day because these medicines work by putting calcium back into bones. It’s important to have enough calcium in your body so these medicines can do their job.


You’ll get about 300mg of calcium daily from your diet, including beans, nuts, and green vegetables, with an additional 300mg of calcium for every 8 ounce glass of milk, fortified orange juice, yogurt, or 1.5 ounces of cheese you consume. Most men need 600mg and most women will need 600mg to 1200mg daily of a calcium supplement.
Most calcium supplements have either calcium carbonate or calcium citrate, with brand names and generics to choose from. Calcium carbonate is nearly twice as concentrated in elemental calcium as calcium citrate. The most concentrated are TUMSÆ antacid tablets, available as 500mg, 750mg and 1000mg each. CaltrateÆ, OsCalÆ, and ViactivÆ each contain either 500mg or 600mg of calcium carbonate. CitracalÆ has calcium citrate in a variety of strengths, from 200mg to a slow-release form containing 600mg. CitracalÆ Gummies use tricalcium phosphate.
It’s best to pick a calcium supplement that you are willing and able to take regularly. A bottle of calcium pills sitting on the shelf because they’re too big to swallow won’t help your bones! Here are some tips to help you out:
6 Tips For Selecting A Calcium Supplement:
1. Most women need 1000-1200mg of elemental calcium as a daily supplement.  That’s two each of calcium carbonate or about four each of calcium citrate for women, and half of that dose for men over 60 years of age. Most calcium supplements show calcium content on the label by a serving size of 2 each.  
2. Take supplemental Vitamin D to help your body absorb calcium. 
Vitamin D is now recommended as 600 IU daily for folks up to 70 years of age and 800 IU daily for those over 70. You can also get Vitamin D from salmon (800 IU per 3 ounces), canned tuna (150 IU per 3 ounces), fortified milk (about 120 IU per 4 ounces), and fortified orange juice (80 IU per 4 ounces). Most calcium supplements contain Vitamin D but you can also take it separately.


3. Maintain an adequate water or fluid intake to avoid kidney stones.  
Calcium is not very soluble in water, and can form painful crystals or stones inside your kidney. Calcium citrate is less likely to do this than calcium carbonate supplements; talk to your doctor first before taking calcium if you have had kidney stones in the past.
4. Choose calcium citrate if you take any medicines for stomach acidity, stomach ulcer, or hiatal hernia. 
PrilosecÆ or omeprazole, PrevacidÆ or lansoprazole, ZantacÆ or ranitidine, and other medicines like these reduce the acid in your stomach. Calcium carbonate needs an acidic stomach to be completely absorbed; calcium citrate is well absorbed regardless. 
5. If you have trouble with constipation, avoid calcium carbonate.
6. Take advantage of chewable calcium if you can’t swallow large pills. 
If you hate to take big pills like me (I tend to gag on them or get them stuck partway down), try smaller tablets (CitracalÆ Petites), caramel-like chews (ViactivÆ), or new gumdrop-like ìgummiesî (CaltrateÆ, CitracalÆ).
As always, I welcome your questions and comments.  
Dr. Louise Achey, Doctor of Pharmacy is a 30 year veteran of pharmacology. Please send questions and comments to



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