Do you need a calcium supplement?

Q: Should I be taking calcium pills for my bones?

Last fall, my 75-year-old next-door neighbor fell down the stairs that lead upward to her front door. Her left ankle shattered into tiny pieces that had to be painstakingly fitted back together during a grueling 5-hour surgery. After years of taking Prednisone every day to control a painful inflammatory condition, her doctor told her she had osteoporosis, or "thin bones." So her doctor prescribed a bone-building medicine for her, plus a daily calcium supplement.

Calcium does more than just keep our bones strong. Our muscles, nerves, and blood vessels depend on calcium to perform their jobs. Every time your heart beats, or you take a breath, your heart and chest muscles use calcium as they work, keeping you alive and healthy.

Suppose you don't get enough calcium in your diet to keep up with the demand. In that case, your body will take the calcium it needs out of your bones, like an ATM (automated teller machine).

If you run low on calcium occasionally, this only happens once in a while. But suppose your body extracts calcium out of your bones regularly. In that case, those withdrawals eventually weaken your bones, increasing your risk of a hip fracture or worse.

How much calcium do you need?

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. Unfortunately, many postmenopausal women get only 600-900mg of calcium daily through their diet. Taking a calcium supplement can make up the difference.

Calcium supplements have been recommended to ensure women and men at risk for osteoporosis get their total recommended daily dose of calcium. However, more recent studies have shown that getting TOO MUCH calcium can increase your risk of having a heart attack or stroke. In addition, it's suspected that the spike in blood levels of calcium you get by taking a concentrated calcium supplement may actually damage your blood vessels.

Taking a calcium supplement encourages the formation of painful kidney stones. So, getting ALL of your recommended daily calcium intake from a calcium supplement is no longer recommended for bone health.

Calcium carbonate is the most concentrated form of calcium supplement available, but it can cause constipation. Calcium citrate is absorbed more completely, and is a better choice if you take an acid-blocking medicine like Prilosec® for heartburn.

Weight-bearing exercises like walking, tai chi or weight training have also been shown to improve bone strength.

Here are 5 Tips on Getting Enough Calcium:

1.Get as much calcium from your diet as you can.

Most people get 300mg of calcium daily from non-dairy sources, and dairy products like milk, yogurt, and cheese supply another 300mg per serving. Green vegetables, oranges, and figs also contain calcium. Calculate your calcium intake with a calcium calculator. It’s available as a phone app for iPhone and Android phones and online at the International Osteoporosis Foundation website , at their Quick Links.

2.If you take a bone-building medicine like Fosamax® (alendronate), Actonel®(risedronate), or Boniva®, make sure you get enough calcium.

These medicines work by encouraging calcium to go back into your bones. However, if you don't have enough calcium to spare, they can’t help you.

3.Avoid taking more than 500mg of a calcium supplement at one time.

Your body absorbs calcium better when you take small amounts at a time. This will also keep your blood calcium levels from "spiking," which could increase your heart attack and stroke risk.

4.Get 400 IU of Vitamin D every day.

Vitamin D is necessary to help your body absorb calcium and can help prevent falls in the elderly. We get vitamin D from the sun. Other sources include 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).

5.Eat dried plums or prunes to build bone.

In one study, women who ate 100 grams of dried plums daily for a year had measurably stronger bones. Despite the extra calories, none of the women in the yearlong study gained weight or blood sugar elevations, most likely because of the plums high fiber content. 100 grams of dried plums equals about 9 of those plump plums sold in big bags at places like Costco®. Because plums (also known as prunes) have a natural laxative effect, you should start slowly at first to avoid experiencing diarrhea.

Dr. Louise Achey, Doctor of Pharmacy, is a 40-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog TheMedicationInsider.com. ®2021 Louise Achey