From the Guidelines
For osteopenia, I recommend taking 1000-1200 mg of calcium daily through a combination of diet and supplements, along with 800-1000 IU of vitamin D daily. This recommendation is based on the most recent and highest quality study available, which suggests that calcium supplements can reduce the risk of total fracture and vertebral fracture, although the evidence is not as strong for hip or forearm fracture 1. It's essential to note that calcium citrate is often better absorbed than calcium carbonate, especially for older adults or those taking acid-reducing medications.
When taking calcium supplements, it's crucial to take them in divided doses of no more than 500-600 mg at once for optimal absorption. Common options for supplements include calcium citrate (Citracal) or calcium carbonate (Caltrate, Os-Cal), which should be taken with food if using calcium carbonate. In addition to supplements, incorporating calcium-rich foods like dairy products, fortified plant milks, leafy greens, and canned fish with bones into your diet is vital.
Weight-bearing exercise for 30 minutes most days of the week is also essential for bone health, as it helps to strengthen bones and improve overall health. Calcium works with vitamin D to strengthen bones by providing the mineral component of bone tissue, while vitamin D helps your body absorb and utilize calcium effectively. If you have kidney disease or a history of kidney stones, it's crucial to consult your healthcare provider before starting supplements, as excessive calcium can potentially cause issues in some individuals.
Some studies suggest that high-dose vitamin D supplementation (≥ 800 IU/d) can reduce the risk of hip fracture and any nonvertebral fracture in persons age 65 years or older 1. However, it's essential to consider the potential risks and benefits of calcium supplementation, as some studies have reported a small but statistically significant increase in the risk for myocardial infarction 1.
In terms of specific patient populations, such as those with cancer, it's essential to consider the unique needs and risks of these individuals. For example, a review of calcium and vitamin D supplementation in men with prostate cancer undergoing ADT found that the doses commonly recommended are inadequate to prevent the loss of BMD 1. Therefore, it's crucial to consult with a healthcare provider to determine the best course of treatment for individual patients.
Key points to consider when recommending calcium supplements for osteopenia include:
- Taking 1000-1200 mg of calcium daily through a combination of diet and supplements
- Taking 800-1000 IU of vitamin D daily
- Using calcium citrate or calcium carbonate supplements
- Taking supplements in divided doses for optimal absorption
- Incorporating calcium-rich foods into your diet
- Engaging in weight-bearing exercise for 30 minutes most days of the week
- Consulting with a healthcare provider before starting supplements, especially if you have kidney disease or a history of kidney stones.
From the Research
Calcium Supplementation for Osteopenia
- Calcium supplementation can help meet the adequate intake requirements for calcium, which is beneficial for bone health in individuals with osteopenia 2.
- Calcium from carbonate and citrate are the most common forms of calcium supplements, with calcium carbonate being the most cost-effective form 2.
- The maximum dose of elemental calcium that should be taken at a time is 500 mg, and U.S. Pharmacopeia-verified calcium supplements meet vigorous manufacturing and quality requirements 2.
Combination Therapy with Calcium and Vitamin D
- Osteoporotic patients with insufficient calcium intake and/or vitamin D insufficiency need adequate calcium and vitamin D supplementation with their bisphosphonate treatment 3.
- A fixed-combination pack of bisphosphonate, calcium, and vitamin D can help patients take the combination therapy correctly and regularly, enhancing adherence to recommended osteoporosis therapy 3.
Bisphosphonates for Osteoporosis
- Bisphosphonates reduce the risk of fracture by suppressing bone resorption and increasing bone strength, and are widely used for the prevention and treatment of osteoporosis 4.
- Bisphosphonates are beneficial in reducing the risk of vertebral fractures, and may also be beneficial in preventing and treating corticosteroid-induced bone loss at both the lumbar spine and femoral neck 5.
Additional Supplements for Skeletal Health
- Vitamin K2 and magnesium may contribute to the maintenance of skeletal health, with vitamin K2 supplementation potentially improving bone quality and reducing fracture risk in osteoporotic patients 6.
- Magnesium deficiency could negatively influence bone and muscle health, but data regarding the efficacy of magnesium supplementation on bone are inconclusive 6.