Best Food Sources for Vitamin D and Calcium
For individuals at risk of osteoporosis, prioritize fatty fish for vitamin D and dairy products for calcium, aiming for 1,000-1,200 mg calcium and 800-1,000 IU vitamin D daily through diet first, with supplementation only to reach these targets. 1
Vitamin D Food Sources
Fatty fish represents the primary dietary source of vitamin D (ergocalciferol/vitamin D2). 2 This includes:
- Salmon, mackerel, sardines, and other oily fish 2
- Fish with edible bones (like canned sardines) provide both vitamin D and calcium 3
Fortified foods serve as important secondary sources:
Critical Caveat on Vitamin D from Diet Alone
Dietary sources alone are typically insufficient to meet vitamin D requirements, particularly in adults over 65 years. 2 While sun exposure can provide vitamin D3 (cholecalciferol) through skin synthesis, concerns about skin cancer limit this approach. 2, 3 Most individuals over 65 require supplementation of 800-1,000 IU daily to achieve optimal serum levels of 30 ng/mL (75 nmol/L). 1, 4
Calcium Food Sources
Dairy products are the most valuable calcium sources, providing both high-quality protein and calcium in optimal ratios. 5
Primary Calcium Sources:
- Milk - preferred low-fat varieties 6
- Yogurt - particularly fermented dairy products, which are associated with lower hip fracture risk 5
- Cheese 3
Secondary Calcium Sources:
- Fish with edible bones (sardines, canned salmon) 3
- Calcium-fortified foods (fortified plant milks, fortified orange juice) 6
- Select vegetables and fruits - though these provide smaller amounts 3
Evidence-Based Dietary Targets
Adults should consume 1,000-1,200 mg calcium daily, with higher needs (1,200 mg) for those 71+ years. 1 The SENECA study revealed that one-third of elderly Europeans consume dangerously low calcium (300-700 mg/day), highlighting the need for dietary assessment. 3
For vitamin D, adults 65+ require 800-1,000 IU daily, achievable only through combined dietary sources and supplementation. 1, 3
Dietary Patterns That Reduce Fracture Risk
Beyond individual nutrients, specific dietary patterns demonstrate fracture prevention benefits: 5
- At least 5 servings daily of fruits and vegetables 5
- Regular consumption of fermented dairy products (yogurt, kefir) 5
- Adherence to Mediterranean diet patterns 5
- Regular tea drinking 5
- Adequate protein intake - higher dietary protein with sufficient calcium is associated with lower fracture risk 5
Important Note on Vegan Diets
Vegan diets are associated with increased fracture risk, likely due to inadequate calcium and vitamin D intake without careful planning. 5
Practical Implementation Strategy
Calculate dietary calcium intake first before adding supplements. 2, 1 This prevents exceeding the safe upper limit of 2,000-2,500 mg daily. 1
Optimize calcium absorption by:
- Dividing calcium intake throughout the day, consuming no more than 500-600 mg per dose 1, 6
- Spreading calcium-rich foods across all meals 6
- For those on proton pump inhibitors or with reduced gastric acid, calcium citrate from supplements is preferred over calcium carbonate 1
When Dietary Sources Are Insufficient
Supplementation should complement, not replace, dietary sources. 3, 6 Dietary calcium is preferred because:
- It carries lower kidney stone risk compared to supplements 1
- High-calcium foods contain other essential nutrients for bone health 6
- Food sources provide calcium in a more physiologically balanced form 6
However, supplementation becomes necessary when:
- Dietary assessment reveals intake below 1,000-1,200 mg daily 1
- Vitamin D insufficiency is documented (serum 25(OH)D below 30 ng/mL) 1, 4
- Patient is on glucocorticoids ≥2.5 mg/day for >3 months 1
- Documented osteoporosis exists 1
Essential Complementary Measures
Nutrition alone is insufficient for fracture prevention. Combine dietary optimization with: