The following groups are among those most likely to need extra calcium.
Postmenopausal women
Menopause leads to bone loss because decreases in estrogen production reduce calcium absorption and increase urinary calcium loss and calcium resorption from bone [1]. On average, women lose approximately 1% of their bone mineral density (BMD) per year after menopause [25]. Over time, these changes lead to decreased bone mass and fragile bones [1]. About 30% of postmenopausal women in the United States and Europe have osteoporosis, and at least 40% of those with this condition develop at least one fragility fracture (a fracture that occurs after minor trauma, such as a fall from standing height or lower) [26].
Individuals who avoid dairy products
People with lactose intolerance, those with an allergy to milk, and those who avoid eating dairy products (including vegans) have a higher risk of inadequate calcium intakes because dairy products are rich sources of calcium [1,27]. Options for increasing calcium intakes in individuals with lactose intolerance include consuming lactose-free or reduced-lactose dairy products, which contain the same amounts of calcium as regular dairy products [1,3]. Those who avoid dairy products because of allergies or for other reasons can obtain calcium from nondairy sources, such as some vegetables (e.g., kale, broccoli, and Chinese cabbage [bok choi]), canned fish with bones, or fortified foods (e.g., fruit juices, breakfast cereals, and tofu) [1]. However, these individuals typically need to eat foods fortified with calcium or take supplements to obtain recommended amounts [28].
References:
Almost all (98%) calcium in the body is stored in the bones, and the body uses the bones as a reservoir for, and source of, calcium to maintain calcium homeostasis [1]. More than 99% of calcium in the body is in the form of calcium hydroxyapatite, an inorganic matrix of calcium and phosphate that is stored in the bones and teeth [1,4,5]. Unlike teeth, bone undergoes continuous remodeling, with constant resorption and deposition of calcium into new bone [4]. Bone remodeling is required to change bone size during growth, repair damage, maintain serum calcium levels, and provide a source of other minerals [4].
A lack of calcium may play a role in the following health conditions and diseases: bone health in older adults, cancer, cardiovascular disease (CVD), preeclampsia, weight management, and metabolic syndrome.
References:
Key sources of calcium include:
Calcium has the potential to interact with certain medications, and several types of medications might adversely affect calcium levels. A few examples are provided below. Individuals taking these and other medications on a regular basis should discuss their calcium status with their health care providers.
Dolutegravir
Dolutegravir (Dovato, Tivicay) is an HIV integrase inhibitor used in adults and children. Concomitant use of calcium supplements and dolutegravir can reduce blood levels of dolutegravir substantially, apparently through chelation [1,2]. The labels approved by the FDA for dolutegravir advise patients to take dolutegravir 2 hours before or 6 hours after taking calcium supplements [3,4].
Levothyroxine
Calcium carbonate supplements can interfere with the absorption of levothyroxine (Synthroid, Levoxyl, and others), a thyroid hormone used to treat hypothyroidism and thyroid cancer [5-7]. The FDA-approved label for this medication instructs patients taking calcium carbonate supplements to avoid taking levothyroxine within 4 hours of taking the supplement [8].
Lithium
Long-term use of lithium (Eskalith, Lithobid), a treatment for bipolar disorder, can lead to hypercalcemia, and use of both lithium and calcium supplements could increase this risk [9].
Quinolone antibiotics
Simultaneous use of calcium supplements and quinolone antibiotics—such as ciprofloxacin (Cipro), gemifloxacin (Factive), and moxifloxacin (Avelox)—can reduce the absorption of quinolones [10-11]. Taking the antibiotic 2 hours before or 2 hours after calcium supplements prevents this effect [8]].
References:
Always read the label. Follow the directions for use. If symptoms persist, consult your healthcare professional. Vitamin supplements should not replace a balanced diet. If you have any pre-existing conditions, or are on any medications always talk to your health professional before use. Store your daily packs below 25°C in a cool, dry place, away from humidity and direct sunlight.