Osteoporosis

In this Article

• What is osteoporosis?
• What are the symptoms of osteoporosis?
• What are the consequences of osteoporosis?
• Why is osteoporosis an important public health issue?
• What factors determine bone strength?
• What are risk factors for developing and causes of osteoporosis?
• How is osteoporosis diagnosed?
• Who should have bone density testing?
• How is osteoporosis treated and prevented?
• Exercise, quitting cigarettes, and curtailing alcohol
• Calcium supplements
• Vitamin D
• Hormone therapy (hormone replacement therapy, menopausal replacement therapy)
• Medications that prevent bone loss and breakdown
• Choosing an osteoporosis medication
• Prevention of osteoporosis caused by long term corticosteroids
• Monitoring osteoporosis therapy medication
• Prevention of hip fractures in elderly persons with osteoporosis
• Osteoporosis At A Glance
• Patient Discussions: Osteoporosis - Symptoms at Onset of Disease

Calcium Supplements

Building strong and healthy bones requires an adequate dietary intake of calcium and exercise beginning in childhood and adolescence for both sexes. Most importantly, however, a high dietary calcium intake or taking calcium supplements alone is not sufficient in treating osteoporosis, and should not be viewed as an alternative to or substituted for more potent prescription osteoporosis medications. In the first several years after menopause, rapid bone loss can occur even if calcium supplements are taken.

The following calcium intake has been recommended by The National Institutes of Health Consensus Conference on Osteoporosis for all people, with or without osteoporosis:

• 800 mg/day for children ages 1 to 10
   
• 1000 mg/day for men, premenopausal women, and postmenopausal women also taking estrogen
   
• 1200 mg/day for teenagers and young adults ages 11 to 24
   
• 1500 mg/day for post menopausal women not taking estrogen
   
• 1200mg to 1500 mg/day for pregnant and nursing mothers
   
• The total daily intake of calcium should not exceed 2000 mg

Daily calcium intake can be calculated by the following method:

1. Excluding dairy products, the average American diet contains approximately 250 mg of calcium;


2. There is approximately 300 mg of calcium in an 8-ounce glass of milk;


3. There is approximately 450 mg of calcium in 8 ounces of plain yogurt;


4. There is approximately 1300 mg of calcium in 1 cup of cottage cheese;


5. There is approximately 200 mg of calcium in 1 ounce of cheddar cheese;


6. There is approximately 90 mg of calcium in ½ cup of vanilla ice cream;


7. There is approximately 300 mg of calcium in 8 ounces of calcium-fortified orange juice.

Unfortunately, surveys have shown that average women in the United States are consuming less than 500 milligrams of calcium per day in their diet, less than the recommended amounts. Additional calcium can be obtained by drinking more milk and eating more yogurt or cottage cheese, or by taking calcium supplement tablets as well from calcium-fortified foods, such as orange juice.

The various calcium supplements contain different amounts of elemental calcium (the actual amount of calcium in the supplement). For example, Caltrate, Os-Cal and Tums are calcium carbonate salts. Each 1250 mg of calcium carbonate salt tablet (such as Caltrate 600 mg, Os-Cal 500 mg, or Tums 500 mg extra strength) contains 500 mg of elemental calcium. A person who needs 1000 mg/day of calcium supplement can take one tablet of Tums 500 mg extra strength (containing 500 mg of elemental calcium) twice daily with meals.

The calcium carbonate supplements are best taken in small divided doses with meals. The intestines may not be able to reliably absorb more than 500 mg of calcium all at once. Therefore, the best way to take 1000 mg of a calcium supplement is to divide it in two doses. Likewise, a dosage of 1500 mg should be divided into three doses.

Calcium supplements are safe and generally well tolerated. Side effects are indigestion and constipation. If constipation and indigestion occur with calcium carbonate supplements, calcium citrate (Citracal) can be used. Some patients have difficulty swallowing calcium tablets. In this situation, chewable candy-like calcium in the form of Viactiv brand is available. Certain medications can interfere with the absorption of calcium carbonate. Examples of such medications include proton-pump inhibitors [omeprazole (Prilosec), lansoprazole (Prevacid), lansoprazole (Protonix), and rabeprazole (Aciphex)], which are used in treating GERD (acid reflux) or peptic ulcers. In these cases, calcium citrate is preferred.

Many "natural" calcium carbonate preparations, such as oyster shells or bone meal, may contain high levels of lead or other harmful elements and should be avoided.

Osteoporosis - Symptoms at Onset of Disease

The MedicineNet physician editors ask:

The symptoms of osteoporosis can vary greatly from patient to patient. What were your symptoms at the onset of your disease?

Comment submissions for this question have ended.
See 22 Viewer Comments

View Comments

Links will open in a new window on MedicineNet.com