William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Catherine Burt Driver, MD
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
In this Article
- Osteoporosis facts
- What is osteoporosis?
- What are osteoporosis symptoms and signs?
- What are the consequences of osteoporosis?
- Why is osteoporosis an important public-health issue?
- What factors determine bone strength?
- What are osteoporosis risk factors and causes?
- How is osteoporosis diagnosed?
- Who should have bone density testing?
- What is the treatment for osteoporosis, and can osteoporosis be prevented?
- Exercise, quitting cigarettes, and curtailing alcohol
- Calcium supplements
- Vitamin D
- Hormone therapy (menopausal hormone therapy)
- Medications that prevent bone loss and breakdown
- Choosing an osteoporosis medication
- Prevention of osteoporosis due to long-term corticosteroids
- Monitoring osteoporosis therapy
- Prevention of hip fractures in elderly people with osteoporosis
- What are complications of osteoporosis?
- What is the prognosis (outlook) for patients with osteoporosis?
- Osteoporosis FAQs
- Find a local Internist in your town
Building strong and healthy bones requires an adequate dietary intake of calcium 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 medications for osteoporosis. In the first several years after menopause, rapid bone loss may 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 1-10 years of age
- 1,000 mg/day for men, premenopausal women, and postmenopausal women also taking estrogen
- 1,200 mg/day for teenagers and young adults 11-24 years of age
- 1,500 mg/day for postmenopausal women not taking estrogen
- 1,200 mg-1,500 mg/day for pregnant and nursing mothers
- The total daily intake of calcium should not exceed 2,000 mg.
Daily calcium intake can be calculated by the following method:
- Excluding dairy products, the average American diet contains approximately 250 mg of calcium.
- There is approximately 300 mg of calcium in an 8-ounce glass of milk.
- There is approximately 450 mg of calcium in 8 ounces of plain yogurt.
- There is approximately 130 mg of calcium in 1 cup of cottage cheese.
- There is approximately 200 mg of calcium in 1 ounce of cheddar cheese.
- There is approximately 90 mg of calcium in ½ cup of vanilla ice cream.
- There is approximately 300 mg of calcium in 8 ounces of calcium-fortified orange juice.
Unfortunately, surveys have shown that the average woman in the U.S. is consuming less than 500 mg 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 1,250 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 1,000 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 since the intestines may not be able to reliably absorb more than 500 mg of calcium all at once. Therefore, the best way to take 1,000 mg of a calcium supplement is to divide it into two doses. Likewise, a dosage of 1,500 mg should be split 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 is available. Certain medications can interfere with the absorption of calcium carbonate. Examples of such medications include proton-pump inhibitors such as omeprazole (Prilosec), lansoprazole (Prevacid), lansoprazole (Protonix), and rabeprazole (Aciphex), which are used in treating gastroesophageal reflux disease (GERD) or peptic ulcers. When these medications are being taken, 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.
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