Osteoporosis (cont.)
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:
- 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 1300 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 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.
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