Issue of March 10, 2019
Mt. Province

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Calcium and vitamin D supplements in postmenopausal women

Postmenopausal women with osteoporosis need a total of 1,200-milligram (mg) calcium (from diet and supplements) and 800 international units (IU) of vitamin D per day. Among premenopausal women with osteoporosis, 1,000 mg calcium (diet plus supplements) and 600 IU of vitamin D per day are recommended.

It is recommended that at least half of the daily requirements come from dietary sources. Milk, yogurt, cheese, and other dairy products have the highest content of calcium per serving. Other sources are orange juice and tofu fortified with calcium, soy milk (300 mg calcium), cooked beans (1/2 cup contains 80 grams calcium), dark leafy vegetables, (1/2 cup cooked, may contain up to 135 grams), whole almonds, and oranges.

If dietary intake is not enough, calcium and vitamin D supplements are recommended. Calcium carbonate and calcium citrate are widely recommended. Calcium carbonate with meals is sufficient. If a person is on medications that reduce acid production in the stomach (proton pump inhibitors like pantoprazole, omeprazole, or H2 blockers like ranitidine) calcium citrate is recommended. It is recommended that the total daily calcium supplementation should not be more that 2,000 grams per day. There are controversies on the possible effects of excess calcium supplementation on heart disease and blood vessels especially when supplements are taken in large doses. A safe recommendation is to take supplements not more than 500 mg elemental calcium per dose, and to try to get calcium more from dietary intake than from supplements.

For vitamin D supplementation, cholecalciferol and not ergocalciferol is recommended. Supplementation should not be more that 4,000 IU per day.

Osteoporosis leads to increased risk for fractures and disability. Prevention or treatment starts with sufficient dietary intake. Other lifestyle measures like exercise, cessation of smoking, avoidance of alcohol intake are also advised. Postmenopausal women with established osteoporosis or history of fragility fracture are candidates for treatment with drugs like biphosphonates (alendronate or risedronate) under medical supervision.

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