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For strong bones, supplements are sometimes needed: calcium and vitamin D supplements must be tailored to your health needs.

If your doctor advises you to take calcium and vitamin D supplements, you may feel overwhelmed when you walk into the store and see the array of products available: The many brands, bottles, and price points present you with a challenging decision, but you needn't worry. "A generic drugstore supplement is fine, because there is no evidence a brand name is better. You can opt for a less expensive brand without sacrificing the benefits," says Linda Russell, MD, a rheumatologist at the Hospital for Special Surgery and an associate professor of medicine at Weill Cornell Medical College. However, understanding how much calcium and vitamin D to take may be even more challenging.

Calcium and vitamin D

You need calcium to keep your bones strong, as well as for optimum functioning of cells throughout your body. Vitamin D, among its many benefits, helps your bones absorb calcium. Your doctor can check your calcium and vitamin D levels with blood tests. A blood test also can detect the level of hormone output by your parathyroid glands, which regulate calcium levels in the blood. "If you're not getting enough calcium, your parathyroid hormone level will increase, and your parathyroid will pull calcium from your bones into your blood," says Dr. Russell.

How much do you need?

Low levels of calcium and vitamin D can contribute to osteoporosis, which increases the risk of fractures. Fighting back against low calcium and D levels is tricky; not everyone agrees exactly how much we need each day.

The National Osteoporosis Foundation recommends 1,200 milligrams (mg) of calcium per day for women ages 51 and older. But, studies have shown that getting too much calcium from supplements may increase the risk of heart disease, stroke, and kidney stones. "The literature on that is controversial, but we don't recommend calcium supplements as much as we used to," says Dr. Russell. "When we do recommend calcium, we suggest it comes from your diet. Take a low-dose supplement only to make up what your diet isn't providing."

Vitamin D recommendations also vary. The Institute of Medicine recommends a daily intake of 600 international units (IU) until the age of 70, and then 800 IU after age 70. Meanwhile, the National Osteoporosis Foundation recommends 1,000 IU daily for people 50 and older. "However, if I have a patient with severe osteoporosis and multiple fractures, I do recommend more vitamin D--between 1,000 and 2,000 IU per day," says Dr. Russell.

Types of supplements

Dr. Russell recommends vitamin D3, rather than vitamin D2, supplements. Dr. Russell says she's most likely to recommend supplements to patients with osteoporosis or with conditions that may interfere with calcium and vitamin D absorption, such as Crohn's disease and ulcerative colitis, as well as those taking glucocorticoids (prednisone, prednisolone, hydrocortisone) or aromatase inhibitors (letrozole, anastrozole, exemestane).

The type of calcium Dr. Russell recommends is calcium citrate. "It's better absorbed than calcium carbonate, and you can take it with or without food. Calcium carbonate must be taken with food for it to work properly, and it may increase the risk of kidney stones," she says.

Other supplements: The jury is still out

Are calcium and vitamin D the only supplements that can boost bone health? "There's a small amount of data that vitamin K might be beneficial for bone, but not enough to recommend it," says Dr. Russell.

Strontium, a trace element, is widely used in Europe as a prescription medication for bone health. "The Europeans use strontium ranelate (Protelos), which is not approved here. In the U.S., you can find strontium citrate supplements, but strontium hasn't been studied well. And, while strontium ranelate raises bone density, it doesn't reduce the risk of fractures," says Dr. Russell.

Instead, Dr. Russell urges you to talk to your doctor about how much calcium and vitamin D you need. She also advises bone-boosting lifestyle choices, such as getting plenty of weight-bearing exercise and consuming adequate calcium.


* Eat foods rich in calcium, such as low-fat dairy products and dark, leafy greens.

* Get vitamin D from salmon, swordfish, trout, and whole eggs.

* Do weight-bearing exercise, such as walking or strength training.


When choosing supplements, select those that are verified by the U.S. Pharmacopeia ("USP verified"). There's no guarantee that supplements contain what the packaging says they do; testing has revealed that many supplements contain less or more of the active ingredient than is stated on the label, and they sometimes contain potentially harmful substances. Those that have been USP-verified have undergone testing for ingredient identity, strength, quality, and purity. For a list of USP-verified products and brands, visit the USP website at
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Title Annotation:PREVENTION
Publication:Women's Health Advisor
Date:Oct 1, 2015
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