Young People Get Osteoporosis Too 

How do I choose a calcium supplement?

• A USP (United States Pharmacopeia) symbol means that the calcium supplement is pure from lead and other metals. The application for the USP symbol is voluntary so many acceptable products do not display this symbol. According to a recent laboratory analysis, calcium supplements, in the dosage prescribed for prevention and treatment of osteoporosis, contain much less than the safe level of lead. A further safeguard is that lead in calcium supplements will not be well absorbed because calcium blocks lead absorption.
   
• Calcium must dissolve in your stomach before it can be absorbed in your intestines and then used by your body. A USP symbol on the label of a calcium supplement means that is it will dissolve in your stomach. If your supplement does not have a USP symbol, you can easily test it to find out if it will dissolve. Simply put the supplement into a glass of clear vinegar. This creates an acidic environment much like that of your stomach. Stir the solution occasionally. If the calcium supplement disintegrates within 30 minutes, it should dissolve in your stomach, too. If the supplement does not completely dissolve, choose an alternative calcium supplement. Be sure to discard the calcium/vinegar solution after the test.
   
• If you are taking acid blockers for indigestion, reflux or other gastrointestinal conditions, your body may use calcium citrate better than other calcium compounds. Acid blockers reduce the acid in your gastrointestinal tract that is usually required for calcium absorption. However, unlike other calcium compounds, calcium citrate does not require an acid environment for calcium absorption.
   
• Read the supplement label to find out the calcium content in milligrams (mg) per serving. The label may refer to the calcium as elemental calcium. This distinguishes the weight (mg) of calcium alone from the weight (mg) of the calcium compound (such as calcium carbonate, calcium citrate, calcium phosphate, or others). It is also important for you to check the serving size to find out how many tablets or capsules provide a specific amount of calcium.
   
• Although vitamin D is readily available in combination with calcium supplements, supplemental vitamin D should only be taken when your daily requirement for vitamin D is not met. If you are over 70 or a homebound individual, you should discuss your risk of vitamin D deficiency with your doctor. For more information, see "Vitamin D and Bone Health".
   
• Magnesium supplements are not required for most healthy individuals. Magnesium is plentiful in a healthy, well-balanced diet. However, certain individuals may be at risk for magnesium deficiency including those with gastrointestinal diseases that cause poor absorption or increased losses of magnesium, frail elderly individuals eating poor diets, alcoholics, individuals receiving chemotherapy and those taking high dose diuretics (water pills) that deplete magnesium. Magnesium deficiency is easily diagnosed by a simple blood test. Your medical professional will prescribe a magnesium supplement if it is necessary or if you have a disease or condition that causes magnesium deficiency.
   
• A well-balanced diet following the food-pyramid approach to good nutrition including adequate calcium and vitamin D is what you need to achieve and maintain healthy bones. For most healthy individuals, additional vitamins or minerals (such as magnesium, boron, vitamin K, selenium or others) in the form of supplements are not required for bone health. In fact, many of these nutrients will be present in a diet with five or more servings of fruits and vegetables a day.

How do I take my calcium supplement?

• It is important to read supplement labels and follow the directions for use.
   
• When your calcium supplement is well absorbed, your body can easily use it. For best absorption, most calcium supplements should be taken with food. Calcium citrate is an exception; it can be taken with or without food.
   
• It is best to spread out the calcium you consume from diet and/or supplements throughout the day. In fact, for best absorption, it is recommended to consume 500mg of calcium or less at one time.

Are there any special considerations?

• If your medical professional recommends an iron supplement and you are also taking a calcium supplement, it is important that your body absorbs both nutrients. For the best absorption of both iron and calcium, it is recommended to take your calcium supplement 2 hours before or after your iron supplement. You should not take them at the same time.
   
• Calcium interferes with the body's ability to use certain antibiotics, tetracycline for example. If your doctor prescribes tetracycline, it is important for you to take it properly. Therefore, you should not take calcium supplements (or eat calcium-rich foods) at the same time as tetracycline. Your antibiotic will work best if you take your calcium supplement (or eat calcium-rich foods) 2 hours before or after taking tetracycline. It is always important to speak to your pharmacist about the proper way to take your medication.
   
• Some people who take calcium supplements complain about constipation. The best way to prevent constipation, is to eat more fiber in your diet from fruits, vegetables, and whole grain products as well as to drink 6 to 8 glasses of water each day. If these simple steps are not helpful enough, take a closer look at your diet to try to get more calcium from foods and less from supplements. Read the label for the amount of calcium in each dose. A lower dose calcium supplement may be better tolerated than a high dose supplement. In general, calcium carbonate has the highest amount of calcium per dose. Calcium citrate has less calcium per dose and calcium gluconate is one of the lowest dose options.