Calcium & Vitamin D

Recently, there has been a lot of medical attention vis-a-vis calcium, and to a lesser extent, Vitamin D.  Many patients are confused, hence this post.  Make no mistake – calcium and vitamin D are crucial for healthy bone.  The current recommendation is for 1000mg of elemental Calcium for women up to age 50 and 1200 mg for women above age 50.  I have been telling my patients for years that you are best off getting your calcium from diet.  Some evidence suggest that calcium supplements may be a factor slightly raising risk for heart disease and kidney stones.  In addition, this is from calcium supplements not dietary sources.  If you are consistently below 1000-1200mg per day depending on your age some supplementation would be appropriate.

Some caveats:

• You cannot absorb more than 500 mg in less than a 2 hour period.  Taking more at the same time is pointless.
• You will only get 40% of what is on the label.  For instance, a 625mg pill of calcium gluconate or oxalate or carbonate – when it dissolves will only yield about 40% (250mg in this case) of elemental calcium.
• You should not take it at the same time as an iron supplement.
•  Beware! The supplements often cause constipation.

Vitamin D is necessary for normal bone metabolism.  A recent study showed 48% of women on a medication for osteoporosis had vitamin D levels insufficient for the medication to work properly (< 30pg/ml).  Normally vitamin D comes from sunlight.  Modern society has damaged the ozone layer, so to protect our skin we use S.P.F. (Sun Protection Factor) which decreases vitamin D delivery from sun light.  I recommend 1000-2000 International Units (IUs) of vitamin D3 daily, available as a stand-alone pill wherever you get supplements.  Any brand is fine.  There may be other health benefits but final convincing research is not at a level to make other claims.  You can take too much.  If one dose is good, two is not better.  Next time you are in ask to have your vitamin D level checked, but realize if it is markedly low (<30) the treatment is a prescription strength of 50,000 IUs once per week for 12 weeks and then to recheck the blood level.

A final word about the NY Times article by Gina Kolata in June “Healthy women advised not to take calcium and vitamin D to prevent fractures”.  This was a report of the USPSTF (United States Preventative Services Task Force).  What they said was that there was “insufficient evidence” to recommend taking calcium and vitamin D, not that they were recommending not taking it.  What is this mainly based on?  In the Women’s Health Initiative (WHI) almost 37,000 women between 50 – 79 years of age took either 1000mg calcium with 400 IUs vitamin D, or a placebo.  The group with vitamin D and calcium had a 12% reduction in hip fracture but it was not statistically significant.  But in the women over 60, the group most likely to have a fracture, there was a 21% reduction and this was statistically significant and in the women who actually took their pills (medical term is “compliant”) there was a significant 30% reduction.  So judge for yourself.  In my mind there is little doubt and little confusion.

If you have any questions please feel free to contact me.

Best regards and wishing you good health,

Dr. Goldstein