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Calcium


What is it?

Calcium is a mineral that is an essential part of bones and teeth. The heart, nerves, and blood-clotting systems also need calcium to work.

Calcium is used for treatment and prevention of low calcium levels and resulting bone conditions including osteoporosis (weak bones due to low bone density), rickets (a condition in children involving softening of the bones), and osteomalacia (a softening of bones involving pain). Calcium is also used for premenstrual syndrome (PMS), leg cramps in pregnancy, high blood pressure in pregnancy (pre-eclampsia), and reducing the risk of colon and rectal cancers.

Some people use calcium for complications after intestinal bypass surgery, high blood pressure, high cholesterol, Lyme disease, to reduce high fluoride levels in children, and to reduce high lead levels.

Calcium carbonate is used as an antacid for “heartburn.” Calcium carbonate and calcium acetate are also used for reducing phosphate levels in people with kidney disease.

Calcium-rich foods include milk and dairy products, kale and broccoli, as well as the calcium-enriched citrus juices, mineral water, canned fish with bones, and soy products processed with calcium.

Calcium can interact with many prescription medications, but sometimes the effects can be minimized by taking calcium at a different time. See the section titled “Are there any interactions with medications?"

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for CALCIUM are as follows:

Effective for...

  • Raising calcium levels in people who have low calcium.
  • Preventing low calcium levels.
  • Reversing high potassium levels, when given intravenously (by IV).
  • Use as an antacid as calcium carbonate.
  • Reducing phosphate levels in people with kidney disease.

Likely effective for...

  • Treating osteoporosis (weak bones). Taking calcium by mouth is effective for preventing and treating bone loss and osteoporosis. Most bone growth occurs in the teenage years, and then bone strength in women remains about the same until age 30-40. After age 40, bone loss typically occurs at rates of 0.5% to 1% per year. In men, this occurs several decades later. There is more bone loss if less than the recommended amount of calcium is obtained from the diet. This is very common among Americans. Bone loss in women over 40 can be reduced by taking calcium supplements. Some researchers estimate that taking calcium for 30 years after menopause might result in a 10% improvement in bone strength, and a 50% overall reduction in bone break rates.
  • Preventing bone loss caused by insufficient calcium in the diet. This can reduce the risk of breaking bones.
  • Reducing symptoms of premenstrual syndrome (PMS). There seems to be a link between low dietary calcium intake and symptoms of PMS. Consuming calcium daily seems to significantly reduce mood swings, bloating, food cravings, and pain. Also, increasing calcium intake from food seems to prevent PMS. Women consuming an average of 1283 mg/day of calcium from foods seem to have about a 30% lower risk of developing PMS than women who consume an average of 529 mg/day of calcium. Taking calcium supplements, however, doesn’t seem to prevent PMS.
  • Increasing fetal bone density in pregnant women with low calcium intake.
  • Reducing bone loss in people taking drugs called corticosteroids, when used in combination with vitamin D.
  • Reducing thyroid hormone levels in people with kidney failure.

Possibly effective for...

  • Reducing the risk of colorectal cancer. Research suggests that high intake of dietary or supplemental calcium seems to reduce the risk of colorectal cancer. Research also shows that taking calcium supplements might help to keep colorectal cancer from returning.
  • High blood pressure. Taking calcium supplements seems to reduce blood pressure slightly (usually around 1-2 mmHg) in people with or without high blood pressure. Calcium seems to be more effective in salt-sensitive people and people who normally get very little calcium. Taking calcium by mouth also seems to be helpful for reducing blood pressure in people with serious kidney disease.
  • High blood pressure in pregnancy (pre-eclampsia). Taking 1-2 grams of calcium by mouth each day seems to reduce pregnancy-related high blood pressure. Calcium appears to reduce the risk of high blood pressure in pregnancy by about 50%. Calcium appears to have the greatest effect in high-risk women and women with low calcium levels.
  • High cholesterol. Taking calcium supplements along with a low-fat or low-calorie diet might modestly reduce cholesterol. Taking calcium alone, without the restricted diet, doesn’t seem to lower cholesterol.
  • Reducing weight and body fat while dieting. Adults and children with low calcium intake are more likely to gain weight, have a higher body mass index (BMI), and be overweight or obese compared to people with high calcium intake. So researchers have studied whether increasing calcium intake might help with weight loss. Some clinical research shows that increasing calcium consumption from dairy products such as yogurt seems to increase weight loss, lean body mass, and body fat loss in people on a low-calorie diet as well as people on a regular unrestricted-calorie diet.
  • Preventing stroke in women.
  • Preventing fluoride poisoning in children when taken with vitamins C and D.
  • Reducing tooth loss in elderly people.

Possibly ineffective for...

  • Preventing breast cancer in older (postmenopausal) women.
  • Reducing lead levels in breast-feeding women.

Insufficient evidence to rate effectiveness for...

  • Preventing falls. Evidence suggests that calcium plus vitamin D might help prevent falls by decreasing body sway and helping to keep blood pressure normal. Calcium alone doesn’t seem to have the same benefit. Interestingly, calcium plus vitamin D seems to prevent falls in women, but not in men.
  • Metabolic syndrome. Some evidence suggests that getting more calcium from diet and supplements, either alone or in combination with vitamin D, might lower the risk of developing metabolic syndrome.
  • Cancer. Research shows that healthy older women who take 1400-1500 mg/day of calcium plus 1100 IU/day of vitamin D3 (cholecalciferol) have a 60% lower risk for developing cancer of any type.
  • Pregnancy-related leg cramps. Limited evidence shows that calcium can help prevent leg cramps in the second half of pregnancy.
  • Diabetes. Some evidence suggests that getting more calcium from diet and supplements, either alone or in combination with vitamin D, might lower the risk of developing type 2 diabetes.
  • Lyme disease.
  • Seizures.
  • Other conditions.
More evidence is needed to rate the effectiveness of calcium for these uses.

How does it work?

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The bones and teeth contain over 99% of the calcium in the human body. Calcium is also found in the blood, muscles, and other tissue. Calcium in the bones can be used as a reserve that can be released into the body as needed. The concentration of calcium in the body tends to decline as we age because it is released from the body through sweat, skin cells, and waste. In addition, as women age, absorption of calcium tends to decline due to reduced estrogen levels. Calcium absorption can vary depending on race, gender, and age.

Bones are always breaking down and rebuilding, and calcium is needed for this process. Taking extra calcium helps the bones rebuild properly and stay strong.

Are there safety concerns?

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Calcium is LIKELY SAFE for most people when taken appropriately in recommended doses. Calcium can cause some minor side effects such as belching or gas.

Avoid taking too much calcium. The Institute of Medicine sets the daily tolerable upper intake level (UL) for calcium based on age as follows: Age 0-6 months, 1000 mg; 6-12 months, 1500 mg; 1-3 years, 2500 mg; 9-18 years, 3000 mg; 19-50 years, 2500 mg; 51+ years, 2000 mg. Higher doses increase the chance of having serious side effects. Some recent research also suggests that doses over the recommended daily requirement of 1000-1300 mg daily for most adults might increase the chance of heart attack. This research is concerning, but it is still too soon to say for certain that calcium is truly the cause of heart attack. Until more is known, continue consuming adequate amounts of calcium to meet daily requirements, but not excessive amounts of calcium. Be sure to consider total calcium intake from both dietary and supplemental sources and try not to exceed 1000-1300 mg of calcium per day. To figure out dietary calcium, count 300 mg/day from non-dairy foods plus 300 mg/cup of milk or fortified orange juice.

Special precautions & warnings:

Pregnancy and breast-feeding: Calcium is LIKELY SAFE when used in recommended amounts during pregnancy and breast-feeding.

High levels of phosphate in the blood (hyperphosphatemia) or low levels of phosphate in the blood (hypophosphatemia): Calcium and phosphate have to be in balance in the body. Taking too much calcium can throw this balance off and cause harm. Don’t take extra calcium without your health provider’s supervision.

Under-active thyroid (hypothyroidism): Calcium can interfere with thyroid hormone replacement treatment. Separate calcium and thyroid medications by at least 4 hours.

Too much calcium in the blood (as in parathyroid gland disorders and sarcoidosis): Calcium should be avoided if you have one of these conditions.

Are there interactions with medications?

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Major

Do not take this combination.

Ceftriaxone (Rocephin)
Administering intravenous ceftriaxone (Rocephin) and calcium can result in life-threatening damage to the lungs and kidneys. Calcium should not be administered intravenously within 48 hours of intravenous ceftriaxone (Rocephin).

Moderate

Be cautious with this combination.

Antibiotics (Quinolone antibiotics)
Calcium might decrease how much antibiotic your body absorbs. Taking calcium along with some antibiotics known as "quinolones" might decrease their effectiveness. To avoid this interaction, take these drugs at least 2 hours before, or 4 to 6 hours after calcium supplements.

Some quinolone antibiotics that might interact with calcium include ciprofloxacin (Cipro), levofloxacin (Levaquin), ofloxacin (Floxin), moxifloxacin (Avelox), gatifloxacin (Tequin), gemifloxacin (Factive), and others.

Antibiotics (Tetracycline antibiotics)
Calcium can attach to some antibiotics called tetracyclines in the stomach. This decreases the amount of tetracyclines that can be absorbed. Taking calcium with tetracyclines might decrease the effectiveness of tetracyclines. To avoid this interaction, take calcium at least 2 hours before or 4 to 6 hours after taking tetracyclines.

Some tetracyclines include demeclocycline (Declomycin), minocycline (Minocin), and tetracycline (Achromycin, and others).

Bisphosphonates
Calcium can decrease how much bisphosphate your body absorbs. Taking calcium along with bisphosphates can decrease the effectiveness of bisphosphate. To avoid this interaction, take bisphosphonate at least 30 minutes before calcium or, preferably, at a different time of day.

Some bisphosphonates include alendronate (Fosamax), etidronate (Didronel), ibandronate (Boniva), risedronate (Actonel), tiludronate (Skelid), and others.

Calcipotriene (Dovonex)
Calcipotriene (Dovonex) is a drug that is similar to vitamin D. Vitamin D helps your body absorb calcium. Taking calcium supplements along with calcipotriene (Dovonex) might cause the body to have too much calcium.

Digoxin (Lanoxin)
Calcium can affect your heart. Digoxin (Lanoxin) is used to help your heart beat stronger. Taking calcium along with digoxin (Lanoxin) might increase the effects of digoxin (Lanoxin) and lead to an irregular heartbeat. If you are taking digoxin (Lanoxin), talk to your doctor before taking calcium supplements.

Diltiazem (Cardizem, Dilacor, Tiazac)
Calcium can affect your heart. Diltiazem (Cardizem, Dilacor, Tiazac) can also affect your heart. Taking large amounts of calcium along with diltiazem (Cardizem, Dilacor, Tiazac) might decrease the effectiveness of diltiazem (Cardizem, Dilacor, Tiazac).

Levothyroxine
Levothyroxine is used for low thyroid function. Calcium can decrease how much levothyroxine your body absorbs. Taking calcium along with levothyroxine might decrease the effectiveness of levothyroxine. Levothyroxine and calcium should be taken at least 4 hours apart.

Some brands that contain levothyroxine include Armour Thyroid, Eltroxin, Estre, Euthyrox, Levo-T, Levothroid, Levoxyl, Synthroid, Unithroid, and others.

Sotalol (Betapace)
Taking calcium with sotalol (Betapace) can decrease how much sotalol (Betapace) your body absorbs. Taking calcium along with sotalol (Betapace) might decrease the effectiveness of sotalol (Betapace). To avoid this interaction, take calcium at least 2 hours before or 4 hours after taking sotalol (Betapace).

Verapamil (Calan, Covera, Isoptin, Verelan)
Calcium can affect your heart. Verapamil (Calan, Covera, Isoptin, Verelan) can also affect your heart. Do not take large amounts of calcium if you are taking verapamil (Calan, Covera, Isoptin, Verelan).

Water pills (Thiazide diuretics)
Some "water pills" increase the amount of calcium in your body. Taking large amounts of calcium with some "water pills" might cause there to be too much calcium in the body. This could cause serious side effects, including kidney problems.

Some of these "water pills" include chlorothiazide (Diuril), hydrochlorothiazide (HydroDIURIL, Esidrix), indapamide (Lozol), metolazone (Zaroxolyn), and chlorthalidone (Hygroton).

Minor

Be watchful with this combination.

Estrogens
Estrogen helps your body absorb calcium. Taking estrogen pills along with large amounts of calcium might increase calcium in the body too much.

Estrogen pills include conjugated equine estrogens (Premarin), ethinyl estradiol, estradiol, and others.

Medications for high blood pressure (Calcium channel blockers)
Some medications for high blood pressure can affect calcium in your body. These medications are called calcium channel blockers. Getting calcium injections might decrease the effectiveness of these medications for high blood pressure.

Some medications for high blood pressure include nifedipine (Adalat, Procardia), verapamil (Calan, Isoptin, Verelan), diltiazem (Cardizem), isradipine (DynaCirc), felodipine (Plendil), amlodipine (Norvasc), and others.

Are there interactions with herbs and supplements?

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Magnesium
Calcium supplements can decrease the absorption of dietary magnesium, but only at very high doses (2600 mg per day). However, in people who have enough magnesium stored in their bodies, taking calcium doesn't cause a problem over the long term. People at high risk for magnesium deficiency, however, should take calcium supplements at bedtime, instead of with meals, to avoid reducing dietary magnesium absorption.

Vitamin D
Taking vitamin D along with calcium increases absorption of calcium.

Are there interactions with foods?

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Caffeine
High caffeine intake from foods and beverages causes the body to remove calcium. Taking more than 300 mg of caffeine per day (three to four cups of coffee, or six 12-oz. cola drinks) is linked to increased bone loss and breaks in elderly women, especially when calcium intake is low. Be sure to get the amount of calcium from food and supplements that is recommended for your age and gender.

Fiber
Dietary fiber from certain sources can interfere with calcium absorption. These sources include wheat bran, spinach, rhubarb, and others. It's best not to eat fibrous foods within two hours of taking calcium supplements.

Iron
Calcium supplements may decrease the absorption of dietary iron. However, in people who have enough iron stored in their body, taking calcium doesn't cause a problem over the long term. People who are at high risk for iron deficiency should take calcium supplements at bedtime, instead of with meals, to avoid reducing the absorption of iron.

Magnesium
Calcium supplements may decrease the absorption of dietary magnesium. However, in people who have enough magnesium stored in their body, taking calcium doesn't cause a problem over the long term. People who are at high risk for magnesium deficiency should take calcium supplements at bedtime, instead of with meals, to avoid reducing the absorption of magnesium.

Sodium
Eating foods that contain a lot of sodium causes the body to remove calcium. A calcium intake of 1000 mg/day is needed to prevent bone loss in postmenopausal women ingesting 2000 mg sodium chloride daily. About 1500 mg/day calcium is needed if sodium chloride intake is 3000 mg/day.

Zinc
Calcium supplements may decrease the absorption of dietary zinc. However, in people who have enough zinc stored in their body, taking calcium doesn't cause a problem over the long term. People who are at high risk for zinc deficiency should take calcium supplements at bedtime, instead of with meals, to avoid reducing the absorption of zinc.

What dose is used?

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The following doses have been studied in scientific research:

BY MOUTH:
  • For preventing low calcium levels: 1 gram elemental calcium daily is typically used.
  • For heartburn: Calcium carbonate as an antacid is usually 0.5-1.5 grams as needed.
  • To reduce phosphates in adults with chronic renal failure: The initial dose of calcium acetate is 1.334 grams (338 mg elemental calcium) with each meal, increasing to 2-2.67 grams (500-680 mg elemental calcium) with each meal if necessary.
  • For prevention of weak bones (osteoporosis): Doses of 1-1.6 grams elemental calcium daily from foods and supplements. Osteoporosis treatment guidelines in North America currently recommend 1200 mg daily of calcium.
  • For prevention of bone loss in premenopausal women over 40: A dose of 1 gram.
  • For pregnant women with low dietary calcium intake: The dose for increasing fetal bone density ranges from 300-1300 mg/day beginning at gestation week 20-22.
  • For premenstrual syndrome (PMS): 1-1.2 grams calcium per day as calcium carbonate.
  • For reducing thyroid hormone levels in people with chronic renal failure: 2-21 grams calcium carbonate.
  • To prevent bone loss in people taking corticosteroid drugs: Divided daily doses of 1 gram of elemental calcium daily.
  • For high blood pressure: 1-1.5 grams calcium daily.
  • For preventing high blood pressure during pregnancy (pre-eclampsia): 1-2 grams elemental calcium daily as calcium carbonate.
  • For preventing colorectal cancer and recurrent colorectal benign tumors (adenomas): Calcium 1200-1600 mg/day.
  • For high cholesterol: 1200 mg daily with or without vitamin D 400 IU daily has been used in conjunction with a low-fat or calorie-restricted diet.
  • For preventing fluoride poisoning in children: Calcium 125 mg twice daily, in combination with ascorbic acid and vitamin D.
  • For weight loss, increasing calcium consumption from dairy products to total intake of 500-2400 mg/day in combination with a calorie-restricted diet has been used.
Calcium carbonate and calcium citrate are the two most commonly used forms of calcium.

Calcium supplements are usually divided into two doses daily in order to increase absorption. It’s best to take calcium with food in doses of 500 mg or less.

The Institute of Medicine publishes a recommended daily allowance (RDA) for calcium which is an estimate of the intake level necessary to meet the requirements of nearly all healthy individuals in the population. The current RDA was set in 2010. The RDA varies based on age as follows: Age 1-3 years, 700 mg; 4-8 years, 1000 mg; 9-18 years, 1300 mg; 19-50 years, 1000 mg; Men 51-70 years, 1000 mg; Women 51-70 years, 1200 mg; 70+ years, 1200 mg; Pregnant or Lactating (under 19 years), 1300 mg; Pregnant or Lactating (19-50 years), 1000 mg.

The Institute of Medicine also sets the daily tolerable upper intake level (UL) for calcium based on age as follows: Age 0-6 months, 1000 mg; 6-12 months, 1500 mg; 1-3 years, 2500 mg; 9-18 years, 3000 mg; 19-50 years, 2500 mg; 51+ years, 2000 mg. Doses above these levels should be avoided.

Doses over the recommended daily intake level of 1000-1300 mg/day for most adults have been associated with an increased risk of heart attack. Until more is known, continue consuming adequate amounts of calcium to meet daily requirements, but not excessive amounts of calcium. Be sure to consider total calcium intake from both dietary and supplemental sources and try not to exceed 1000-1300 mg of calcium per day. To figure out dietary calcium, count 300 mg/day from non-dairy foods plus 300 mg/cup of milk or fortified orange juice.

Other names

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Acétate de Calcium, Aspartate de Calcium, Bone Meal, Calcio, Calcium Acetate, Calcium Aspartate, Calcium Carbonate, Calcium Chelate, Calcium Chloride, Calcium Citrate, Calcium Citrate Malate, Calcium D-Gluconate, Calcium Disuccinate, Calcium Gluconate, Calcium Glycerophosphate, Calcium Hydrogen Phosphate, Calcium Hydroxyapatite, Calcium Lactate, Calcium Lactogluconate, Calcium Orotate, Calcium Phosphate, Calcium Sulfate, Carbonate de Calcium, Chélate de Calcium, Chlorure de Calcium, Citrate de Calcium, Citrate Malate de Calcium, Coquilles d’Huîtres Moulues, Coquilles d’œuf, Dicalcium Phosphate, Di-Calcium Phosphate, Dolomite, Egg Shell Calcium, Gluconate de Calcium, Glycérophosphate de Calcium, Heated Oyster Shell-Seaweed Calcium, Hydroxyapatite, Lactate de Calcium, Lactogluconate de Calcium, MCHA, MCHC, Microcrystalline Hydroxyapatite, Orotate de Calcium, Ossein Hydroxyapatite, Oyster Shell, Oyster Shell Calcium, Phosphate de Calcium, Phosphate de Calcium Hydrogène, Phosphate de di-Calcium, Phosphate Tricalcium, Poudre d’os, Sulfate de Calcium, Tricalcium Phosphate.

Methodology

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To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.methodology (http://www.nlm.nih.gov/medlineplus/druginfo/natural/methodology.html).

References

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To see all references for the Calcium page, please go to http://www.nlm.nih.gov/medlineplus/druginfo/natural/781.html.

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Page last updated: 12 March 2014