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Menopause leads to bone loss because decreases in estrogen production both increase bone absorption and decrease calcium absorption.  Annual decreases in bone mass of 3%–5% per year frequently occur in the first years of menopause, but the decreases are typically less than 1% per year after age 65 .  Increased calcium intakes during menopause do not completely offset this bone loss. Hormone replacement therapy (HRT) with estrogen and progesterone  has been noted to help increase calcium levels and prevent osteoporosis and fractures.

Dietary Supplements
The two main forms of calcium supplements are carbonate and citrate.  Calcium carbonate is more commonly available and is both inexpensive and convenient.  Due to its dependence on stomach acid for absorption, calcium carbonate is absorbed most efficiently when taken with food, whereas calcium citrate is absorbed equally well when taken with or without food.

Because of its ability to neutralize stomach acid, calcium carbonate is found in some over-the-counter antacid products, such as Tums and Rolaids.  Depending on its strength, each chewable pill or soft chew provides 200-400 mg of elemental calcium.  Calcium carbonate is an acceptable form of supplemental calcium, especially for individuals who have normal levels of stomach acid.

Your body must be able to absorb the calcium for it to be effective.  All varieties of calcium supplements are better absorbed when taken in small doses (500 mg or less) at mealtimes.  Calcium citrate is also useful for people with achlorhydria, inflammatory bowel disease, or history of kidney stones.  Other calcium forms in supplements or fortified foods include gluconate, lactate, and phosphate.  Calcium citrate malate is a well-absorbed form of calcium found in some fortified juices.

More isn’t always better: Too much calcium has risks
Dietary calcium is generally safe, but more isn’t necessarily better, and excessive calcium doesn’t provide extra bone protection.  In fact, if the calcium in your diet and from supplements exceeds the tolerable upper limit, you could increase your risk of health problems, such as:

  • Kidney stones
  • Prostate cancer in men
  • Constipation
  • Calcium buildup in your blood vessels
  • Impaired absorption of iron and zinc

For patients who have had kidney stone(s)
Continue eating calcium-rich foods, but use caution with calcium supplements. Calcium in food has shown no evidence of having an affect on your risk of kidney stones.  Continue eating calcium-rich foods unless your physician advises otherwise.  Ask your doctor before taking calcium supplements, as certain supplements have been linked to an increased risk of kidney stones.  You may reduce the risk by taking supplements with meals.


For an appointment or consultation with Dr. Gary Bellman,
please contact the office or call 818-912-1899