Can Calcium Supplements Prevent Osteoporosis?

We all need calcium for a healthy body, bones and teeth. For the most part, we absorb calcium through a good diet. But as we age, the loss of bone density and strength can lead to osteoporosis.

Osteoporosis can progress without any symptoms, and it’s often not discovered until a weakened bone fractures. That can be followed by pain, disability and even premature death.

Scary, right? But if you know your risk for osteoporosis, there are steps you can take to help protect your bones.

Rheumatologist Chad Deal, MD, and menopause specialist Pelin Batur, MD, explain the role that calcium plays in preventing osteoporosis — and why dietary sources of calcium are preferable over calcium supplements.

Who’s at risk for osteoporosis?

There are lots of minerals in your body, but calcium is the most plentiful. More than 95% of your body’s calcium stores are in your skeleton. Calcium also plays a role in muscle and tissue health.

When you’re young, your body builds new bone faster than it breaks down old bone, so your total bone mass increases. This continues until about age 30, when new bone formation and old bone breakdown start to happen at about the same rate.

“In older adults, especially those who are post-menopausal, bone breaks down at a faster rate than it’s built,” Dr. Batur explains. “If your calcium intake is too low, this can contribute to osteoporosis.”

The Bone Health and Osteoporosis Foundation reports that half of all women and people assigned female at birth (AFAB) over age 50 and a quarter of men and people assigned male at birth (AMAB) older than age 50 will break a bone due to osteoporosis. Post-menopausal white and Asian women are at the highest risk.

You may be at risk for osteoporosis if you:

• Are over the age of 50.
• Don’t get enough calcium in your diet.
• Have a family history of osteoporosis.
• Have a naturally small, thin body build.
• Smoke.
• Use certain medications, including some breast cancer treatments (aromatase inhibitors), anti-seizure medications (phenytoin) and steroids.

Getting enough calcium every day can help keep your bones strong and prevent osteoporosis. But what’s the best source of calcium? Let’s get into the specifics.

Do calcium supplements help osteoporosis?

Your body needs calcium to continue to build and maintain strong bones. But increasingly, data shows that calcium supplements aren’t the best route for getting this important mineral.

“Calcium is best absorbed through the foods we eat and the beverages we drink,” Dr. Deal shares. “For most healthy people, it’s important to eat a well-balanced diet rather than relying on supplements.”

Why? Well, studies show that calcium supplements may be associated with an increased risk of cardiovascular disease. So, while calcium supplements may help you lower your risk of osteoporosis, they also have the potential to raise your risk of heart issues.

“There is concern about calcium supplements and cardiovascular risk,” Dr. Deal echoes. “Fortunately, though, studies seem to show that the same risk doesn’t exist when you get your calcium from your diet.”

For that reason, he reaffirms that the calcium you get from food is considered safer than calcium supplements. There are some cases when your healthcare provider may recommend that you take calcium supplements (more on that in a moment!), but diet should always be your first line of defense.

What’s the best form of calcium to take for osteoporosis?

There are lots of ways to get calcium in your diet instead of in supplement form. It’s found naturally in some foods, especially dairy products, and it’s added to others, like some orange juices, cereals and milk plant-based substitutes.

“Unlike calcium supplements, calcium from foods is associated with less or no cardiovascular risk,” Dr. Deal emphasizes.

The amount of calcium you need depends on your age and sex, but on average, older adults need 1,000 to 1,200 milligrams of calcium a day. Good sources include:

• Dairy-rich foods like milk, yogurt and cheese.
• Plant-based milks, including almond, soy, cashew and coconut milk.
• Fortified orange juice.
• Leafy greens, like spinach, kale, collards and bok choy.
• Tofu with added calcium sulfate.
• Almonds.

If you can’t get enough calcium in your diet

“We prefer dietary calcium as opposed to supplements whenever possible,” Dr. Batur reiterates, “but that’s not always possible.”

You might have a hard time getting enough calcium through diet alone if you:

• Are lactose intolerant and can’t consume dairy products.
• Follow a vegan diet and avoid consuming dairy products.
• Have absorption problems due to gastrointestinal illness.
• Consume large amounts of protein and/or sodium.

If your dietary calcium is low, first try to figure out which calcium-rich foods you can eat — like lactose-free milk if you’re lactose intolerant or alternative kinds of milk if you’re vegan.

These days, most dairy substitutes are fortified with calcium so you get the same amount of calcium from them as you’d get from the dairy product they imitate.

“If you’re below the recommended calcium limit and your doctor is concerned, the first move is usually to change your diet to include additional dietary calcium,” Dr. Deal says. “If they determine that you can’t get enough calcium through your diet, they may still recommend that you take a calcium supplement.”

How to help your body absorb calcium

All right, you’re thinking, I’ll get in all my calcium at breakfast, and then I won’t have to think about it again! Not so fast. Your body can only handle so much calcium at a time, so you can’t bulk up on it all at once.

“We can typically only absorb about 500 milligrams of calcium at one time,” Dr. Batur clarifies, “which means you can’t just eat a bowl of fortified cereal, drink a glass of fortified orange juice, pop a multivitamin and call it a day.”

When you consume a bunch of calcium-rich foods all at once, your body can’t absorb it all and will pass it out in your stool (poop). Instead, break up your calcium intake throughout the day so your body can properly process it.

It’s also important to get enough vitamin D every day, as it helps your body absorb and use calcium from food. It’s often difficult to get enough vitamin D in a diet, so a supplement may be needed. Sunlight allows the body to manufacture vitamin D. But again, always check with a healthcare provider before introducing supplements to your routine.

What about other supplements for osteoporosis?

You may have heard that other kinds of supplements, like strontium and fluoride, can help you prevent osteoporosis. But Dr. Deal and Dr. Batur note that neither of these supplements have been shown to reduce fracture risk.

“If there were more strict regulation of the supplement market, I would feel much more comfortable with supplements,” Dr. Deal says, “but it’s a business model built on very little oversight by any federal body.”

Because of that, he adds that it’s hard to know which natural supplements, if any, truly work.

“There are big issues with impurities in supplements,” Dr. Batur warns, “so without strong, conclusive data to show that there’s any supplement that helps, I’m hesitant to recommend them.”

How to prevent osteoporosis

Keeping your bones strong is about a lot more than drinking a glass of milk here and there. It’s a lifelong commitment to overall health.

“To promote healthy bones and reduce calcium loss, focus on living a healthy lifestyle,” Dr. Batur encourages. “This includes eating a balanced diet, getting proper calcium and vitamin D intake, not smoking, and taking it easy on caffeine and alcohol.”

Enjoy regular exercise, too, especially weight-bearing activities like walking or jogging.

Despite getting adequate calcium and vitamin D, some people may need to take one of the many prescription medications shown to treat low bone mass and reduce fracture risk.

Finally, ask your healthcare provider when you should have a bone density screening. The National Osteoporosis Foundation recommends them starting at age 65 for women and age 70 for men, but your doctor’s recommendation may vary depending on your individual risk factors.

“The test is covered by Medicare, and most commercial insurance will pay for it if you have risk factors,” Dr. Deal says. “Getting it done will help you maintain skeletal integrity and prevent fractures.”