Calcium supplementation

• Though recommendations vary, optimum calcium intake (dietary + oral supplements) is 1000mg/day in adult men and pre menopausal women and 1500mg/day in post menopausal women and osteoporotic men.

• Absorption of calcium from oral supplements is as good as absorption from milk. The superiority of natural sources like milk lies in the fact that supplementary calcium increases the incidence of kidney stones. This does not happen with equivalent amounts of natural calcium.

• Calcium supplements containing carbonate are best taken with food since they require acid for solubility. This is also why calcium carbonate is not the preferred salt in patients on PPIs or H2 receptor blockers. Examples of brands of calcium carbonate are Shelcal, Tayo, Sandocal.

• If a calcium supplement of 1000mg/day is to be given, it should be administered in divided doses of 500mg each, since the calcium absorption fraction decreases at higher doses.

• If a calcium supplement of 1000mg/day is to be given, it should be administered in divided doses of 500mg each, since the calcium absorption fraction decreases at higher doses.

• Side effects such as eructations and constipation are more commonly seen with carbonate salts of calcium than with other salts.

• Adequate vitamin K status is required for optimal incorporation of calcium in bones. Vitamin K should be added to calcium ONLY in patients on warfarin or those with cirrhosis.

• 240 ml of milk contains 300mg calcium and 100 IU of vitamin D.

• Calcium carbonate is cheaper, but calcium citrate has two advantages – it can be taken before or after meals & is well absorbed even in PPI induced achlorhydria.

• DRUG INTERACTIONS WITH CALCIUM SUPPLEMENTS
    1) Hypercalcemia can occur when calcium supplements are given with thiazide diuretics or high doses of vitamin D.
    2) Iron, steroids and wheat bran decrease calcium absorption.
• Calcium reduces the absorption of bisphosphonates, tetracyclines, some fluroquinolones and thyroxine. In these situations one should give calcium at least three hours apart

• There are some people who are not just vegetarian but ‘vegans’. They don’t consume milk products as a matter of choice. Then there are also people who are lactose-intolerant. These persons can be suggested the following calcium-rich non-dairy foods—
  1) Green-leafy vegetables like spinach, pok-choy.
  2) Sesame seeds (’til’)
  3) Vegetables like okra (bhindi), broccoli.
  4) Nachani (Ragi)
  5) Calcium-fortified soya milk.

CALCIUM CONTENT OF COMMON FOODS IN COMMON PORTIONS

Calcium citrate brands

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