Dear Dr. Malik,
For many years, in addition to vitamins, I took Calcium and Vitamin D supplements, thinking I needed the extra Calcium for bone health and D for lack of sun in the Northeast Kingdom. Then a few years ago, there was a rash of articles about “no need for supplements.” Our bodies get everything they need naturally. Being a middle-aged woman in my late 50’s, do you recommend adding Calcium and Vitamin D back into my regimen?

Sincerely,
Healthy Bones So Far, A Bit Sun Deprived

Bone health is important as we age. Our bodies accumulate as much calcium as possible during our childhood and adolescence to make up our “peak bone mass”. For many of us this process is over by our late teens and early twenties. This means that eating a healthy diet with an excellent supply of calcium and being as active as possible (preferably outdoors where we can soak up sun for vitamin D) is most important during our childhood. Up to 70% of healthy bone is made of calcium. After peak bone mass is achieved we slowly begin to lose calcium and our bones thin with time raising the concern for fractures in the elderly.

This doesn’t mean that the adult world should despair. Because calcium is so important for so many functions in our body it is important to maintain a constant amount. If we don’t have enough our bodies look for it where we have an abundant supply; our bones. By continuing to eat foods rich in calcium and taking supplements we are providing enough for our bodies so that they don’t need to break down bone in order to meet the demand. Vitamin D works by increasing the amount of calcium that’s absorbed in your gut, as well as decreasing the amount that is washed out in your urine. This is in addition to the hundreds of other jobs in the body that vitamin D holds.

On the other side of things too much calcium can be harmful. It can lead to constipation, nausea, fatigue and some people may be prone to kidney stones. Vitamin D toxicity is also a possibility although it is much rarer and tends to only occur in people taking too much supplementation. So how much is enough? If you’re eating a diet rich in dairy, green vegetables and healthy animal protein you are probably getting enough calcium. Women over the age of 50 should get about 1,200mg of calcium daily and the same is true for men over 70. Getting it in small increments helps in the absorption, so a one time pill greater than 1,000mg may not be helpful. Diets rich in wild-caught fish, milk (in the US we add vitamin D to dairy), and a lifestyle with healthy sun exposure provide you with most, but maybe not all, of your supply of vitamin D. Men and women over the age of 50 need a minimum of 800-1000 IU daily, and I wouldn’t recommend going over 4,000 IU.

If you’re a woman over the age of 65 talk to your doctor about getting a bone scan to assess your risk for bone disease. For everyone else you may want to have a discussion about how calcium and vitamin D is right for you.

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