The foods we eat contain a variety of vitamins, minerals, and other important nutrients that help keep our bodies healthy. Two nutrients in particular, calcium and vitamin D, are needed for strong bones.
The role of calcium
Calcium is needed for our heart, muscles, and nerves to function properly and for blood to clot. Inadequate calcium significantly contributes to the development of osteoporosis. Many published studies show that low calcium intake throughout life is associated with low bone mass and high fracture rates. National nutrition surveys have shown that most people are not getting the calcium they need to grow and maintain healthy bones. To find out how much calcium you need, see the "Recommended calcium intakes" chart below.
| Infants 0 to 6 months | 200 |
| Infants 6 to 12 months | 260 |
| 1 to 3 years old | 700 |
| 4 to 8 years old | 1,000 |
| 9 to 13 years old | 1,300 |
| 14 to 18 years old | 1,300 |
| 19 to 30 years old | 1,000 |
| 31 to 50 years old | 1,000 |
| 51- to 70-year-old males | 1,000 |
| 51- to 70-year-old females | 1,200 |
| 70 years old | 1,200 |
| 14 to 18 years old, pregnant/lactating | 1,300 |
| 19 to 50 years old, pregnant/lactating | 1,000 |
To learn how easily you can include more calcium in your diet without adding much fat, see the "Selected calcium-rich foods" list below.
| Fortified oatmeal, 1 packet | 350 |
| Sardines, canned in oil, with edible bones, 3 oz. | 324 |
| Cheddar cheese, 1½ oz. shredded | 306 |
| Milk, nonfat, 1 cup | 302 |
| Milkshake, 1 cup | 300 |
| Yogurt, plain, low fat, 1 cup | 300 |
| Soybeans, cooked, 1 cup | 261 |
| Tofu, firm, with calcium, ½ cup | 204 |
| Orange juice, fortified with calcium, 6 oz. | 200–260 (varies) |
| Salmon, canned, with edible bones, 3 oz. | 181 |
| Pudding, instant (chocolate, banana, etc.) made with 2% milk, ½ cup | 153 |
| Baked beans, 1 cup | 142 |
| Cottage cheese, 1% milk fat, 1 cup | 138 |
| Spaghetti, lasagna, 1 cup | 125 |
| Frozen yogurt, vanilla, soft serve, ½ cup | 103 |
| Ready-to-eat cereal, fortified with calcium, 1 cup | 100–1,000 (varies) |
| Cheese pizza, 1 slice | 100 |
| Fortified waffles, 2 | 100 |
| Turnip greens, boiled, ½ cup | 99 |
| Broccoli, raw, 1 cup | 90 |
| Ice cream, vanilla, ½ cup | 85 |
| Soy or rice milk, fortified with calcium, 1 cup | 80–500 (varies) |
Calcium culprits
Although a balanced diet aids calcium absorption, high levels of protein and sodium (salt) in the diet are thought to increase calcium excretion through the kidneys. Excessive amounts of these substances should be avoided, especially in those with low calcium intake.
Lactose intolerance also can lead to inadequate calcium intake. Those who are lactose intolerant have insufficient amounts of the enzyme lactase, which is needed to break down the lactose found in dairy products. To include dairy products in the diet, dairy foods can be taken in small quantities or treated with lactase drops, or lactase can be taken as a pill. Some milk products on the market already have been treated with lactase.
Calcium supplements
If you have trouble getting enough calcium in your diet, you may need to take a calcium supplement. The amount of calcium you will need from a supplement depends on how much calcium you obtain from food sources. There are several different calcium compounds from which to choose, such as calcium carbonate and calcium citrate, among others. Except in people with gastrointestinal disease, all major forms of calcium supplements are absorbed equally well when taken with food.
Calcium supplements are better absorbed when taken in small doses (500 mg or less) several times throughout the day. In many individuals, calcium supplements are better absorbed when taken with food. It is important to check supplement labels to ensure that the product meets United States Pharmacopeia (USP) standards.
Vitamin D
The body needs vitamin D to absorb calcium. Without enough vitamin D, one can’t form enough of the hormone calcitriol (known as the “active vitamin D”). This in turn leads to insufficient calcium absorption from the diet. In this situation, the body must take calcium from its stores in the skeleton, which weakens existing bone and prevents the formation of strong, new bone.
You can get vitamin D in three ways: through the skin from sunlight, from the diet, and from supplements. Experts recommend a daily intake of 600 IU (International Units) of vitamin D up to age 70. Men and women over age 70 should increase their uptake to 800 IU daily, which also can be obtained from supplements or vitamin D-rich foods such as egg yolks, saltwater fish, liver, and fortified milk. The Institute of Medicine recommends no more than 4,000 IU per day for adults. However, sometimes doctors prescribe higher doses for people who are deficient in vitamin D.
A complete osteoporosis program
Remember, a balanced diet rich in calcium and vitamin D is only one part of an osteoporosis prevention or treatment program. Like exercise, getting enough calcium is a strategy that helps strengthen bones at any age. But these strategies may not be enough to stop bone loss caused by lifestyle, medications, or menopause. Your doctor can determine the need for an osteoporosis medication in addition to diet and exercise.
The National Institutes of Health Osteoporosis and Related Bone Diseases ~ National Resource Center acknowledges the assistance of the National Osteoporosis Foundation in the preparation of this publication.
For your information
This publication contains information about medications used to treat the health condition discussed here. When this publication was developed, we included the most up-to-date (accurate) information available. Occasionally, new information on medication is released.
For updates and for any questions about any medications you are taking, please contact:
U.S. Food and Drug Administration Toll Free: 888-INFO-FDA (888-463-6332)
Website: //www.fda.gov
For additional information on specific medications, visit Drugs@FDA at //www.accessdata.fda.gov/scripts/cder/daf. Drugs@FDA is a searchable catalog of FDA-approved drug products.
NIH Pub. No. 18-7878-E
When you were a child, your mom may have encouraged you to drink milk to build strong bones. But as an adult, you’re much more likely to take a calcium supplement than down four glasses of milk a day to protect your bone health. However you do it, getting enough calcium is a good idea, since women are far more likely than men to develop osteoporosis — a condition of weak and fragile bones that makes you prone to fractures: Of the 10 million Americans with osteoporosis, 80 percent are women.
But before you unwrap that chocolate-flavored calcium chew or swallow a calcium pill, you should know that taking calcium supplements may not be helping your bones at all. Even worse? The supplements may lead to major health problems
It’s important to protect your bone strength and guard against fractures as you age, but taking a supplement isn’t the best way to do that, says Erin Michos, MD, MHS , associate director of preventive cardiology for the Ciccarone Center for the Prevention of Heart Disease . “A nutrient in pill form is not processed in the body the same way as it is when ingested from a food source. Furthermore, people believe that the proof that calcium supplements fortify bones is more robust than it really is,” she says. “The truth is, the research is inconclusive. But there is a growing body of evidence that suggests no health benefit, or even worse, that calcium supplements may be harmful.”
Multiple studies have found that there’s little to no benefit to taking calcium supplements for the prevention of hip fractures. On the other hand, recent studies have linked calcium supplements with an increased risk of colon polyps (small growths in the large intestine that can become cancerous) and kidney stones, which are hard masses usually formed in the kidneys from an accumulation of calcium and other substances. Additionally, a 2016 study by Michos and her colleagues suggested that calcium supplements may increase the risk of calcium buildup in the heart’s arteries.
“I’m very concerned about the potential for calcium supplements to contribute to heart attacks and heart disease,” says Michos. “The body can’t process more than 500 milligrams of calcium at a time. If you take a supplement with more than that, your body has to do something with the excess. It’s possible that higher calcium levels in the blood could trigger blood clots or that calcium could be deposited along artery walls, which would contribute to the narrowing of blood vessels.”
While taking calcium supplements may produce unwanted side effects, meeting your calcium needs through your diet is safe. “When you get calcium through your diet, you’re taking it in small amounts spread throughout the day along with other food sources, which helps you absorb the nutrient,” explains Michos. “Most people can get adequate calcium through their diet if they make an effort.”
Women ages 19 to 50 should consume 1,000 milligrams of calcium a day, and the target for women over 50 is 1,200 milligrams per day. Good dietary sources of calcium include:
- Almonds
- Oranges
- Dried figs
- Soybeans
- Garbanzo, white and pinto beans
- Low-fat dairy such as milk and yogurt
- Leafy green vegetables such as kale and spinach
Exercise to Strengthen Bones
Being active and exercising on a regular basis protects bone health. Weight-bearing exercises such as walking, jogging and weight training are especially helpful in preventing bone loss.
Simply moving more throughout the day supports bone health, too. Research indicates that women who sit for more than nine hours a day are 50 percent more likely to have a hip fracture than those who are less sedentary. Finding ways to work more walking or standing into your day can add up. For example, park farther away from buildings, take the stairs instead of the elevator and pace while on phone calls.
For most women, skipping calcium supplements in favor of boosting dietary calcium and focusing on weight-bearing exercise is the best way to keep bones strong. But if you’re still concerned about getting enough calcium, talk to your doctor first before taking supplements to see if you really need them.