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Guidelines on Calcium and Vitamin D Supplements

In April 2018, the United States Preventive Services Task Force (USPSTF) updated its recommendations on the use of calcium and vitamin D supplements. Based on its findings from the review of the current scientific evidence, it does not recommend calcium or vitamin D supplements in healthy women without vitamin D deficiency citing that the studies do not show that supplements reduce the risk of fractures. 

The USPSTF recommendations are not a blanket recommendation for everyone. They are suggesting that the evidence is not strong enough to suggest that all healthy adults take calcium and vitamin D supplements.

What we know

Calcium and vitamin D are crucial components of good bone health. Calcium is the principal mineral that makes bones strong and people need enough vitamin D to help get calcium absorbed into the bones. In addition to bone strength, calcium is important for muscle contraction, nerve transmission, and blood clotting.

To meet the current Recommended Daily Allowance (RDA) of calcium, women ages 18 to 50, and men ages 18 to 70 need 1,000 milligrams (mg) of calcium. This equals two servings of a calcium-rich food, like dairy or foods and beverages fortified with calcium. Adults who eat cheese, yogurt, milk, and fortified beverages daily are likely getting sufficient calcium from their food and do not need a supplement.

As we age and hormone levels drop, we need more calcium to reduce bone loss that can lead to the risk of fractures. For women age 50+ and men age 70+, the RDA increases to 1,200 mg daily. This amount equals 2–3 servings of a calcium-rich food every day in addition to a balanced diet of fruits and vegetables.  Meeting this calcium requirement can be more challenging in older adults.

Only about 30% of women in the US get enough calcium from their diet alone.

Finally, the USPSTF is linking calcium and vitamin D supplementation to fracture risk reduction. In general, we do not see osteoporosis-related fractures among women until their 50s. The most typical fractures we see in this age group is wrist or upper arm fractures. The average age for hip fractures is 81. Therefore, supplementation at younger ages may be unnecessary.

Adults who may need supplements

Even if an adult gets sufficient calcium from their food, there are situations where the calcium may not be adequately absorbed in the body.

  • Vitamin D deficiency is very common in the US. Without sufficient vitamin D, calcium will not be absorbed and benefit the body.
  • Adults with intestinal problems like lactose intolerance, Celiac or Crohn’s disease do not absorb many nutrients well, including calcium.
  • Women who have premature menopause will experience bone loss and need to be vigilant about their diets.
  • Vegans who do not eat dairy.
  • Adults over age 45 who have had a broken bone from a low impact fall or injury.
  • Adults who have been diagnosed with osteoporosis or low bone density.

What you can do

Know your RDA. Take a careful look at your diet for a few days and log your food sources of calcium.

  • If you are younger, have a balanced diet, get 1–2 servings of a dairy food or calcium-fortified food, and do not fall into one of the categories above, you do not need a calcium supplement.
  • If you are a woman age 50+ or a man age 70+, you need an additional serving of a calcium food a day or may need to consider a calcium supplement with vitamin D.
  • Adults who do not live in their own homes, for example, those who are in assisted care facilities, may also need supplementation with calcium and vitamin D.

Download PDF Version—

USPSTF. Final Recommendation Statement: Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: Preventive Medication. 2018. 

Posted: 5/22/18; Revised: 3/11/20. 
As a service to our readers, American Bone Health provides access to our library of archived content. Please note the date of the last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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What to know about bone health
and fracture prevention during COVID-19

  • Remove fall dangers in your home.
  • Stay physically active, and at least 6 feet away from others.
  • Eat for proper nutrition, and take a supplement if needed to get enough calcium and vitamin D.
  • Stick with your osteoporosis medicines and ask your doctor for extra if you’re unable to go to the pharmacy.
  • If you are due for Reclast, there is little concern about delaying for a few weeks or months.
  • If you take Prolia or Evenity injections, don’t miss your appointment.  Some facilities offer “drive-through” injections. Check with your doctor.
  • Bone density testing can be postponed, if necessary.
  • Speak with your doctor about the possibility of telephone and video visits.

The Centers for Disease Control and Prevention has a page with steps you can take to reduce your risk of catching the virus if you have a chronic illness.

Be well. We are here for you if you have any questions.