How much calcium do you need?

Q: Should I be taking calcium pills for my bones? 
Last fall, my 75-year-old next-door neighbor fell down 3 steps, shattering her left ankle into tiny pieces that were painstakingly put back together during a 5-hour surgery. She has osteoporosis, or thin bones due to years of taking daily prednisone for an inflammatory condition called lupus. Now her doctor has her taking a bone-building medicine, and she was told to take a calcium supplement every day.  
Calcium helps keep our bones healthy, but it has other critical jobs as well: your muscles, nerves, and blood vessels depend on calcium to work properly. Every time your heart beats and you take a breath, the muscles of your heart and chest work to keep you alive and well. However, if you don’t have enough calcium available, your body will take some out of your bones, like an ATM (automated teller machine) for calcium instead of $20 bills. 
If you run low on calcium occasionally, this only happens once in a while, and it’s no big deal. Still, if your body pulls calcium out of your bones regularly, those withdrawals eventually weaken your bones, increasing your risk of a hip fracture, or worse. 
How much calcium do you need?
The Institute of Medicine recommends 1000mg daily of calcium for men and women up to age 50, and 1200mg for adults older than 50 years of age. Most postmenopausal women get 600-900mg of calcium daily through their food, falling short of that goal unless they make up the difference with a calcium supplement. 
Calcium supplements were recommended as a way to ensure women and men at risk for osteoporosis get their full recommended daily dose of calcium, but recent studies have shown that you can actually get TOO MUCH calcium, which increases your risk of having a heart attack or stroke. It’s suspected that the spike in blood levels of calcium you get by taking a concentrated calcium supplement may actually damage blood vessels. 
Taking large doses of calcium supplements also encourages the formation of painful kidney stones, so for bone health, getting ALL of your recommended daily calcium from taking a calcium supplement is no longer recommended. 
Calcium carbonate is the most concentrated form of calcium supplement available but can cause constipation. Calcium citrate is absorbed better and a better choice if you also take an acid-blocking medicine like PrilosecÆ for heartburn.
Weight-bearing exercises like walking and eating prunes have also been shown to improve bone strength.  
Here are 5 Tips on Getting Enough Calcium:
1. Get as much calcium from your diet as you can.
Most people get 300mg of calcium daily from non-dairy sources. You can also get 300mg per serving of dairy products like milk, yogurt, and cheese. Green vegetables, oranges, and figs also contain calcium. You also can use the Calcium Calculator available both as a phone app for iPhone and Android phones and online at The International Osteoporosis Foundation website at their Quick Links.
2. If you take a bone-building medicine like FosamaxÆ (alendronate), ActonelÆ(risedronate), or BonivaÆ, make sure you get enough calcium.
These medicines work by encouraging calcium back into your bones, but if you don’t have enough extra calcium available in your diet or by taking a supplement, they can’t help you. 
3. Avoid taking more than 500mg of a calcium supplement at one time. 
Your body absorbs calcium better, and keeping your blood levels of calcium from ìspikingî will help avoid increasing your risk of heart attack and stroke.
4. Get 400 IU of Vitamin D every day. 
Vitamin D is necessary to help your body absorb calcium, and can help prevent falls in the elderly. You can get vitamin D from the sun, but salmon (800 IU per 3 ounces), canned tuna (150 IU per 3 ounces), fortified milk (about 120 IU per 4 ounces), and fortified orange juice (80 IU per 4 ounces) are also good sources. 
5. Eat dried plums or prunes to build bone. 
In one study, women who ate 100 grams of dried plums daily for a year had measurably stronger bones. Despite the extra calories, none of the women in the year-long study gained weight, possibly because of the very high fiber content of the plums. 100 grams of dried plums are about 9 of those plump plums sold in big bags at places like CostcoÆ. Watch out, though; plums (also known as prunes) have a natural laxative effect, so go slowly at first to avoid embarrassing side effects. 
 Dr. Louise Achey, Doctor of Pharmacy, is a 40-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Check out her NEW website for daily tips on how to take your medicine safely. ®2020 Louise Achey

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