I have been in postmenopause for 5years. I've always been faithful about exercise, weight-training, and taking my calcium, and yet I've recently been told that I have osteopenia. Why didn't doing these things prevent bone loss? What more can I do?

Being postmenopausal is the most significant risk factor for having osteopenia and osteoporosis. Don't forget that if you are postmenopausal, you may lose about 2% to 5% of your bone mass per year for the first 4 to 8 years following menopause. Because you are between 4 and 8 years postmenopause, you are experiencing the time of greatest bone loss.

Even with the explanation of being postmenopausal, it can feel pretty discouraging if it seems like you're doing all the right things but you find out you have bone loss anyway. This doesn't mean that you are doing anything wrong. And you absolutely should not stop exercising and taking your calcium and vitamin D. Your healthy habits may not have prevented osteopenia for several reasons.

First, look back at your pattern of growth and food intake. Were you very thin as a child and adolescent? Did you drink enough milk and eat plenty of dairy products? Was your diet overall a healthy one with a good balance of protein, carbohydrates, and fats, without a lot of junk food, soda, and coffee? If you were excessively thin; if you did not get enough calcium, vitamin D, and other nutrients; if you smoked; or if you consumed excessive amounts of caffeine- and phosphorus-containing foods and beverages that replaced those with calcium, it is possible that you did not reach peak bone mass as a young adult. Therefore, your T-score may reflect a failure to reach peak bone mass rather than loss of bone mass as a midlife adult.

Second, what is your family history? If you have a first-degree relative (mother, father, sister, brother, daughter, son) with osteoporosis, you are much more likely to have osteopenia or osteoporosis even if you've done everything you can to prevent bone loss.

Third, do you have other risk factors besides family history that may have contributed to the condition of your bones? For example, if you are on steroids for chronic asthma or other medical conditions, significant loss of bone density can happen in as little as 3 weeks. Unfortunately, steroid use can create loss of bone density faster than exercise and calcium can increase it.

And fourth, are there lifestyle changes that you should be making? You already exercise and take calcium, but you should also quit smoking and cut down on alcohol if you are consuming more than one or two drinks per day.

Regardless of how you happened to be diagnosed with osteopenia, you will need to discuss goals and treatment with your clinician. Even though there are other reasons why you may have sustained bone loss, you should also reexamine your exercise regimen. Are you gradually and consistently increasing load on your bones?

And have another look at your calcium supplementation to make sure you are correctly calculating how much calcium you are taking in through diet and supplements. Add more calcium if you are not getting enough (see Question 47). Prescription medications may prevent further bone loss (see Question 55).

You have a chance to make some real changes in your life based on that one bone density test, so take advantage of this opportunity. There's always more we can do to get and stay healthy.

My clinician has encouraged me to take calcium supplements. There are so many kinds of calcium. How do I know I'm taking the right kind and the right amount?

Calcium is one of the cornerstones of developing and maintaining healthy bones. It is important to get adequate calcium in your diet, no matter how old you are. Table 3 lists the amount of calcium recommended for your age and gender. Your daily intake should never exceed 2500 mg of elemental calcium.

Before your clinician can recommend calcium supplementation, you will need to calculate the amount of calcium you take in through your diet on a daily basis. Table 4 shows the many different dietary sources of calcium. If you have a reasonably healthy diet, you can make it easy on yourself by using a simple formula to determine how much calcium you will need to supplement what you are getting in food. The formula goes like this: Take the number of dairy servings that you eat or drink every day and multiply that number by 300. Add 290 if you are female, or if you are male and over the age of 60; add 370 if you are a male under 60 (an expected amount of calcium from all other dietary sources except supplements). Then subtract that total from the recommended daily allowance (RDA) that is correct for your age and sex (see Table 3). The remainder is the number of milligrams of elemental calcium that you should add through supplements.

Table 3 Daily Calcium Requirements by Age and Sex

Age and Gender

Adequate Daily Intake of Calcium

Infants male or female 0-6 months

210 mg

Infants male or female 7-12 months

270 mg

Children male or female 1-3 years

500 mg

Children male or female 4-8 years

800 mg

Males and females 9-18 years

1300 mg

Males and females* 19-50 years

1000 mg

Males and females** 51 years and older

1200 mg

Pregnant or lactating female 14-18 years

1300 mg

Pregnant or lactating female 19-50 years

1000 mg

*If you are female and in menopause, you should increase your calcium intake to 1200 mg.

**Some clinicians recommend 1500 mg of calcium per day for postmenopausal women.

Source: National Academy of Sciences

Formula for all women and for men over 60:

RDA — (300 x number of daily dairy servings) + 290 = Total number of milligrams of elemental calcium you need to take in supplements.

Formula for men under the age of 60:

RDA — (300 x number of daily dairy servings) + 370 = Total number of milligrams of elemental calcium you need to take in supplements.

Table 4 Food Sources of Calcium

Food Source

Serving Size

Calcium Amount

Tofu (with calcium sulfate)

V2 cup

434 mg

Milk, skim

1 cup

321 mg

Yogurt, low fat

1 cup

300 mg

Calcium-fortified orange juice

8 oz

300 mg

Milk, whole

1 cup

291 mg

Milk, whole, chocolate

1 cup

280 mg

Swiss cheese

1 slice

270 mg

Collard greens (cooked)

1 cup

226 mg

Monterey Jack cheese

1 slice

210 mg

Canned sardines (with bones)**

3 oz

204 mg

Cheddar cheese

1 slice

200 mg

Canned salmon (with bones)**

3 oz

181 mg


1 cup

180 mg

American processed cheese

1 slice

174 mg

Mozzarella cheese

1 slice

174 mg

Yogurt, frozen

V2 cup

152 mg

Bread (calcium-fortified)

1 slice

150 mg

Turnip greens (cooked)

1 cup

147 mg

Cottage cheese

1 cup

140 mg

Food Source

Serving Size

Calcium Amount

Mustard greens

1 cup

103 mg


V4 cup

92 mg

Ice cream

V2 cup

75 mg

Cereal (calcium-fortified)

1 cup


*Spinach and Swiss chard have binders that can interfere with calcium absorption, and most green leafy vegetables provide only a very small amount of calcium in the diet due to poor absorption. **Calcium content includes eating the bones.

Here's the tricky part. Not all forms of calcium are created equal. The kind of calcium that your body can absorb and use is called elemental calcium[1]. So the calcium in your regular diet is elemental calcium because it occurs naturally in the foods you eat and drink. The kind of calcium that is added to food is different from the type of calcium that is found naturally in foods.

When you are deciding how much calcium you need to supplement your dietary intake, you have to be aware that the different forms of calcium provide different amounts of elemental calcium (the kind that your body can absorb and use). Table 5 shows how the different types of calcium provide different percentages of elemental calcium.

You need to look at supplement labels carefully, as many now list the elemental calcium that your body can actually absorb. For example, both Citracal® and Tums list the elemental calcium per serving, and a serving is usually two tablets. Similar to foods, elemental

Table 5 Types of Calcium Supplements

Type of Calcium

Amount of Elemental Calcium

Amount of Elemental Calcium Absorbed per 1000 mg**

Sample Product Names

Calcium carbonate*


400 mg

Tums, Os-Cal, Calci-Fresh Gum®, Viactiv, many others

Calcium phosphate tribasic


375 mg

Posture, fortified products

Calcium citrate*


211 mg

Citracal, Calci-Fresh Gum

Calcium gluconate


90 mg

Various; often mixed with other mineral and calcium supplements

Calcium glubionate


64 mg

Neo-Calglucon syrup

*Most frequently used supplements

**Many manufacturers now list the elemental calcium in their product per one serving, which is often two tablets. (For example, if you are taking two tablets that contain 750 mg of calcium carbonate each, you can absorb 600 mg of elemental calcium. The label will say 600 mg calcium per serving because one serving is two tablets. If you take two tablets that contain 1500 mg of calcium citrate each, you can absorb 630 mg of elemental calcium; the label will say 630 mg calcium per serving because one serving is two tablets.) The easiest way to determine if the label is listing elemental calcium is to see how it relates to the suggested daily amount. The suggested daily amount is based on 1000 mg of elemental calcium (even though many people need more than that). If the label says there is 630 mg per serving (or two tablets) and the amount listed is 63% of the suggested daily amount, you know it is elemental calcium because 630 mg is 63% of 1000 mg. calcium amounts are based on a recommended intake of 1000 mg per day (even though intake requirements vary by age and sex). So if a serving provides 600 mg of elemental calcium, the supplement label will also note that it provides 60% of the recommended daily intake.

Because calcium supplements are manufactured in other forms besides tablets, you have more options for getting the right amount of calcium in your diet. This means that if you can't swallow big tablets, you can use chewable tablets or candy, liquid, or gum, or drink fortified orange juice.

When you buy calcium supplements, you will need to read the label so that you can get the type that is best for you:

• Calcium carbonate is the most commonly manufactured form of calcium. It comes in tablets that you swallow whole, chewable tablets, soft-gel tablets, liquid, flavored chewy candies, and even chewing gum. Calcium carbonate is best absorbed in an acidic environment, so it should be taken with meals. The main drawbacks to calcium carbonate are constipation and the gastrointestinal gas it can cause. To avoid excessive rumblings, discomfort, and flatulence, try taking it with a preparation that also contains magnesium. Tums, Viactiv®, Os-Cal®, and Mylanta are all examples of calcium carbonate.

• Calcium citrate is better tolerated and doesn't need the high level of acid from your stomach that calcium carbonate does for absorption, so it can be taken at bedtime or on an empty stomach. Calcium citrate, which comes in tablets and liquid, is a good option for people who tend to have heartburn or chronic stomach upset and for those who take medication to reduce stomach acid. Citracal is an example of calcium citrate.

• Calcium phosphate is most often found in fortified beverages like orange juice or by itself in a product called Posture®. Calcium phosphate does not usually cause stomach upset.

• Calcium gluconate and calcium glubionate are less commonly used because they have relatively low levels of absorbable elemental calcium. Neo-Calglucon Syrup® is an example of calcium glubionate. Calcium gluconate is sometimes combined with calcium carbonate in certain products and vitamin preparations.

It may feel like you need a math degree in order to get the right amount of calcium, but once you find the calcium that you like and can tolerate, stick with it and try to take the same number of tablets, chews, or liquid every day. Don't forget to add in what you may also take in through a daily vitamin and antacids, both of which commonly contain some form of calcium. As long as you don't go over the maximum of 2500 mg of elemental calcium per day, don't worry about getting too much.

Besides keeping your bones healthy, calcium has many other benefits:

Keeping up with your calcium is a win-win situation, for both your bones and your overall health.

• It builds and maintains strong teeth.

• It can lower the risk of breast cancer (if you're pre-menopausal).

• It may reduce the risk of prostate cancer.

• It can reduce the risk of colon cancer.

• When combined with magnesium, it can reduce the occurrence of headaches.

• It can reduce premenstrual syndrome (PMS) symptoms.

• It may reduce the number of hot flashes experienced by peri- and postmenopausal women.

• It can help you lose weight!

• It maintains the mineral balance in all other organs, including your brain and heart, keeping your mental function healthy and your blood pressure normal.

• It helps with muscle contractions and relaxation.

• It helps your blood clot appropriately.

• It helps to regulate hormone secretion.

Keeping up with your calcium is a win-win situation, for both your bones and your overall health.

Recently, coral calcium has been touted as a cure-all for many diseases as well as the best source of calcium.

Coral calcium is believed to be taken from the Japanese island of Okinawa where people are thought to live much longer than the rest of the world's peoples. Calcium manufactured from sea coral or hard shell sea creatures, however, is actually calcium carbonate, the same calcium that is available and less costly in many calcium supplements. Don't be misled by the claims that coral calcium can cure you of many diseases, even cancer and Alzheimer's disease[2].

  • [1] The calcium that your body absorbs and uses.
  • [2] Degenerative brain disorder that gradually causes disorientation, confusion, and memory loss.
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