Bone Health
Common FAQs
Why is calcium important?
Calcium supports bones, muscles, nerves, blood clotting, and blood pressure.
How to maintain bone health?
Eat calcium-rich foods, get vitamin D, and exercise regularly.
When is osteoporosis usually diagnosed?
Osteoporosis is usually silent until people reach their later years. Calcium deficiency is usually diagnosed in later years through bone density studies.
When does bone mass peak?
Bone mass builds until about age 29, after which it cannot increase further, but maintaining calcium, vitamin D intake, and regular exercise helps prevent bone loss.
What happens if calcium is chronically low?
Chronic low calcium can weaken bones leading to osteoporosis and increased risks of bone fracture.
What can increase my risk of bone loss?
Those who have had prolonged bed rest, diet intensively, and/or inadequate vitamin D intake are also at risk to lose bone mass.
Recommended daily calcium requirements
Vitamin D is critical to aid in absorption of calcium from the gastrointestinal tract and in bone formation.
From 6 months - 24 years a person should have 400 IU (International Units) of vitamin D daily.
*Note that a cup of vitamin D fortified milk has 100 IU.
From age 24 - 50, 200 IU vitamin D is adequate, especially if you get 15 minutes of sunshine exposure three times a week, but there is no harm from taking supplements which contain 400 IU of vitamin D (a common dose in supplements).
Healthy adults ages 50+ years should have 400 IU per day.
Elderly persons who are frail, housebound and have little sun exposure should have 600 IU of vitamin D daily.
Avoid doses of vitamin D above 1000 IU, as this can be toxic.
Recommended daily vitamin D requirements
0-6 months
7-12 months
1-3 years
4-8 years
9-18 years
19-50 years
>50 years (for women not on estrogen replacement)
>50 years (for women on estrogen replacement & men)
210mg
270mg
500mg
800mg
1300mg
1000mg
1500mg
1200mg
Calcium Supplements
If your food intake of calcium is too low, take an over the counter calcium supplement. Multivitamins do not contain much calcium. The best researched calcium supplements are calcium carbonate and calcium citrate. Read labels carefully; insure adequate elemental calcium (i.e. the amount provided by the calcium within the supplement).
Commonly Available Calcium Supplements
Calcium Carbonate
Calcium carbonate, such as Alka-Mints, Caltrate, Rolaids, Titralac, Tums or Viactiv, are best taken with meals to enhance absorption. (Provides 40% elemental calcium per tablet). May cause constipation or gas. Cheapest form of calcium available. Avoid calcium carbonate derived from oyster shells, unless it is purified, since it may contain heavy metal contaminants.
Calcium Citrate
Calcium Phosphate
Calcium Citrate, such as Calcitrate or Citrical, are easily absorbed and can be taken anytime. Contains 21% elemental calcium per tablet so need more tablets to get recommended amount of elemental calcium. More expensive than calcium carbonate.
Calcium Phosphate, Calcium Lactate, and Calcium Gluconate is not recommended. Calcium phosphate is difficult to absorb; calcium lactate and calcium gluconate contain low concentrations of calcium and so require many pills to achieve recommended amount of elemental calcium.
Read labels carefully to insure that you obtain adequate elemental calcium. Elemental calcium is the amount by weight (in milligrams, mg) provided by the calcium itself in each tablet or portion. In general, you must take several tablets or portions to receive the recommended daily allowance of calcium.
Exercise and Bone Health
Exercising regularly will help maintain bone density, agility, and strength, making falls less likely and falls that do occur less likely to cause fracture.
The American Heart Association recommends:
At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150 minutes a week OR at least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes
AND
Moderate- to high-intensity muscle-strengthening activity at least 2 days per week to reduce muscle mass loss as we age (and/or lose weight).
Examples of Moderate Intensity aerobic activity: (you can talk but cannot sing)
Walking briskly (3 miles per hour or faster, but not race-walking)
Water aerobics
Bicycling slower than 10 miles per hour
Tennis (doubles)
General gardening
Examples of Vigorous Intensity aerobic activity: (you have difficulty saying more than few words at a time)
Race walking, jogging, or running
Swimming laps
Tennis (singles)
Aerobic dancing
Bicycling 10 miles per hour or faster
Jumping rope
Heavy gardening (continuous digging or hoeing)
Hiking uphill or with a heavy backpack
Strength training- pick one exercise per each of these six categories twice a week
PUSH: Wall push ups, counter push ups, floor push ups, bench press; overhead shoulder press and downward dog push ups (work with physical therapist on the latter two if any shoulder issues)
PULL: elastic band row, dumbbell row, lat pulls, pull ups
SQUAT: sit to stand, bodyweight squat, squat with weights, single leg squats
HINGE: bridge, single-leg bridge, weight bridge, deadlifts
CARRY: farmer's carry, single arm carry, bottom's up carry
REACH/PRESS: elastic band press, overhead press
You can search in YouTube if you are not sure what each movement term means.
Start small and work your way into this. Strength training can happen everywhere. When you go up stairs, try using every other stair (close to a lunge). Squat in and out of the chair 10 times before you sit down after a coffee or work break.
Perform 2-3 sets in each category twice a week.
Prioritize effort! Try to get to an 8 out of 10 effort, and do repetitions until you have about 2 repetitions “left in the tank” (or that you could do with good form). If it takes you more than 15 repetitions to get here, consider progressing in one of the following three ways: increasing weight/resistance, increasing range of motion, or slowing down the movement. To ensure proper form, consider working with a personal trainer or physical therapist, particularly if any pain in the joints arises that increases with activity or you have a history of injury or immobility in joints.
Strength Training Resources
OvaryActive Podcast Ep 28 - Stronger Not Thinner: Strength Training in Perimenopause
Hosted by gynecologists Dr. Rebecca Dunsmoor-Su and Dr. Amy Voedisch, this episode features guest Dr. Marily Oppezzo, a behavior-change expert from Stanford University
Strength Training for Healthy Aging with Dr. Marily Oppezzo: Part 2
Strength Training for Healthy Aging with Dr. Marily Oppezzo: Part 1