Medically reviewed in August 2022
Updated on September 14, 2022
All of us want to prevent osteoporosis, but how? More milk? More calcium? More vitamin D? Supplements?
There is an ongoing debate about our daily calcium intake and how much we really need. The issue is nuanced.
We have to consider a person’s age or whether they have certain medical conditions, such as hypocalcemia or hypercalcemia (where the body has too little or too much calcium in the blood). We also need to know the recommended dose for vitamin D, which the body needs to absorb calcium, and whether a person is in a high risk group for calcium and vitamin D deficiency. On top of everything, we need to be aware of the fact that many of us are vitamin D deficient.
Getting the right amount of calcium
Finding a connection between higher daily calcium intake and stronger bones has been hard for experts to prove.
Some dietary intake studies depend on adults remembering how much of a particular food or nutrient they consumed 10 or more years ago. These kinds of studies report mixed results on the connection between extra intake of dairy (which is high in calcium) in childhood and indicators of bone health such as bone density and fracture risk.
Some older studies have found positive associations between childhood dairy consumption and bone health, but more recent studies have not reported similar findings. And loading up on dairy as an adult may also not provide the benefit that experts have long suspected. In fact, a 2019 study published in the British Medical Journal found that in a cohort of women, higher consumption of dairy as an adult was associated with an increased risk of fractures.
It’s important to know that this particular study was not saying dairy products led to the fractures, just that women who ate more dairy as adults were also more likely to have fractures. Ultimately, extra dairy consumption in adulthood hasn’t been confirmed to benefit adult bones.
What's more, in a 2021 meta-analysis of clinical trials published in Nutrients, taking calcium supplements as an adult was associated with a 15 percent increase in heart disease risk in healthy postmenopausal women.
Vitamin D deficiency
What about vitamin D? Research has shown that many people are vitamin D deficient due to diet, lack of adequate sun exposure, and a variety of other factors. How much vitamin D you need depends on your age group and health status.
A couple of facts that are true for everyone:
Calcium from your diet and calcium from supplements are not the same thing. Notably, supplemental calcium can increase your risk of developing kidney stones, while a similar association has not been reported for dietary calcium. Aim to get most of your daily recommended calcium and vitamin D from your diet, supplementing only when necessary.
When looking for high-calcium foods, the richest sources are milk, calcium-enriched non-dairy milks (such as soy milk), plain yogurt, and hard, waxy cheeses, such as cheddar and Swiss. Some tofu and cereal options are also high in calcium and may contain up to 15 percent or more of the daily value per serving. Always check your food labels to be sure.
Certain lifestyle habits are important for bone health. Exercise is proven to help maintain and increase bone mass, while smoking and drinking too much alcohol can lower it.
How much calcium and vitamin D should you get? Here are some general guidelines for how much calcium and vitamin D you need at each age for your bones and overall health:
Children under 13 years old
Adequate calcium and vitamin D consumption is critical during the early years to support bone growth and health.
- For children 0 to 12 months, aim for 200 to 260 mg of calcium per day. Aim for 700 mg of calcium per day for children 1 to 3 years old, 1,000 mg of calcium per day for children between the ages of 4 and 8, and 1,300 mg of calcium per day for children 9 to 13 years old.
- The recommended amount of vitamin D for children under one year is 400 IU (International Units) per day. From age 1 until age 70, the recommended amount is 600 IU of vitamin D per day.
Age 13 to 30 in good health
The second and third decades of life are times of peak bone building. Once you hit 30, bone mass reaches its peak and will only decrease from there. That’s why getting adequate calcium and vitamin D before reaching 30 is crucial. Many guidelines say ages 9 to 18 is the best window to build bone mass, but since your bones are still building in your 20s, you should strive to get good amounts of calcium and D during this decade.
Aim for 1,000 to 1,300 mg per day of calcium and 600 IU of vitamin D per day. Additionally, it’s important to do the following:
- Maximize how much calcium you get through your diet. Some children may need a supplement to get enough calcium but check with your pediatrician first.
- Don’t forget the impact of exercise. Resistance exercises, such as those that use resistance bands, weight machines, or medicine balls, can help maintain and increase bone mass and density.
Adults over the age of 30 without osteoporosis
This area is not clear-cut. There is a lack of evidence that calcium supplementation is beneficial for healthy adults who do not have osteoporosis or osteopenia (low bone density). In fact, the risks of heart disease and kidney stones may outweigh the benefits. As a result, the United States Preventive Services Task Force (USPSTF) does not recommend taking calcium supplements if you’re in this age group.
- Aim to get 1,000 mg per day in your diet if you’re over the age of 30. If you’re a woman over 50 or a man over 70, aim to get 1,200 mg per day.
- Adults at risk for vitamin D deficiency should have their vitamin D levels checked, and take a supplement as needed if recommended by a healthcare provider (HCP). This group includes older adults, anyone who has been hospitalized, people with kidney or intestinal disease, or those with other chronic conditions. People who don’t get adequate sun exposure are also at risk. That includes most of us in the winter, especially if you live in the northern part of the country.
The Office of Dietary Supplements also includes people with dark skin, people who are obese, and those who have had gastric bypass surgery among those at risk for vitamin D deficiency. Aim for a total of 600 IU of vitamin D daily (including diet plus supplements) and 800 IU per day if you’re over the age of 70.
Adults over the age of 30 with osteoporosis or osteopenia
In this group, calcium supplementation has been shown to reduce the rate of bone loss, so supplementation is recommended.
Women who have reached menopause should get 1,200 mg per day of calcium. Those under age 70 should get 600 IU per day of vitamin D, and those 70 and older should aim for 800 IU per day.
The bottom line? When it comes to calcium and vitamin D, stick to the daily recommended intake for your age and health status. Most dietary supplements are not regulated by the U.S. Food and Drug Administration so always talk with your HCP first before taking one, and follow the recommended doses indicated on the label.
