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Introduction

Woman shopping for dietary supplements

See QuickFacts for easy-to-read facts about Calcium.

Calcium, the most abundant mineral in the body, is found in some foods, added to others, available as a dietary supplement, and present in some medicines (such as antacids). Calcium is required for vascular contraction and vasodilation, muscle function, nerve transmission, intracellular signaling and hormonal secretion, though less than 1% of total body calcium is needed to support these critical metabolic functions [1]. Serum calcium is very tightly regulated and does not fluctuate with changes in dietary intakes; the body uses bone tissue as a reservoir for, and source of calcium, to maintain constant concentrations of calcium in blood, muscle, and intercellular fluids [1].

The remaining 99% of the body's calcium supply is stored in the bones and teeth where it supports their structure and function [1]. Bone itself undergoes continuous remodeling, with constant resorption and deposition of calcium into new bone. The balance between bone resorption and deposition changes with age. Bone formation exceeds resorption in periods of growth in children and adolescents, whereas in early and middle adulthood both processes are relatively equal. In aging adults, particularly among postmenopausal women, bone breakdown exceeds formation, resulting in bone loss that increases the risk of osteoporosis over time [1].

Recommended Intakes

Intake recommendations for calcium and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine of the National Academies (formerly National Academy of Sciences) [1]. DRI is the general term for a set of reference values used for planning and assessing the nutrient intakes of healthy people. These values, which vary by age and gender, include:

  • Recommended Dietary Allowance (RDA): average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals.
  • Adequate Intake (AI): established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy.
  • Estimated Average Requirement (EAR): average daily level of intake estimated to meet the requirements of 50% of healthy individuals. It is usually used to assess the adequacy of nutrient intakes in populations but not individuals.
  • Tolerable Upper Intake Level (UL): maximum daily intake unlikely to cause adverse health effects [1].

The FNB established RDAs for the amounts of calcium required for bone health and to maintain adequate rates of calcium retention in healthy people. They are listed in Table 1 in milligrams (mg) per day.

Table 1: Recommended Dietary Allowances (RDAs) for Calcium [1]
Age Male Female Pregnant Lactating
0–6 months*200 mg200 mg  
7–12 months*260 mg260 mg  
1–3 years700 mg700 mg  
4–8 years1,000 mg1,000 mg  
9–13 years1,300 mg1,300 mg  
14–18 years1,300 mg1,300 mg1,300 mg1,300 mg
19–50 years1,000 mg1,000 mg1,000 mg1,000 mg
51–70 years1,000 mg1,200 mg  
71+ years1,200 mg1,200 mg  

* Adequate Intake (AI)

Sources of Calcium

Food
Milk, yogurt, and cheese are rich natural sources of calcium and are the major food contributors of this nutrient to people in the United States [1]. Nondairy sources include vegetables, such as Chinese cabbage, kale, and broccoli. Spinach provides calcium, but its bioavailability is poor. Most grains do not have high amounts of calcium unless they are fortified; however, they contribute calcium to the diet because they contain small amounts of calcium and people consume them frequently. Foods fortified with calcium include many fruit juices and drinks, tofu, and cereals. Selected food sources of calcium are listed in Table 2.

Table 2: Selected Food Sources of Calcium [2]
Food Milligrams (mg)
per serving
Percent DV*
Yogurt, plain, low fat, 8 ounces41542
Mozzarella, part skim, 1.5 ounces33333
Sardines, canned in oil, with bones, 3 ounces32533
Yogurt, fruit, low fat, 8 ounces313–38431–38
Cheddar cheese, 1.5 ounces30731
Milk, nonfat, 8 ounces**29930
Soymilk, calcium-fortified, 8 ounces29930
Milk, reduced-fat (2% milk fat), 8 ounces29329
Milk, buttermilk, lowfat, 8 ounces28428
Milk, whole (3.25% milk fat), 8 ounces27628
Orange juice, calcium-fortified, 6 ounces26126
Tofu, firm, made with calcium sulfate, ½ cup***25325
Salmon, pink, canned, solids with bone, 3 ounces18118
Cottage cheese, 1% milk fat, 1 cup13814
Tofu, soft, made with calcium sulfate, ½ cup***13814
Ready-to-eat cereal, calcium-fortified, 1 cup 100–1,00010–100
Frozen yogurt, vanilla, soft serve, ½ cup 10310
Turnip greens, fresh, boiled, ½ cup 9910
Kale, raw, chopped, 1 cup 10010
Kale, fresh, cooked, 1 cup 949
Ice cream, vanilla, ½ cup 848
Chinese cabbage, bok choi, raw, shredded, 1 cup 747
Bread, white, 1 slice 737
Pudding, chocolate, ready to eat, refrigerated, 4 ounces 556
Tortilla, corn, ready-to-bake/fry, one 6" diameter465
Tortilla, flour, ready-to-bake/fry, one 6" diameter 323
Sour cream, reduced fat, cultured, 2 tablespoons 313
Bread, whole-wheat, 1 slice 303
Broccoli, raw, ½ cup 212
Cheese, cream, regular, 1 tablespoon 141

* DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration to help consumers compare the nutrient contents among products within the context of a total daily diet. The DV for calcium is 1,000 mg for adults and children aged 4 years and older. Foods providing 20% of more of the DV are considered to be high sources of a nutrient, but foods providing lower percentages of the DV also contribute to a healthful diet. The U.S. Department of Agriculture’s (USDA’s) Nutrient Databaseexternal link icon Web site lists the nutrient content of many foods and provides comprehensive list of foods containing calcium arranged by nutrient content and by food name.
** Calcium content varies slightly by fat content; the more fat, the less calcium the food contains.
*** Calcium content is for tofu processed with a calcium salt. Tofu processed with other salts does not provide significant amounts of calcium.

In its food guidance system, MyPlate, the U.S. Department of Agriculture recommends that persons aged 9 years and older eat 3 cups of foods from the milk group per day [3]. A cup is equal to 1 cup (8 ounces) of milk, 1 cup of yogurt, 1.5 ounces of natural cheese (such as Cheddar), or 2 ounces of processed cheese (such as American).

Dietary supplements
The two main forms of calcium in supplements are carbonate and citrate. Calcium carbonate is more commonly available and is both inexpensive and convenient. Due to its dependence on stomach acid for absorption, calcium carbonate is absorbed most efficiently when taken with food, whereas calcium citrate is absorbed equally well when taken with or without food [4]. Calcium citrate is also useful for people with achlorhydria, inflammatory bowel disease, or absorption disorders [1]. Other calcium forms in supplements or fortified foods include gluconate, lactate, and phosphate. Calcium citrate malate is a well-absorbed form of calcium found in some fortified juices [5].

Calcium supplements contain varying amounts of elemental calcium. For example, calcium carbonate is 40% calcium by weight, whereas calcium citrate is 21% calcium. Fortunately, elemental calcium is listed in the Supplement Facts panel, so consumers do not need to calculate the amount of calcium supplied by various forms of calcium supplements.

The percentage of calcium absorbed depends on the total amount of elemental calcium consumed at one time; as the amount increases, the percentage absorption decreases. Absorption is highest in doses ≤500 mg [1]. So, for example, one who takes 1,000 mg/day of calcium from supplements might split the dose and take 500 mg at two separate times during the day.

Some individuals who take calcium supplements might experience gastrointestinal side effects including gas, bloating, constipation, or a combination of these symptoms. Calcium carbonate appears to cause more of these side effects than calcium citrate [1], so consideration of the form of calcium supplement is warranted if these side effects are reported. Other strategies to alleviate symptoms include spreading out the calcium dose throughout the day and/or taking the supplement with meals.

Medicines
Because of its ability to neutralize stomach acid, calcium carbonate is found in some over-the-counter antacid products, such as Tums® and Rolaids®. Depending on its strength, each chewable pill or softchew provides 200 to 400 mg of elemental calcium. As noted above, calcium carbonate is an acceptable form of supplemental calcium, especially for individuals who have normal levels of stomach acid.

Calcium Intakes and Status

In the United States, estimated calcium intakes from both food and dietary supplements are provided by the National Health and Nutrition Examination Survey (NHANES), 2003–2006 [6]. Mean dietary calcium intakes for males aged 1 year and older ranged from 871 to 1,266 mg/day depending on life stage group; for females the range was 748 to 968 mg/day. Groups with mean intakes falling below their respective EAR—and thus with a prevalence of inadequacy in excess of 50%—include boys and girls aged 9–13 years, girls aged 14–18 years, women aged 51–70 years, and both men and women older than 70 years [1,6]. Overall, females are less likely than males to get adequate amounts of calcium from food [7].

About 43% of the U.S. population (including almost 70% of older women) uses dietary supplements containing calcium, increasing calcium intakes by about 330 mg/day among supplement users [1,6]. According to NHANES 2003–2006 data, mean total calcium intakes from foods and supplements ranged from 918 to 1,296 mg/day for people aged 1 year and older [6]. When considering total calcium intakes, calcium inadequacy remains a concern for several age groups. These include females aged 4 years and older—particularly adolescent girls—and males aged 9 to 18 years and older than 51 years [1,8]. At the other end of the spectrum, some older women likely exceed the UL when calcium intakes from both food and supplements are included [1].

Not all calcium consumed is actually absorbed in the gut. Humans absorb about 30% of the calcium in foods, but this varies depending upon the type of food consumed [1]. Other factors also affect calcium absorption including the following:

  • Amount consumed: the efficiency of absorption decreases as calcium intake increases [1].
  • Age and life stage: net calcium absorption is as high as 60% in infants and young children, who need substantial amounts of the mineral to build bone [1,9]. Absorption decreases to 15%–20% in adulthood (though it is increased during pregnancy) and continues to decrease as people age; compared with younger adults, recommended calcium intakes are higher for females older than 50 years and for both males and females older than 70 years [1,9,10].
  • Vitamin D intake: this nutrient, obtained from food and produced by skin when exposed to sunlight of sufficient intensity, improves calcium absorption [1].
  • Other components in food: phytic acid and oxalic acid, found naturally in some plants, bind to calcium and can inhibit its absorption. Foods with high levels of oxalic acid include spinach, collard greens, sweet potatoes, rhubarb, and beans. Among the foods high in phytic acid are fiber-containing whole-grain products and wheat bran, beans, seeds, nuts, and soy isolates [1]. The extent to which these compounds affect calcium absorption varies. Research shows, for example, that eating spinach and milk at the same time reduces absorption of the calcium in milk [11]. In contrast, wheat products (with the exception of wheat bran) do not appear to lower calcium absorption [12]. For people who eat a variety of foods, these interactions probably have little or no nutritional consequence and, furthermore, are accounted for in the overall calcium DRIs, which factor in differences in absorption of calcium in mixed diets.

Some absorbed calcium is eliminated from the body in urine, feces, and sweat. This amount is affected by such factors as the following:

  • Sodium and protein intakes: high sodium intake increases urinary calcium excretion [13,14]. High protein intake also increases calcium excretion and was therefore thought to negatively affect calcium status [13,14]. However, more recent research suggests that high protein intake also increases intestinal calcium absorption, effectively offsetting its effect on calcium excretion, so whole body calcium retention remains unchanged [15].
  • Caffeine intake: this stimulant in coffee and tea can modestly increase calcium excretion and reduce absorption [16]. One cup of regular brewed coffee, for example, causes a loss of only 2–3 mg of calcium [14]. Moderate caffeine consumption (1 cup of coffee or 2 cups of tea per day) in young women has no negative effects on bone [17].
  • Alcohol intake: alcohol intake can affect calcium status by reducing its absorption [18] and by inhibiting enzymes in the liver that help convert vitamin D to its active form [19]. However, the amount of alcohol required to affect calcium status and whether moderate alcohol consumption is helpful or harmful to bone is unknown.
  • Phosphorus intake: the effect of this mineral on calcium excretion is minimal. Several observational studies suggest that consumption of carbonated soft drinks with high levels of phosphate is associated with reduced bone mass and increased fracture risk. However, the effect is probably due to replacing milk with soda rather than the phosphorus itself [20,21].
  • Fruit and vegetable intakes: metabolic acids produced by diets high in protein and cereal grains increase calcium excretion [22]. Fruits and vegetables, when metabolized, shift the acid/base balance of the body towards the alkaline by producing bicarbonate, which reduces calcium excretion. However, it is unclear if consuming more fruits and vegetables affects bone mineral density. These foods, in addition to reducing calcium excretion, could possibly reduce calcium absorption from the gut and therefore have no net effect on calcium balance.

Calcium Deficiency

Inadequate intakes of dietary calcium from food and supplements produce no obvious symptoms in the short term. Circulating blood levels of calcium are tightly regulated. Hypocalcemia results primarily from medical problems or treatments, including renal failure, surgical removal of the stomach, and use of certain medications (such as diuretics). Symptoms of hypocalcemia include numbness and tingling in the fingers, muscle cramps, convulsions, lethargy, poor appetite, and abnormal heart rhythms [23]. If left untreated, calcium deficiency leads to death.

Over the long term, inadequate calcium intake causes osteopenia which if untreated can lead to osteoporosis. The risk of bone fractures also increases, especially in older individuals [1]. Calcium deficiency can also cause rickets, though it is more commonly associated with vitamin D deficiency [1].

Groups at Risk of Calcium Inadequacy

Although frank calcium deficiency is uncommon, dietary intakes of the nutrient below recommended levels might have negative health consequences over the long term. The following groups are among those most likely to need extra calcium.

Postmenopausal women
Menopause leads to bone loss because decreases in estrogen production both increase bone resorption and decrease calcium absorption [10,24,25]. Annual decreases in bone mass of 3%–5% per year frequently occur in the first years of menopause, but the decreases are typically less than 1% per year after age 65 [26]. Increased calcium intakes during menopause do not completely offset this bone loss [27,28]. Hormone replacement therapy (HRT) with estrogen and progesterone helps increase calcium levels and prevent osteoporosis and fractures. Estrogen therapy restores postmenopausal bone remodeling to the same levels as at premenopause, leading to lower rates of bone loss [24], perhaps in part by increasing calcium absorption in the gut. Several medical groups and professional societies support the use of HRT as an option for women who are at increased risk of osteoporosis or fractures [29-31]. Such women should discuss this matter with their health care providers. In addition, consuming adequate amounts of calcium in the diet might help slow the rate of bone loss in all women.

Amenorrheic women and the female athlete triad
Amenorrhea, the condition in which menstrual periods stop or fail to initiate in women of childbearing age, results from reduced circulating estrogen levels that, in turn, have a negative effect on calcium balance. Amenorrheic women with anorexia nervosa have decreased calcium absorption and higher urinary calcium excretion rates, as well as a lower rate of bone formation than healthy women [32]. The "female athlete triad" refers to the combination of disordered eating, amenorrhea, and osteoporosis. Exercise-induced amenorrhea generally results in decreased bone mass [33,34]. In female athletes and active women in the military, low bone-mineral density, menstrual irregularities, certain dietary patterns, and a history of prior stress fractures are associated with an increased risk of future stress fractures [35]. Such women should be advised to consume adequate amounts of calcium and vitamin D. Supplements of these nutrients have been shown to reduce the risk of stress fractures in female Navy recruits during basic training [36].

Individuals with lactose intolerance or cow's milk allergy
Lactose intolerance refers to symptoms (such as bloating, flatulence, and diarrhea) that occur when one consumes more lactose, the naturally occurring sugar in milk, than the enzyme lactase produced by the small intestine can hydrolyze into its component monosaccharides, glucose and galactose [37]. The symptoms vary, depending on the amount of lactose consumed, history of consumption of lactose-containing foods, and type of meal. Although the prevalence of lactose intolerance is difficult to discern [38], some reports suggest that approximately 25% of U.S. adults have a limited ability to digest lactose, including 85% of Asians, 50% of African Americans, and 10% of Caucasians [39,40,41].

Lactose-intolerant individuals are at risk of calcium inadequacy if they avoid dairy products [1,38,39]. Research suggests that most people with lactose intolerance can consume up to 12 grams of lactose, such as that present in 8 ounces of milk, with minimal or no symptoms, especially if consumed with other foods; larger amounts can frequently be consumed if spread over the day and eaten with other foods [1,38,39]. Other options to reduce symptoms include eating low-lactose dairy products including aged cheeses (such as Cheddar and Swiss), yogurt, or lactose-reduced or lactose-free milk [1,38,39]. Some studies have examined whether it is possible to induce adaptation by consuming incremental lactose loads over a period of time [42,43], but the evidence in support of this strategy is inconsistent [38].

Cow's milk allergy is less common than lactose intolerance, affecting 0.6% to 0.9% of the population [44]. People with this condition are unable to consume any products containing cow's milk proteins and are therefore at higher risk of obtaining insufficient calcium.

To ensure adequate calcium intakes, lactose-intolerant individuals and those with cow's milk allergy can choose nondairy food sources of the nutrient (such as kale, bok choy, Chinese cabbage, broccoli, collards and fortified foods) or take a calcium supplement.

Vegetarians
Vegetarians might absorb less calcium than omnivores because they consume more plant products containing oxalic and phytic acids [1]. Lacto-ovo vegetarians (who consume eggs and dairy) and nonvegetarians have similar calcium intakes [45,46]. However, vegans, who eat no animal products and ovo-vegetarians (who eat eggs but no dairy products), might not obtain sufficient calcium because of their avoidance of dairy foods [47,48]. In the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition, bone fracture risk was similar in meat eaters, fish eaters and vegetarians, but higher in vegans, likely due to their lower mean calcium intake [49]. It is difficult to assess the impact of vegetarian diets on calcium status because of the wide variety of eating practices and thus should be considered on a case by case basis.

Calcium and Health

Many claims are made about calcium's potential benefits in health promotion and disease prevention and treatment. This section focuses on several areas in which calcium is or might be involved: bone health and osteoporosis; cardiovascular disease; blood pressure regulation and hypertension; cancers of the colon, rectum, and prostate; kidney stones; and weight management.

Bone health and osteoporosis
Bones increase in size and mass during periods of growth in childhood and adolescence, reaching peak bone mass around age 30. The greater the peak bone mass, the longer one can delay serious bone loss with increasing age. Everyone should therefore consume adequate amounts of calcium and vitamin D throughout childhood, adolescence, and early adulthood. Osteoporosis, a disorder characterized by porous and fragile bones, is a serious public health problem for more than 10 million U.S. adults, 80% of whom are women. (Another 34 million have osteopenia, or low bone mass, which precedes osteoporosis.) Osteoporosis is most associated with fractures of the hip, vertebrae, wrist, pelvis, ribs, and other bones [50]. An estimated 1.5 million fractures occur each year in the United States due to osteoporosis [51]. Supplementation with calcium plus vitamin D has been shown to be effective in reducing fractures and falls (which can cause fractures) in institutionalized older adults [52,53].

When calcium intake is low or ingested calcium is poorly absorbed, bone breakdown occurs as the body uses its stored calcium to maintain normal biological functions. Bone loss also occurs as part of the normal aging process, particularly in postmenopausal women due to decreased amounts of estrogen. Many factors increase the risk of developing osteoporosis, including being female, thin, inactive, or of advanced age; smoking cigarettes; drinking excessive amounts of alcohol; and having a family history of osteoporosis [54].

Various bone mineral density (BMD) tests are available. The T-score from these tests compares an individual's BMD to an optimal BMD (that of a healthy 30-year old adult). A T-score of -1.0 or above indicates normal bone density, -1.0 to -2.5 indicates low bone mass (osteopenia), and lower than -2.5 indicates osteoporosis [55]. Although osteoporosis affects individuals of all races, ethnicities, and both genders, women are at highest risk because their skeletons are smaller than those of men and because of the accelerated bone loss that accompanies menopause. Regular exercise and adequate intakes of calcium and vitamin D are critical to the development and maintenance of healthy bones throughout the life cycle. Both weight-bearing exercises (such as walking, running, and activities where one's feet leave and hit the ground and work against gravity) and resistance exercises (such as calisthenics and that involve weights) support bone health.

In 1993, the U.S. Food and Drug Administration authorized a health claim related to calcium and osteoporosis for foods and supplements [56]. In January 2010, this health claim was expanded to include vitamin D. Model health claims include the following: "Adequate calcium throughout life, as part of a well-balanced diet, may reduce the risk of osteoporosis" and "Adequate calcium and vitamin D as part of a healthful diet, along with physical activity, may reduce the risk of osteoporosis in later life" [56].

Cancer of the colon and rectum
Data from observational and experimental studies on the potential role of calcium in preventing colorectal cancer, though somewhat inconsistent, are highly suggestive of a protective effect [1]. Several studies have found that higher intakes of calcium from foods (low-fat dairy sources) and/or supplements are associated with a decreased risk of colon cancer [57-60]. In a follow-up study to the Calcium Polyp Prevention Study, supplementation with calcium carbonate led to reductions in the risk of adenoma (a nonmalignant tumor) in the colon, a precursor to cancer [61,62], even as long as 5 years after the subjects stopped taking the supplement [63]. In two large prospective epidemiological trials, men and women who consumed 700–800 mg per day of calcium had a 40%–50% lower risk of developing left-side colon cancer [64]. But other observational studies have found the associations to be inconclusive [60,65,66].

In the Women's Health Initiative, a clinical trial involving 36,282 postmenopausal women, daily supplementation with 1,000 mg of calcium and 400 International Units (IU) of vitamin D3 for 7 years produced no significant differences in the risk of invasive colorectal cancer compared to placebo [67]. The authors of a Cochrane systematic review concluded that calcium supplementation might moderately help prevent colorectal adenomas, but there is not enough evidence to recommend routine use of calcium supplements to prevent colorectal cancer [68]. Given the long latency period for colon cancer development, long-term studies are needed to fully understand whether calcium intakes affect colorectal cancer risk.

Cancer of the prostate
Several epidemiological studies have found an association between high intakes of calcium, dairy foods or both and an increased risk of developing prostate cancer [69-75]. However, others have found only a weak relationship, no relationship, or a negative association between calcium intake and prostate cancer risk [76-79]. The authors of a meta-analysis of prospective studies concluded that high intakes of dairy products and calcium might slightly increase prostate cancer risk [80].

Interpretation of the available evidence is complicated by the difficulty in separating the effects of dairy products from that of calcium. But overall, results from observational studies suggest that total calcium intakes >1,500 mg/day or >2,000 mg/day may be associated with increased prostate cancer risk (particularly advanced and metastatic cancer) compared with lower amounts of calcium (500–1,000 mg/day [1,81]. Additional research is needed to clarify the effects of calcium and/or dairy products on prostate cancer risk and elucidate potential biological mechanisms.

Cardiovascular disease
Calcium has been proposed to help reduce cardiovascular disease (CVD) risk by decreasing intestinal absorption of lipids, increasing lipid excretion, lowering cholesterol levels in the blood, and promoting calcium influx into cells [1]. However, data from prospective studies of calcium's effects on CVD risk are inconsistent, and whether dietary calcium has different effects on the cardiovascular system than supplemental calcium is not clear. In the Iowa Women's Health Study, higher calcium intake from diet and/or supplements was associated with reduced ischemic heart disease mortality in postmenopausal women [82]. Conversely, in a cohort of older Swedish women, both total and dietary calcium intakes of 1,400 mg/day and higher were associated with higher rates of death from CVD and ischemic heart disease than intakes of 600–1,000 mg/day [83]. Other prospective studies have shown no significant associations between calcium intake and cardiac events or cardiovascular mortality [81]. Data for stroke are mixed, with some studies linking higher calcium intakes to lower risk of stroke, and others finding no associations or trends in the opposite direction [81,83].

Several recent studies have raised concerns about the safety of calcium supplements with respect to CVD. Xiao and colleagues reported that men who took more than 1,000 mg/day supplemental calcium had a 20% higher risk of total CVD death than men who did not take supplemental calcium, but supplemental calcium intake in women was unrelated to CVD mortality [84]. In a reanalysis of data from the Women's Health Initiative (WHI), Bolland and colleagues found that calcium supplements (1,000 mg/day) taken with or without vitamin D (400 IU/day) increased the risk of cardiovascular events in women who were not taking calcium supplements when they entered the study [85]. Other studies have also shown that people who take calcium supplements have an increased risk of cardiovascular events, including myocardial infarction [86-88] and coronary heart disease [89]. However, the authors of a 2013 analysis of WHI clinical trial data combined with data from the WHI observational study, which followed over 93,000 postmenopausal women for about 8 years, concluded that "there was little evidence for an adverse influence of calcium and vitamin D supplementation on the risk for myocardial infarction, coronary heart disease, total heart disease, stroke or total cardiovascular disease" [90].

Scientists hypothesize that any adverse effects of calcium supplementation on the cardiovascular system could be mediated through hypercalcemia which can occur when excessively high calcium intakes override normal homeostatic control of serum calcium levels [83]. Hypercalcemia has been associated with increased blood coagulation, vascular calcification, and arterial stiffness, thereby raising CVD risk [84,85,91,92]. High calcium intakes can also increase circulating levels of fibroblast growth factor 23, which is associated with an increased risk of cardiovascular events [83]. Supplemental calcium, in particular, causes an acute increase in serum calcium levels, and some researchers hypothesize that this abrupt change, rather than total calcium load, could be responsible for the observed adverse effects [85].

Many scientists have questioned the strength of the available evidence that links supplemental calcium intake with CVD risk, noting that researchers have only considered CVD outcomes in secondary analyses of trial data and these outcomes have not been the primary endpoint of any calcium supplementation trials to date [91,93]. In their 2012 review of prospective studies and randomized clinical trials, Wang and colleagues concluded that calcium intake from diet or supplements appears to have little or no effect on CVD risk but the available evidence does not allow for a definitive conclusion [91]. The possibility that calcium supplements might harm the cardiovascular system has become a topic of much debate within the scientific community and warrants further investigation.

Blood pressure and hypertension
Several clinical trials have demonstrated a relationship between increased calcium intakes and both lower blood pressure and risk of hypertension [94-96], although the reductions are inconsistent. In the Women's Health Study, calcium intake was inversely associated with risk of hypertension in middle-aged and older women [97]. However, other studies have found no association between calcium intake and incidence of hypertension [81]. The authors of a systematic review of the effects of calcium supplements for hypertension found any link to be weak at best, largely due to the poor quality of most studies and differences in methodologies [98].

Calcium's effects on blood pressure might depend upon the population being studied. In hypertensive subjects, calcium supplementation appears to lower systolic blood pressure by 2–4 mmHg, whereas in normotensive subjects, calcium appears to have no significant effect on systolic or diastolic blood pressure [81].

Other observational and experimental studies suggest that individuals who eat a vegetarian diet high in minerals (such as calcium, magnesium, and potassium) and fiber and low in fat tend to have lower blood pressure [48,99-102]. The Dietary Approaches to Stop Hypertension (DASH) study was conducted to test the effects of three different eating patterns on blood pressure: a control "typical" American diet; one high in fruits and vegetables; and a third diet high in fruits, vegetables, and low-fat dairy products. The diet containing dairy products resulted in the greatest decrease in blood pressure [103], although the contribution of calcium to this effect was not evaluated. Additional information and sample DASH menu plans are available on the National Heart, Lung, and Blood Institute Web siteexternal link icon.

Kidney stones
Kidney stones in the urinary tract are most commonly composed of calcium oxalate. Some, but not all, studies suggest a positive association between supplemental calcium intake and the risk of kidney stones, and these findings were used as the basis for setting the calcium UL in adults [1]. In the Women's Health Initiative, postmenopausal women who consumed 1,000 mg of supplemental calcium and 400 IU of vitamin D per day for 7 years had a 17% higher risk of kidney stones than subjects taking a placebo [104]. The Nurses' Health Study also showed a positive association between supplemental calcium intake and kidney stone formation [105]. High intakes of dietary calcium, on the other hand, do not appear to cause kidney stones and may actually protect against developing them [1,105-108]. For most individuals, other risk factors for kidney stones, such as high intakes of oxalates from food and low intakes of fluid, probably play a bigger role than calcium intake [109].

Weight management
Several studies have linked higher calcium intakes to lower body weight or less weight gain over time [110-113]. Two explanations have been proposed. First, high calcium intakes might reduce calcium concentrations in fat cells by decreasing the production of two hormones (parathyroid hormone and an active form of vitamin D) that increase fat breakdown in these cells and discourage fat accumulation [112]. Secondly, calcium from food or supplements might bind to small amounts of dietary fat in the digestive tract and prevent its absorption [112,114,115]. Dairy products, in particular, might contain additional components that have even greater effects on body weight than their calcium content alone would suggest [116-121].

Despite these findings, the results from clinical trials have been largely negative. For example, dietary supplementation with 1,500 mg/day of calcium (from calcium carbonate) for 2 years was found to have no clinically significant effects on weight in 340 overweight and obese adults as compared with placebo [122]. Three reviews of published studies on calcium from supplements or dairy products on weight management came to similar conclusions [81,123,124]. A meta-analysis of 13 randomized controlled trials published in 2006 concluded that neither calcium supplementation nor increased dairy product consumption had a statistically significant effect on weight reduction [123]. More recently, a 2009 evidence report from the Agency for Healthcare Research and Quality concluded that, overall, clinical trial results do not support an effect of calcium supplementation on weight loss [81]. Also, a 2012 meta-analysis of 29 randomized controlled trials found no benefit of an increased consumption of dairy products on body weight and fat loss in long-term studies [124]. Overall, the results from clinical trials do not support a link between higher calcium intakes and lower body weight or weight loss.

Health Risks from Excessive Calcium

Excessively high levels of calcium in the blood known as hypercalcemia can cause renal insufficiency, vascular and soft tissue calcification, hypercalciuria (high levels of calcium in the urine) and kidney stones [1]. Although very high calcium intakes have the potential to cause hypercalcemia [83], it is most commonly associated with primary hyperparathyroidism or malignancy [1].

High calcium intake can cause constipation. It might also interfere with the absorption of iron and zinc, though this effect is not well established [1]. High intake of calcium from supplements, but not foods, has been associated with increased risk of kidney stones [1,104,105]. Some evidence links higher calcium intake with increased risk of prostate cancer, but this effect is not well understood, in part because it is challenging to separate the potential effect of dairy products from that of calcium [1]. Some studies also link high calcium intake, particularly from supplements, with increased risk of cardiovascular disease [83-89].

The Tolerable Upper Intake Levels (ULs) for calcium established by the Food and Nutrition Board are listed in Table 3 in milligrams (mg) per day. Getting too much calcium from foods is rare; excess intakes are more likely to be caused by the use of calcium supplements. NHANES data from 2003–2006 indicate that approximately 5% of women older than 50 years have estimated total calcium intakes (from foods and supplements) that exceed the UL by about 300–365 mg [1,6].

Table 3: Tolerable Upper Intake Levels (ULs) for Calcium [1]
Age Male Female Pregnant Lactating
0–6 months1,000 mg1,000 mg  
7–12 months1,500 mg1,500 mg  
1–8 years2,500 mg2,500 mg  
9–18 years3,000 mg3,000 mg3,000 mg 3,000 mg
19–50 years2,500 mg2,500 mg2,500 mg2,500 mg
51+ years2,000 mg2,000 mg  

Interactions with Medications

Calcium supplements have the potential to interact with several types of medications. This section provides a few examples. Individuals taking these medications on a regular basis should discuss their calcium intake with their healthcare providers.

Calcium can decrease absorption of the following drugs when taken together: biphosphonates (to treat osteoporosis), the fluoroquinolone and tetracycline classes of antibiotics, levothyroxine, phenytoin (an anticonvulsant), and tiludronate disodium (to treat Paget's disease) [125-127].

Thiazide-type diuretics can interact with calcium carbonate and vitamin D supplements, increasing the risks of hypercalcemia and hypercalciuria [126].

Both aluminum- and magnesium-containing antacids increase urinary calcium excretion. Mineral oil and stimulant laxatives decrease calcium absorption. Glucocorticoids, such as prednisone, can cause calcium depletion and eventually osteoporosis when they are used for months [126].

Calcium and Healthful Diets

The federal government's 2010 Dietary Guidelines for Americans notes that "nutrients should come primarily from foods. Foods in nutrient-dense, mostly intact forms contain not only the essential vitamins and minerals that are often contained in nutrient supplements, but also dietary fiber and other naturally occurring substances that may have positive health effects. ...Dietary supplements...may be advantageous in specific situations to increase intake of a specific vitamin or mineral."

For more information about building a healthful diet, refer to the Dietary Guidelines for Americansexternal link icon and the U.S. Department of Agriculture's food guidance system, MyPlateexternal link icon.

The Dietary Guidelines for Americans describes a healthy diet as one that:

  • Emphasizes a variety of fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products.
    Many dairy products, such as milk, cheese, and yogurt, are rich sources of calcium. Some vegetables provide significant amounts of calcium, as do some fortified cereals and juices.
  • Includes lean meats, poultry, fish, beans, eggs, and nuts.
    Tofu made with calcium salts is a good source of calcium (check the label), as are canned sardines and canned salmon with edible bones.
  • Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.
    Low-fat and nonfat dairy products provide amounts of calcium that are roughly similar to the amounts in their full-fat versions.
  • Stays within your daily calorie needs.

References

  1. Committee to Review Dietary Reference Intakes for Vitamin D and Calcium, Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press, 2010.
  2. U.S. Department of Agriculture, Agricultural Research Service. 2011. USDA National Nutrient Database for Standard Reference, Release 24. Nutrient Data Laboratory Home Page, http://www.ars.usda.gov/ba/bhnrc/ndlexternal link icon.
  3. U.S. Department of Agriculture, Center for Nutrition Policy and Promotion. ChooseMyPlate.govexternal link icon, 2011.
  4. Straub DA. Calcium supplementation in clinical practice: a review of forms, doses, and indications. Nutr Clin Pract. 2007;22:286-96. [PubMed abstract]
  5. Andon MB, Peacock M, Kanerva RL, De Castro JAS. Calcium absorption from apple and orange juice fortified with calcium citrate malate (CCM). J Am Coll Nutr 1996;15:313-6. [PubMed abstract]
  6. Bailey RL, Dodd KW, Goldman JA, Gahche JJ, Dwyer JT, Moshfegh AJ, Sempos CT, Picciano MF. Estimation of total usual calcium and vitamin D intakes in the United States. J Nutr. 2010 Apr;140(4):817-22. [PubMed abstract]
  7. Ervin RB, Wang C-Y, Wright JD, Kennedy-Stephenson J. Dietary intake of selected minerals for the United States population: 1999-2000. Advance Data from Vital and Health Statistics, number 341. Hyattsville, MD: National Center for Health Statistics, 2004.
  8. Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA. Clarification of DRIs for calcium and vitamin D across age groups. J Am Diet Assoc. 2011 Oct;111(10):1467. [PubMed abstract]
  9. National Institutes of Health. Optimal calcium intake. NIH Consensus Statement: 1994;12:1-31. [PubMed abstract]
  10. Heaney RP, Recker RR, Stegman MR, Moy AJ. Calcium absorption in women: relationships to calcium intake, estrogen status, and age. J Bone Miner Res 1989;4:469-75. [PubMed abstract]
  11. Weaver CM, Heaney RP. Isotopic exchange of ingested calcium between labeled sources: evidence that ingested calcium does not form a common absorptive pool. Calcif Tissue Int 1991;49:244-7. [PubMed abstract]
  12. Weaver CM, Heaney RP, Martin BR, Fitzsimmons ML. Human calcium absorption from whole-wheat products. J Nutr 1991;121:1769-75. [PubMed abstract]
  13. Weaver CM, Proulx WR, Heaney RP. Choices for achieving adequate dietary calcium with a vegetarian diet. Am J Clin Nutr 1999;70:543S-8S. [PubMed abstract]
  14. Heaney RP. Bone mass, nutrition, and other lifestyle factors. Nutr Rev 1996;54:S3-S10. [PubMed abstract]
  15. Kerstetter JE, O'Brien KO, Caseria DM, Wall DE, Insogna KL. The impact of dietary protein on calcium absorption and kinetic measures of bone turnover in women. J Clin Endocrinol Metab. 2005 Jan;90(1):26-31. [PubMed abstract]
  16. Barrett-Connor E, Chang JC, Edelstein SL. Coffee-associated osteoporosis offset by daily milk consumption. JAMA 1994;271:280-3. [PubMed abstract]
  17. Massey LK, Whiting SJ. Caffeine, urinary calcium, calcium metabolism, and bone. J Nutr 1993;123:1611-4. [PubMed abstract]
  18. Hirsch PE, Peng TC. Effects of alcohol on calcium homeostasis and bone. In: Anderson J, Garner S, eds. Calcium and Phosphorus in Health and Disease. Boca Raton, FL: CRC Press, 1996:289-300.
  19. U.S. Department of Agriculture. Results from the United States Department of Agriculture's 1994-96 Continuing Survey of Food Intakes by Individuals/Diet and Health Knowledge Survey, 1994-96.
  20. Calvo MS. Dietary phosphorus, calcium metabolism and bone. J Nutr 1993;123:1627-33. [PubMed abstract]
  21. Heaney RP, Rafferty K. Carbonated beverages and urinary calcium excretion. Am J Clin Nutr 2001;74:343-7. [PubMed abstract]
  22. Fenton TR, Eliasziw M, Lyon AW, Tough SC, Hanley DA. Meta-analysis of the quantity of calcium excretion associated with the net acid excretion of the modern diet under the acid-ash diet hypothesis. Am J Clin Nutr. 2008 Oct;88(4):1159-66. [PubMed abstract]
  23. Weaver CM, Heaney RP. Calcium. In: Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ. Modern Nutrition in Health and Disease. 10th ed. Baltimore, MD: Lippincott Williams & Wilkins, 2006:194-210.
  24. Breslau NA. Calcium, estrogen, and progestin in the treatment of osteoporosis. Rheum Dis Clin North Am 1994;20:691-716. [PubMed abstract]
  25. Gallagher JC, Riggs BL, Deluca HF. Effect of estrogen on calcium absorption and serum vitamin D metabolites in postmenopausal osteoporosis. J Clin Endocrinol Metab 1980;51:1359-64. [PubMed abstract]
  26. Daniels CE. Estrogen therapy for osteoporosis prevention in postmenopausal women. Pharmacy Update-NIH 2001;March/April.
  27. Dawson-Hughes B, Dallal GE, Krall EA, Sadowski L, Sahyoun N, Tannenbaum S. A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med 1990;323:878-83. [PubMed abstract]
  28. Elders PJ, Lips P, Netelenbos JC, van Ginkel FC, Khoe E, van der Vijgh WJ, et al. Long-term effect of calcium supplementation on bone loss in perimenopausal women. J Bone Min Res 1994;9:963-70. [PubMed abstract]
  29. National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health. Osteoporosis Handout on Healthexternal link icon. NIH Publication No. 11-5158; 2011.
  30. American College of Obstetricians and Gynecologists. Hormone Therapyexternal link icon, April 2013.
  31. North American Menopause Society. The 2012 hormone therapy position statement of: The North American Menopause Society. Menopause 2012;19:257-71. [PubMed abstract]
  32. Abrams SA, Silber TJ, Esteban NV, Vieira NE, Stuff JE, Meyers R, et al. Mineral balance and bone turnover in adolescents with anorexia nervosa. J Pediatr 1993;123:326-31. [PubMed abstract]
  33. Drinkwater B, Bruemner B, Chesnut C. Menstrual history as a determinant of current bone density in young athletes. JAMA 1990;263:545-8. [PubMed abstract]
  34. Marcus R, Cann C, Madvig P, Minkoff J, Goddard M, Bayer M, et al. Menstrual function and bone mass in elite women distance runners: endocrine and metabolic features. Ann Intern Med 1985;102:158-63. [PubMed abstract]
  35. Nattiv A. Stress fractures and bone health in track and field athletes. J Sci Med Sport 2000;3:268-79. [PubMed abstract]
  36. Lappe J, Cullen D, Haynatzki G, Recker R, Ahlf R, Thompson K. Calcium and vitamin d supplementation decreases incidence of stress fractures in female navy recruits. J Bone Miner Res. 2008 May;23(5):741-9. [PubMed abstract]
  37. Wilt TJ, Shaukat A, Shamliyan T, Taylor BC, MacDonald R, Tacklind J, Rutks I, Schwarzenberg SJ, Kane RL, and Levitt M. Lactose Intolerance and Health. No. 192 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. HHSA 290-2007-10064-I.) AHRQ Publication No. 10-E004. Rockville, MD. Agency for Healthcare Research and Quality. February 2010.
  38. Suchy FJ, Brannon PM, Carpenter TO, Fernandez JR, Gilsanz V, Gould JB, Hall K, Hui SL, Lupton J, Mennella J, Miller NJ, Osganian SK, Sellmeyer DE, Wolf MA. NIH Consensus Development Conference Statement: Lactose Intolerance and Healthexternal link icon. NIH Consens State Sci Statements. 2010 Feb 22–24; 27(2):1–27.
  39. Johnson AO, Semenya JG, Buchowski MS, Enwonwu CO, Scrimshaw NS. Correlation of lactose maldigestion, lactose intolerance, and milk intolerance. Am J Clin Nutr 1993;57:399-401. [PubMed abstract]
  40. Nose O, Iida Y, Kai H, Harada T, Ogawa M, Yabuuchi H. Breath hydrogen test for detecting lactose malabsorption in infants and children: prevalence of lactose malabsorption in Japanese children and adults. Arch Dis Child 1979;54:436-40. [PubMed abstract]
  41. Rao DR, Bello H, Warren AP, Brown GE. Prevalence of lactose maldigestion: influence and interaction of age, race, and sex. Dig Dis Sci 1994;39:1519-24. [PubMed abstract]
  42. Hertzler SR, Savaiano DA. Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. Am J Clin Nutr 1996;64:232-6. [PubMed abstract]
  43. Pribila BA, Hertzler SR, Martin BR, Weaver CM, Savaiano DA. Improved lactose digestion and intolerance among African-American adolescent girls fed a dairy-rich diet. J Am Diet Assoc 2000;100:524-8. [PubMed abstract]
  44. Rona RJ, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, Sigurdardottir ST, Lindner T, Goldhahn K, Dahlstrom J, McBride D, Madsen C. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol. 2007 Sep;120(3):638-46. [PubMed abstract]
  45. Marsh AG, Sanchez TV, Midkelsen O, Keiser J, Mayor G. Cortical bone density of adult lacto-ovo-vegetarian and omnivorous women. J Am Diet Assoc 1980;76:148-51. [PubMed abstract]
  46. Reed JA, Anderson JJ, Tylavsky FA, Gallagher JCJ. Comparative changes in radial-bone density of elderly female lactoovovegetarians and omnivores. Am J Clin Nutr 1994;59:1197S-202S. [PubMed abstract]
  47. Janelle KC, Barr SI. Nutrient intakes and eating behavior scores of vegetarian and nonvegetarian women. J Am Diet Assoc 1995;95:180-6. [PubMed abstract]
  48. American Dietetic Association, Dietitians of Canada. Position of the American Dietetic Association and Dietitians of Canada: vegetarian diets. J Am Diet Assoc 2003;103:748-65. [PubMed abstract]
  49. Appleby P, Roddam A, Allen N, Key T. Comparative fracture risk in vegetarians and nonvegetarians in EPIC-Oxford. Eur J Clin Nutr. 2007 Dec;61(12):1400-6. [PubMed abstract]
  50. National Institutes of Health. Osteoporosis prevention, diagnosis, and therapy. NIH Consensus Statement Online 2000:1-45. [PubMed abstract]
  51. Riggs BL, Melton L. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 1995;17:505S-11S. [PubMed abstract]
  52. Cranney A, Horsley T, O’Donnell S, Weiler HA, Puil L, Ooi DS, Atkinson SA, Ward LM, Moher D, Hanley DA, Fang M, Yazdi F, Garritty C, Sampson M, Barrowman N, Tsertsvadze A, Mamaladze V. Effectiveness and Safety of Vitamin D in Relation to Bone Health. Evidence Report/Technology Assessment No. 158 (Prepared by the University of Ottawa Evidence-based Practice Center (UO-EPC) under Contract No. 290-02-0021. AHRQ Publication No. 07-E013. Rockville, MD: Agency for Healthcare Research and Quality. August 2007.
  53. Moyer VA. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013; published online ahead of print on February 26. [PubMed abstract]
  54. National Osteoporosis Foundation. About Osteoporosis: Factors that Put You at Riskexternal link icon, 2011.
  55. National Osteoporosis Foundation. About Osteoporosis: Having a Bone Density Testexternal link icon, 2011.
  56. U.S. Food and Drug Administration. Food labeling: health claimsexternal link icon; calcium and osteoporosis, and calcium, vitamin D, and osteoporosis.
  57. Slattery M, Edwards S, Boucher K, Anderson K, Caan B. Lifestyle and colon cancer: an assessment of factors associated with risk. Am J Epidemiol 1999;150:869-77. [PubMed abstract]
  58. Kampman E, Slattery M, Bette C, Potter J. Calcium, vitamin D, sunshine exposure, dairy products, and colon cancer risk. Cancer Causes Control 2000;11:459-66. [PubMed abstract]
  59. Holt P, Atillasoy E, Gilman J, Guss J, Moss SF, Newmark H, et al. Modulation of abnormal colonic epithelial cell proliferation and differentiation by low-fat dairy foods. JAMA 1998;280:1074-9. [PubMed abstract]
  60. Biasco G, Paganelli M. European trials on dietary supplementation for cancer prevention. Ann N Y Acad Sci 1999;889:152-6. [PubMed abstract]
  61. Baron JA, Beach M, Mandel JS, van Stolk RU, Haile RW, Sandler RS, et al. Calcium supplements for the prevention of colorectal adenomas. N Engl J Med 1999;340:101-7. [PubMed abstract]
  62. Bonithon-Kopp C, Kronborg O, Giacosa A, Rath U, Faivre J. Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial. European Cancer Prevention Organisation Study Group. Lancet. 2000;356:1300-6. [PubMed abstract]
  63. Grau MV, Baron JA, Sandler RS, Wallace K, Haile RW, Church TR, et al. Prolonged effect of calcium supplementation on risk of colorectal adenomas in a randomized trial. J Natl Cancer Inst 2007;99:129-36. [PubMed abstract]
  64. Wu K, Willett WC, Fuchs CS, Colditz GA, Giovannucci EL. Calcium intake and risk of colon cancer in women and men. J Natl Cancer Inst 2002;94:437-46. [PubMed abstract]
  65. Cascinu S, Del Ferro E, Cioccolini P. Effects of calcium and vitamin supplementation on colon cancer cell proliferation in colorectal cancer. Cancer Invest 2000;18:411-6. [PubMed abstract]
  66. Martinez ME, Willett WC. Calcium, vitamin D, and colorectal cancer: a review of epidemiologic evidence. Cancer Epidemiol Biomarkers Prev 1998;7:163-8. [PubMed abstract]
  67. Wactawski-Wende J, Kotchen JM, Anderson GL, Assaf AR, Brunner RL, O'Sullivan MJ, et al. Calcium plus vitamin D supplementation and the risk of colorectal cancer. N Engl J Med 2006;354:684-96. [PubMed abstract]
  68. Weingarten MA, Zalmanovici A, Yaphe J. Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD003548. [PubMed abstract]
  69. Chan JM, Stampfer MJ, Gann PH, Gaziano JM, Giovannucci EL. Dairy products, calcium, and prostate cancer risk in the Physicians Health Study. Am J Clin Nutr 2001;74:549-54. [PubMed abstract]
  70. Giovannucci EL, Rimm EB, Wolk A, Ascherio A, Stampfer MJ, Colditz GA, et al. Calcium and fructose intake in relation to risk of prostate cancer. Cancer Res 1998;58:442-7. [PubMed abstract]
  71. Chan JM, Giovannucci E, Andersson SO, Yuen J, Adami HO, Wok A. Dairy products, calcium, phosphorous, vitamin D, and risk of prostate cancer (Sweden). Cancer Causes Control 1998;9:559-66. [PubMed abstract]
  72. Chan JM, Giovannucci EL. Dairy products, calcium, and vitamin D and risk of prostate cancer. Epidemiol Rev 2001;23:87-92. [PubMed abstract]
  73. Rodriguez C, McCullough ML, Mondul AM, Jacobs EJ, Fakhrabadi-Shokoohi D, Giovannucci EL, et al. Calcium, dairy products, and risk of prostate cancer in a prospective cohort of United States men. Cancer Epidemiol Biomarkers Prev 2003;12:597-603. [PubMed abstract]
  74. Kesse E, Bertrais S, Astorg P, Jaouen A, Arnault N, Galan P, et al. Dairy products, calcium and phosphorus intake, and the risk of prostate cancer: results of the French prospective SU.VI.MAX (Supplementation en Vitamines et Mineraux Antioxydants) study. Br J Nutr 2006;95:539-45. [PubMed abstract]
  75. Mitrou PN, Albanes D, Weinstein SJ, Pietinen P, Taylor PR, Virtamo J, et al. A prospective study of dietary calcium, dairy products and prostate cancer risk (Finland). Int J Cancer 2007;120:2466-73. [PubMed abstract]
  76. Chan JM, Pietinen P, Virtanen M, Chan JM, Pietinen P, Virtanen M, et al. Diet and prostate cancer risk in a cohort of smokers, with a specific focus on calcium and phosphorus (Finland). Cancer Causes Control 2000;11:859-67. [PubMed abstract]
  77. Schuurman AG, Van den Brandt PA, Dorant E, Goldbohm RA. Animal products, calcium and protein and prostate cancer risk in the Netherlands Cohort Study. Br J Cancer 1999;80:1107-13. [PubMed abstract]
  78. Kristal AR, Stanford JL, Cohen JH, Wicklund K, Patterson RE. Vitamin and mineral supplement use is associated with reduced risk of prostate cancer. Cancer Epidemiol Biomarkers Prev 1999;8:887-92. [PubMed abstract]
  79. Vlajinac HD, Marinkovic JM, Ilic MD, Kocev NI. Diet and prostate cancer: a case-control study. Eur J Cancer 1997;33:101-7. [PubMed abstract]
  80. Gao X, LaValley MP, Tucker KL. Prospective studies of dairy product and calcium intakes and prostate cancer risk: a meta-analysis. J Natl Cancer Inst 2005;97:1768-77. [PubMed abstract]
  81. Chung M, Balk EM, Brendel M, Ip S, Lau J, Lee J, Lichtenstein A, Patel K, Raman G, Tatsioni A, Terasawa T, Trikalinos TA. Vitamin D and Calcium: Systematic Review of Health Outcomes. Evidence Report/Technology Assessment No. 183. (Prepared by Tufts Evidence-based Practice Center under Contract No. 290-2007-10055-I). AHRQ Publication No. 09-E015, Rockville, MD: Agency for Healthcare Research and Quality. August 2009.
  82. Bostick RM, Kushi LH, Wu Y, Meyer KA, Sellers TA, Folsom AR. Relation of calcium, vitamin D, and dairy food intake to ischemic heart disease mortality among postmenopausal women. Am J Epidemiol. 1999 Jan 15;149(2):151-61. [PubMed abstract]
  83. Michaelsson K, Melhus H, Warensjo Lemming E, Wold A, Byberg L. Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study. BMJ 2013;12;346:f228. [PubMed abstract]
  84. Xiao Q, Murphy RA, Houston DK, Harris TB, Chow WH, Park Y. Dietary and Supplemental Calcium Intake and Cardiovascular Disease Mortality: The National Institutes of Health-AARP Diet and Health Study. JAMA Intern Med. 2013 Feb 4:1-8. [PubMed abstract]
  85. Bolland MJ, Grey A, Avenell A, Gamble GD, Reid IR. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis. BMJ. 2011 Apr 19;342:d2040. [PubMed abstract]
  86. Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, Reid IR.Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010 Jul 29;341:c3691. [PubMed abstract]
  87. Bolland MJ, Barber PA, Doughty RN, Mason B, Horne A, Ames R, Gamble GD, Grey A, Reid IR. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ 2008; 2;336:262-6. [PubMed abstract]
  88. Li K, Kaaks R, Linseisen J, Rohrmann S. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg). Heart 2012;98:920-5. [PubMed abstract]
  89. Pentti K, Tuppurainen MT, Honkanen R, Sandini L, Kröger H, Alhava E, Saarikoski S. Use of calcium supplements and the risk of coronary heart disease in 52–62-year-old women: The Kuopio Osteoporosis Risk Factor and Prevention Study. Maturitas 2009;63:73-8. [PubMed abstract]
  90. Prentice RL, Pettinger MB, Jackson RD, Wactawski-Wende J, Lacroix AZ, Anderson GL, Chlebowski RT, Manson JE, Van Horn L, Vitolins MZ, Datta M, Leblanc ES, Cauley JA, Rossouw JE. Health risks and benefits from calcium and vitamin D supplementation: Women's Health Initiative clinical trial and cohort study. Osteoporos Int 2013;24:567-80. [PubMed abstract]
  91. Wang L, Manson JE, Sesso HD. Calcium intake and risk of cardiovascular disease: a review of prospective studies and randomized clinical trials. Am J Cardiovasc Drugs 2012;12:105-16. [PubMed abstract]
  92. Seely S. Is calcium excess in western diet a major cause of arterial disease? Int J Cardiol 1991;33:191-8. [PubMed abstract]
  93. Heaney RP, Kopecky S, Maki KC, Hathcock J, Mackay D, Wallace TC. A review of calcium supplements and cardiovascular disease risk. Adv Nutr 2012;3:763-71. [PubMed abstract]
  94. Allender PS, Cutler JA, Follmann D, Cappuccio FP, Pryer J, Elliott P. Dietary calcium and blood pressure. Ann Intern Med 1996;124:825-31. [PubMed abstract]
  95. Bucher HC, Cook RJ, Guyatt GH, Lang JD, Cook DJ, Hatala R, et al. Effects of dietary calcium supplementation on blood pressure. JAMA 1996;275:1016-22. [PubMed abstract]
  96. McCarron D, Reusser M. Finding consensus in the dietary calcium-blood pressure debate. J Am Coll Nutr 1999;18:398S-405S. [PubMed abstract]
  97. Wang L, Manson JE, Buring JE, Lee IM, Sesso HD. Dietary intake of dairy products, calcium, and vitamin D and the risk of hypertension in middle-aged and older women. Hypertension. 2008 Apr;51(4):1073-9. [PubMed abstract]
  98. Dickinson HO, Nicolson DJ, Cook JV, Campbell F, Beyer FR, Ford GA, et al. Calcium supplementation for the management of primary hypertension in adults. Cochrane Database Syst Rev 2006;(2):CD004639. [PubMed abstract]
  99. Rouse IL, Beilin LJ, Armstrong BK, Vandongen R. Blood-pressure-lowering effect of a vegetarian diet: controlled trial in normotensive subjects. Lancet 1983;1:5-10. [PubMed abstract]
  100. Margetts BM, Beilin L, Armstrong BK, Vandongen R. Vegetarian diet in the treatment of mild hypertension: a randomized controlled trial. J Hypertens 1985:S429-31. [PubMed abstract]
  101. Beilin LJ, Armstrong BK, Margetts BM, Rouse IL, Vandongen R. Vegetarian diet and blood pressure. Nephron 1987;47:37-41. [PubMed abstract]
  102. Berkow SE, Barnard ND. Blood pressure regulation and vegetarian diets. Nutr Rev 2005;63:1-8. [PubMed abstract]
  103. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med 1997;336:1117-24. [PubMed abstract]
  104. Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 2006;354:669-83. [PubMed abstract]
  105. Curhan GC, Willett WC, Speizer FE, Spiegelman D, Stampfer MJ. Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Intern Med. 1997 Apr 1;126(7):497-504. [PubMed abstract]
  106. Curhan G, Willett WC, Rimm E, Stampher MJ. A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med 1993;328:833-8. [PubMed abstract]
  107. Bihl G, Meyers A. Recurrent renal stone disease—advances in pathogenesis and clinical management. Lancet 2001;358:651-6. [PubMed abstract]
  108. Hall WD, Pettinger M, Oberman A, Watts NB, Johnson KC, Paskett ED, et al. Risk factors for kidney stones in older women in the Southern United States. Am J Med Sci 2001;322:12-8. [PubMed abstract]
  109. Borghi L, Schianchi T, Meschi T, Guerra A, Allegri F, Maggiore U, et al. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med 2002;346:77-84. [PubMed abstract]
  110. Davies KM, Heaney RP, Recker RR, Lappe JM, Barger-Lux MJ, Rafferty K, et al. Calcium intake and body weight. J Clin Endocrinol Metab 2000;85:4635-8. [PubMed abstract]
  111. Heaney RP. Normalizing calcium intake: projected population effects for body weight. J Nutr 2003;133:268S-70S. [PubMed abstract]
  112. Parikh SJ, Yanovski JA. Calcium intake and adiposity. Am J Clin Nutr 2003;77:281-7. [PubMed abstract]
  113. Zemel MB, Shi H, Greer B, DiRienzo D, Zemel P. Regulation of adiposity by dietary calcium. FASEB J 2000;14:1132-8. [PubMed abstract]
  114. Jacobsen R, Lorenzen JK, Toubro S, Krog-Mikkelsen I, Astrup A. Effect of short-term high dietary calcium intake on 24-h energy expenditure, fat oxidation, and fecal fat excretion. Int J Obes 2005;29:292-301. [PubMed abstract]
  115. Christensen R, Lorenzen JK, Svith CR, Bartels EM, Melanson EL, Saris WH, et al. Effect of calcium from dairy and dietary supplements on faecal fat excretion: a meta-analysis of randomized controlled trials. Obes Rev 2009;10:475-86. [PubMed abstract]
  116. Heaney RP. Calcium and weight: clinical studies. J Am Coll Nutr 2002;21:152S-5S. [PubMed abstract]
  117. Shi H, DiRienzo DD, Zemel MB. Effects of dietary calcium on adipocyte lipid metabolism and body weight regulation in energy-restricted aP2-agouti transgenic mice. FASEB J 2001;15:291-3. [PubMed abstract]
  118. Zemel MB, Shi H, Greer B, DiRienzo D, Zemel P. Regulation of adiposity by dietary calcium. FASEB J 2000;14:1132-8. [PubMed abstract]
  119. Zemel MB, Thompson W, Milstead A, Morris K, Campbell P. Calcium and dairy acceleration of weight and fat loss during energy restriction in obese adults. Obes Res 2004;12:582-90. [PubMed abstract]
  120. Zemel MB, Richards J, Mathis S, Milstead A, Gebhardt L, Silva E. Dairy augmentation of total and central fat loss in obese subjects. Int J Obes 2005;29:391-7. [PubMed abstract]
  121. Zemel MB, Richards J, Milstead A, Campbell P. Effects of calcium and dairy on body composition and weight loss in African-American adults. Obes Res 2005;13:1218-25. [PubMed abstract]
  122. Yanovski JA, Parikh SJ, Yanoff LB, Denkinger BI, Calis KA, Reynolds JC, et al. Effects of calcium supplementation on body weight and adiposity in overweight and obese adults. Ann Intern Med 2009;150:821-829. [PubMed abstract]
  123. Trowman R, Dumville JC, Hahn S, Torgerson DJ. A systematic review of the effects of calcium supplementation on body weight. Br J Nutr 2006;95:1033-8. [PubMed abstract]
  124. Chen M, Pan A, Malik VS, Hu FB. Effects of dairy intake on body weight and fat: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2012;96:735-747. [PubMed abstract]
  125. Shannon MT, Wilson BA, Stang CL. Health Professionals Drug Guide. Stamford, CT: Appleton and Lange, 2000.
  126. Jellin JM, Gregory P, Batz F, Hitchens K. Pharmacist's Letter/Prescriber's Letter Natural Medicines Comprehensive Database. 3rd ed. Stockton, CA: Therapeutic Research Facility, 2000.
  127. Peters ML, Leonard M, Licata AA. Role of alendronate and risedronate in preventing and treating osteoporosis. Cleve Clin J Med 2001;68:945-51. [PubMed abstract]

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This fact sheet by the Office of Dietary Supplements provides information that should not take the place of medical advice. We encourage you to talk to your health care providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. Any mention in this publication of a specific brand name is not an endorsement of the product.

Reviewed: November 21, 2013