Calcium has many functions in human body, bones’ strength is being one of those, and so there are many forms of calcium supplements available. Most of those forms of calcium help restore calcium level of our bones. But their functionalities and actions are different and so we need to shortlist 5 best calcium supplements bases their usage and action.

Our body’s framework consists of bones and connective tissues which includes cartilage, ligaments, and tendons. At the time of birth, infants have around 300 bones, which fuse to form larger bones and so 206 bones remains in adults. These 206 bones are called skeleton which majorly may be classified as:

· Skull which includes the jaw bone

· Spine – cervical, thoracic and lumbar vertebrae, sacrum and tailbone (coccyx)

· Chest – ribs and breastbone (sternum)

· Arms – shoulder blade (scapula), collar bone (clavicle), humerus, radius and ulna

· Hands – wrist bones (carpals), metacarpals and phalanges

· Pelvis – hip bones

· Legs – thigh bone (femur), kneecap (patella), shin bone (tibia) and fibula

· Feet – tarsals, metatarsals and phalanges.

Functions of bones

· Provides shape to the body.

· Protects internal organs like brain, heart, lungs etc.

· Provides support to the body and anchors muscles.

· Serves as storage space for minerals like calcium and phosphate

· Helps in facilitating body movements.

Bones serve as the birthplace for red blood cells.

Bone Tissues

The different layers of bone tissue include:

· Periosteum – the dense, tough outer shell that contains blood vessels and nerves

· Compact or dense tissue – the hard, smooth layer that protects the tissue within

· Spongy or cancellous tissue – the porous, honeycombed material found inside most bones, which allows the bone to be strong yet lightweight

· Bone marrow – the jelly-like substance found inside the cavities of some bones (including the pelvis) that produces blood cells.

Bone marrow

Bone marrow is where blood cells are made. The three different types of blood cell made by bone marrow include:

· Red blood cells – carry oxygen around the body.

· White blood cells – make up the body’s immune system.

· Platelets – are used for clotting.

Bone Cells

Our body is constantly remodelling its skeleton by building up and breaking down bone tissue as required. As a result, each bone is rebuilt from scratch about every decade. The bone cells involved in this process include:

· Osteoblasts – the cells that build bone tissue

· Osteocytes – the cells that maintain bone tissue by controlling the mineral and calcium content

· Osteoclasts – the cells that break down old bone tissue.

Bone Conditions

· Fractures – broken bones of various types

· Osteoporosis – loss of bone density and strength

· Osteomyelitis – infection of the bone

· Osteitis – bone inflammation, for example, Paget’s disease of the bone

· Acromegaly – overgrowth of bones in the face, hands and feet

· Fibrous dysplasia – abnormal growth or swelling of bone

· Rickets – a child’s growing bones fail to develop due to a lack of vitamin D

· Multiple myeloma – cancer of the plasma cells in bone marrow

· Bone cancer – primary bone cancers include osteosarcomas and chondrosarcomas.

What our Bones are made-up of?

Bones are mostly made up of collagen, which gets its strength through mineralisation process, i.e. by adding Calcium to the bone matrix. Collagen is the most abundant protein in the human body and contributes 30% of the protein in the human body whereas Calcium is a chemical element with the symbol Ca and atomic number 20. Apart from bones, proteins are found in muscles, skin, and tendons.

What is Calcium and why is it so Vital?

Calcium (atomic number 20) is the fifth abundant element in the Earth crust and is the third most abundant metal after Iron and Aluminum. Because of its highly reactive nature, it is available in mineral form. The most commonly found calcium mineral is calcium carbonate.

Calcium mineral is the most abundant mineral in human body and almost all calcium is present in bones and teeth. Only 1% of the calcium in our body is in our blood. The rest 99% is stored in our bones and teeth. Having the right amount of calcium in our blood is necessary for our nerves, muscles, and heart to work properly. If calcium levels drop too low in the blood, parathyroid hormone (PTH) will signal the bones to release calcium into the bloodstream, which can weaken our bones. This hormone may also activate vitamin D to improve the absorption of calcium in the intestines. At the same time, PTH signals the kidneys to release less calcium in the urine.

Calcium Health Benefits

· Cellular Function: Our body maintains a certain level of calcium in your blood at all times so that your cells can properly function. A dip in calcium blood levels will trigger your body to borrow calcium from your bones.

· Bone Health: Our bones continually break down and rebuild. Before age 30, the rate that you build bone is higher than the rate that you break it down. Beyond age 30, the rates reverse. This is why people who are elderly have more brittle bones that are more at risk of breaking.

· Osteoporosis: Consuming enough calcium by an osteoporosis patient helps prevent the damage of bones from osteoporosis (a condition when there is an imbalance between bone building and bone breakdown).

· In Pregnancy:

ü Fetus: For structural and overall growth of fetus, calcium is required.

ü Mother: Mother needs calcium for bearing extra weight as well as to prevent help prevent pre‐eclampsia and preterm birth and lower the risk of a woman dying or having serious problems related to high blood pressure.

· Help maintain body strength.

· Assist in the movement of muscles.

· Assist with nerve messaging between the brain and body systems.

· May prevent colon cancer.

· Relieves heartburn

· Blood Pressure Control: Calcium helps blood vessels relax and constrict.

· Release hormones and enzymes that support body functions.

· Decreased Risk of Kidney stones: Calcium also prevents kidney stones from forming by decreasing the absorption of oxalates, which are found in many plant foods like spinach, beets, raspberries, and sweet potatoes. Oxalates are associated with a higher risk of developing kidney stones.

Symptoms of Low Calcium Level

· Painful muscle spasms and cramps.

· Twitching of muscles.

· Numbness or tingling in feet and hands.

· Numbness or tingling around the mouth.

· Fatigue / weakness

· Halogenations

Reasons for Calcium Deficiency

· Low calcium intake

· Calcium absorption is low inside body

· Consuming foods / drinks that lower calcium level

· Hereditary

· Hormonal conditions

· Few medication interfering with calcium and limiting its absorption

Caution

· Don’t overdose

· Maintain a gap of 2-3 hours between calcium and Iron supplements

· Prolong use of calcium may increase the risk of kidney stones

· Prolong use of calcium may increase the risk of bone enlargement

· Prolong use may increase the risk of prostate cancer

· Generally its alkaline form may cause stomach upset

Natural / Food Sources of Calcium

Calcium content of Foods

Food	Serving in mg	Percent Daily Value
Yogurt, plain, low fat, 8 ounces	415	32
Orange juice, calcium fortified, 1 cup	349	27
Yogurt, fruit, low fat, 8 ounces	344	27
Mozzarella, part skim, 1.5 ounces	333	26
Sardines, canned in oil, with bones, 3 ounces	325	25
Milk, nonfat, 1 cup**	299	23
Soymilk, calcium fortified, 1 cup	299	23
Milk, whole (3.25% milk fat), 1 cup**	276	21
Tofu, firm, made with calcium sulfate, ½ cup***	253	19
Salmon, pink, canned, solids with bones, 3 ounces	181	14
Cottage cheese, 1% milk fat, 1 cup	138	11
Tofu, soft, made with calcium sulfate, ½ cup***	138	11
Soybeans, cooked, ½ cup	131	10
Breakfast cereals, fortified with 10% of the DV for calcium, 1 serving	130	10
Spinach, boiled, drained, ½ cup	123	9
Frozen yogurt, vanilla, soft serve, ½ cup	103	8
Turnip greens, fresh, boiled, ½ cup	99	8
Kale, fresh, cooked, 1 cup	94	7
Chia seeds, 1 tablespoon	76	6
Chinese cabbage (bok choi), raw, shredded, 1 cup	74	6
Beans, pinto, canned, drained, ½ cup	54	4
Tortilla, corn, one, 6” diameter	46	4
Sour cream, reduced fat, 2 tablespoons	31	2
Bread, whole-wheat, 1 slice	30	2
Kale, raw, chopped, 1 cup	24	2
Broccoli, raw, ½ cup	21	2
Apple, golden delicious, with skin, 1 medium	10	0

** Calcium content varies slightly by fat content; the more fat in the food, the less calcium it contains.

*** Calcium content is for tofu processed with a calcium salt. Tofu processed with other salts does not provide significant amounts of calcium.

Food Sources of Calcium: The Do’s & Don’ts

Do’s:

· Include calcium rich foods like dairy products, spinach, ragi, green leafy vegetables, soya beans, Rajma, pulses, pumpkin etc in your daily diet.

Don’ts:

· Salt: The daily recommended salt consumption limit of salt is 5 g, but the actual daily average salt consumed in India is 10 g (double). Salt maintains homeostasis between minerals like calcium and magnesium in bones. A low salt diet can cause the body to pull sodium from bones in order to meet the needs of the rest of the body. So, insufficient salt level disrupts the balance of calcium and magnesium levels in bones. On the other hand, people consuming more salt excrete more calcium in the urine and therefore are at higher risk of osteoporosis and kidney stones.

· Sugar: Sugar (fructose) increases production of lactic acid in bone tissue which weakens the bone building cells osteoblasts. To worsen the condition, sugar disrupts absorption of vitamin D, which is needed for absorption of calcium in bones. Additionally, sugar causes body weight gain, which again is not good for overall body’s health including bones. WHO recommends 5 to 10 teaspoons sugar intake every day. It’s better to consume sugar through natural sources like fruits and not the processed sugar crystals. Better alternatives of sugar are jiggery, honey etc, but these should also to be consumed in recommended dose.

· Soft Drinks & Soda: Most soft drinks (including diet soft drinks) contains phosphoric acid which causes increased calcium excretion from urine, and so promotes osteoporosis. Replace soft drinks with juices, smoothies, coconut water etc.

· Alcohol: Alcohol disrupts absorption of calcium and vitamin D3 and so impacts healthy bone density.

· Caffeine: We lose approximately 6 mg of calcium for every 100 mg of caffeine. So avoid chocolates and coffee for a healthy lifestyle.

· Legumes & Wheat Bran: Beans and wheat bran have phytates (phytic acid), which interface with body’s ability to absorb calcium. By soaking beans overnight, and then rinsing it properly, may decrease the amount of phylates.

· Don’t Overdo with Protein and Oxalates: This is yet to be established, but as per few studies, we should avoid overdoing with protein and oxalates as they may bind with minerals like calcium and excrete it through urine.

As a rule of thumb, follow a diet chart prepared by a qualified dietician customised for you.

Taking Care of our Bones

Points of Ponder for a Healthy Bone

Calcium, Vitamin D3, Vitamin C, Collagen and minerals are essential for healthy bones. Vitamin D3 helps absorb calcium in bones and vitamin C helps in Collagen production. Vitamin k2-7 catalyse bone mineralisation process. Apart from these, Magnesium, Boron and other vitamins are also important for a healthy bone.

· Eat calcium rich foods and avoid or control the foods interfering with calcium and vitamin D3 absorption.

· Maintain adequate vitamin D from sunlight and food. Vitamin D helps absorb calcium in our bones.

· Count your daily calories intake: For body metabolism, around 2000 daily calories intake is required. If calorie consumption is more than calorie utilisation, it will result in weight gain and fatty liver (fat build up in liver. Extra weight on bones leads to various bones diseases. To worsen the condition, it has been found that people with fatty liver are vitamin D deficient. Therefore, a balanced diet with all sorts of vitamins, minerals, proteins etc is required.

· Regularly do weight bearing exercises.

· Maintain healthy BMI (Body Mass Index).

BMI (Body Mass Index) Calculation:

BMI = kg/m²

Where kg = Body’s weight in Kilogram and height is measured in meter suare.

Normal BMI = 18.5 to 25

Less than 15 is considered sever underweight

Above 30 is considered obesity

How Much Calcium We Need Daily?

Recommended Dietary Allowances (RDAs) for Calcium

Understand how much calcium you’re getting from your diet, before you take supplements. Taking too much calcium can be bad for your health. An adult shouldn’t take more that 1200 mg of calcium within a day in the form of supplement, unless instructed by his/ her doctor.

Age	Male	Female	Pregnant	Lactating
0-6 months*	200 mg	200 mg
7–12 months*	260 mg	260 mg
1–3 years	700 mg	700 mg
4–8 years	1,000 mg	1,000 mg
9–13 years	1,300 mg	1,300 mg
14–18 years	1,300 mg	1,300 mg	1,300 mg	1,300 mg

19–50 years	1,000 mg	1,000 mg	1,000 mg	1,000 mg

51–70 years	1,000 mg	1,200 mg
>70+ years	1,200 mg	1,200 mg

* Adequate Intake (AI)

Dose for Medical Conditions

Medical Condition	Range
Bone Health	1000 mg – 1200 mg
Pregnancy	1000 mg – 1200 mg
Premenstrual Syndrome (PMS)	1000 mg – 1200 mg
Preeclampsia (high BP in pregnancy)	1000 mg
High Blood Pressure	1000 mg – 1500 mg
Inflammation	1000 mg
Colon Cancer	1200 mg – 2000 mg
Fatty Liver disease	500 mg

(consult your doctor for best guidance on doses)

Calcium Supplement Options:

1. Calcium Carbonate:

· Alkaline based compound found in limestone, rocks, shells of marine animals, egg shells and snails.

· High Calcium ratio (around 40%)

· Not easily absorbed, needs extra stomach acid

· Most economical source of calcium

2. Coral Calcium

· Natural source of calcium

· Low accuracy of elemental calcium and so quality control is very difficult

3. Calcium Gluconate

· Low calcium concentration

· Low bioavailability

4. Calcium Phosphate

· Sourced from cow’s milk

· Not very bio-available (although cow’s milk are good source of calcium, but this processed form of
calcium loses its bioavailability)

5. Calcium Orotate:

· Created with Orotic Acid salt

· High elemental calcium (92%)

6. Calcium Aspartate

· High absorption rate of 90%

7. Calcium Acetate:

· Created with Acetic acid

· Used to control high blood levels of phosphorus in people with kidney disease

8. Calcium Citrate

· Acidic in nature

· Low calcium ratio (20%) and hence higher quantity is used to match the daily calcium intake.

·
More bio-available than any
other form of calcium listed above.

9. Calcium Citrate Malate

· Acidic in nature (formed with citric acid and malic acid)

· Low calcium ratio (20%) and hence higher quantity is used to match the daily calcium intake.

· Most bio-available than any other form of calcium listed above.

Choosing the 5 Best Calcium Supplements

1) Calcium Citrate Malate: Most bio-available / easy absorption. Can be taken by people with digestion problem with calcium like elderly people. Can be given for a longer period of time with minimum or no side effects.

2) Calcium Acetate: Prescribed to chronic kidney patients as it lowers high phosphorus level of such patients.

3) Calcium Orotate: Useful when high calcium absorption is to achieved like osteoporosis.

4) Calcium Aspartate: Same as Calcium Orotate i.e. when high calcium absorption is to achieved like osteoporosis. Both Orotate and aspertate have around 90% elemental calcium.

5) Calcium Carbonate: Most economical yet with a high 40% of elemental calcium.

Frequently Asked Questions on Calcium:

1) Is calcium safe for heart patients?

Ans: No, researches show that high calcium intake (by food or by supplements) can increase the risk of heart attack.

2) Who should take calcium supplements?

Ans: Anyone (except heart patients) with calcium deficiency, should take calcium supplements. It is required by fetus, pregnant woman, elderly people, children for better growth, calcium acetate by kidney patients, patients with numbness in feet, hands, someone facing muscle twitching, in osteoporosis, high blood pressure patients (along with their regular high BP medicines), etc with the recommendation of a doctor.

3) How long should I take calcium supplements to work?

Ans: This depends upon the reason of taking calcium. For example, if one has fracture, s/he should take calcium for 2-3 months. Osteoporosis patients should continue taking it with the consultation of a doctor. A doctor will evaluate your reason versus your health condition and then may prescribe a calcium salt and will tell how long to continue it?

4) Which is the best calcium for Osteoporosis?

Ans: Generally Calcium Asparate or Calcium Orotate or sometimes calcium carbonate is prescribed to an osteoporosis patient. But, if the problem has problem digesting it, then the doctor may prescribe Calcium Citrate or Calcium Citrate Malate.

Conclusion

Our bones are made-up of collagen and get its strength from calcium through bone mineralisation process. Adequate calcium rich food is required for healthy bones as well as for other metabolic activities of our body. Women, during pregnancy and post menopause should take special care to maintain a good calcium level. Calcium Citrate and Calcium Citrate Malate are best bio-available and Calcium Orotate and Calcium Aspartate have highest elemental calcium content. Calcium Acetate is to be prescribed to chronic kidney patients. We must consult a doctor to ensure which form of calcium is most suited for us and how much calcium we need to take in the form of supplement.

4 thoughts on “5 Best Calcium Supplements for Bones”

Avinash Singh
21 May 2023 at 9:56 PM

Good

1. Drongo Admin
  29 May 2023 at 12:30 PM
  
  Thanks
  
  1. SUNIL GOYAL
    30 May 2023 at 10:15 PM
    
    Very very nice information in deep knowledge about Calcium ad What,Why, Where, When etc.
    Calcium hold to all body.
    Try calcium with magnisium, vitamin D, Magnish ,potassium as Cal mag D
    9315684952 Ranibagh DELHI
    
    1. Drongo Admin
      3 June 2023 at 11:06 PM
      
      Thank you

5 Best Calcium Supplements for Bones

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