A jog on a Hawaiian beach was all it took for Jan, a post-menopausal registered nurse, to fracture a bone in her foot. The sand shifted slightly as she took a step, and she felt the pain.

The vacation that Jan and her husband had anticipated for months? Ruined.

Jan always assumed she got enough calcium to keep her bones strong through her healthy diet and didn’t dwell on taking supplements before she entered menopause. Even her nursing training had only briefly touched upon nutrition.

If she had known the full truth, she might have spent more time in Hawaii outside of her hotel room, catching sun rays, instead of in the emergency room, getting x-rays.

Why is calcium important in perimenopause and menopause?

Minerals like calcium are vital to a healthy body. Your bones and teeth are home to 99% of your body’s calcium, while the remaining 1% helps your blood clot, your nervous system relay information, your muscles and blood vessels contract, and performs many other functions.

Your bones are constantly remodeling, breaking down and rebuilding to repair injuries and the daily wear and tear from normal activities.

During bone remodeling, your bones release calcium into the bloodstream and reabsorb it back. If your body doesn't have enough available calcium, it will use the calcium released into your blood to repair nerves, cells, and muscles instead of reabsorbing it into your skeleton.

In childhood, our bodies build more bone than we lose. This is how we grow. From adolescence until our thirties, our bones are the strongest because they build up and break down at an equal pace.

In our mid-thirties, this changes. We start to lose bone mass faster than we can maintain it.

Bone loss speeds up when your body’s estrogen production decreases during perimenopause and menopause, as estrogen aids calcium absorption from food and reabsorption into bones.

This all can lead to osteoporosis, a condition where bones become porous, brittle, and break easily, and its precursor, osteopenia. Forty percent of post-menopausal women in the US will have an osteoporosis-related fracture at some point in their lives; our friend Jan is one of these women. If your mother or grandmother had osteoporosis, you are at greater risk of developing it.

The calcium that you consumed as a teen and young adult is what shapes your risk of osteoporosis entering menopause.

‘This is great for my daughter,’ you might say, ‘but how does it help me now?’

You can’t have your teenage body back, including your bones, but keeping adequate levels of calcium in your bloodstream as you enter menopause and beyond can help your bones stay strong.

How much calcium do I need?

For more than 20 years, the USDA has defined the recommended daily allowance (RDA) of calcium for American women as 1000mg for women 50 and under and 1200mg for women over 50; The National Osteoporosis Society supports this recommendation.

Some nutritionists now suggest that as low as 500mg per day may be enough. However, more research is needed to support this conclusion.

How do I get enough calcium?

The foods you eat are the most effective sources of calcium. Great sources of dietary calcium include yogurt (310 mg/serving), cheese (up to 210 mg/serving), sardines (325 mg/serving), cow’s milk (300 mg/serving), fortified soy milk or orange juice (300 mg/serving), tofu (205 mg/serving), and leafy greens (up to 360 mg/serving). [Learn more: A Guide to Calcium-Rich Foods]

You can figure out how much calcium you’re getting from your diet by checking food labels or using a calcium calculator. Note: the “DV” (daily value) for calcium on food labels is based on 1000 mg, so “30% of DV” is 300 mg. If you are over 50, this isn’t 30% of your daily need!

Your doctor may also suggest taking a daily calcium supplement. For best absorption, take calcium supplements in doses smaller than 600mg; if you need more calcium than this, space out your supplement several times throughout the day

Calcium carbonate is the more affordable and available form of calcium supplement. You may already have calcium carbonate in your medicine cabinet as an antacid, like Tums or Rolaids. Take it with food, as stomach acid increases absorption.

Calcium citrate is another form of over-the-counter calcium. You can take it with or without food.

Side effects of calcium supplements may include gas, bloating, and constipation. Calcium carbonate tends to have more side effects than calcium citrate, so if you’re experiencing gastro discomfort, consider making the switch.

How to maximize calcium absorption

  • Take calcium with vitamin D. Your body needs vitamin D for optimal calcium absorption. Experts recommend 600 IU daily for women under 70 and 800 IU daily for women 71 and up. We get vitamin D naturally from the sun, but people with darker skin and those who see less sunlight due to location (hello, Seattle!) or limited mobility may need more. A multivitamin with 800-1000 IU vitamin D should be sufficient,
  • Take calcium at a different time than iron, zinc, or magnesium supplements or an iron-rich meal. Calcium can affect how your body absorbs these important minerals.
  • Add milk to your coffee or tea. Some studies suggest adverse effects of caffeine consumption on calcium metabolism. You can offset this by adding a few tablespoons of milk to your coffee. Or, treat yourself to a latte for even more calcium!
  • Avoid alcohol. While you may enjoy a glass of wine with dinner or a celebratory cocktail, alcohol increases calcium loss in your urine. (Alcohol can increase hot flashes, too--another reason to teetotal.)
  • Get the right amount of protein. Protein is essential for muscle and bone health, and the body absorbs more calcium when you’re getting your recommended daily allowance of protein. However, too much protein can increase urinary calcium loss. Aim for 46 grams every day.

What to watch out for

The amount of calcium that’s right for you may defer from the norm if…

  • You are taking other medications: Calcium supplements can interfere with antibiotics, medications to treat osteoporosis, and blood pressure medications. Consult your doctor or pharmacist before adding a calcium supplement to your diet.
  • You have a medical condition that interferes with calcium absorption: cancer, thyroid disorders, tuberculosis, and immobilization can impact the levels of calcium in your blood. Talk to your doctor to determine what’s best for you.

Is it bad to get too much calcium?

Getting more than the RDA value of calcium may increase your risk of kidney stones, heart disease from increased calcification in the arteries, and potentially colon cancer, though more evidence is needed to support these claims.

Preliminary research shows that vitamin K2, which plays an important role in calcium metabolization, can help with heart health if this is a concern for you; be sure to talk to your doctor first.

(Did you know that vitamin K is great for your bones, too? Women who get at least 110 micrograms of vitamin K daily are 30% less likely to break a hip than women who don’t!)

There is no catching up, only moving forward

Studies suggest that exceeding the RDA of calcium doesn’t actually increase bone health in patients with osteoporosis but meeting your daily needs now and taking preventative measures will reduce your risk of fracture in the future.

If you are 65+ or have risk factors for osteoporosis before entering menopause, get a bone mineral density test (BMD) to evaluate your bone health before you break something.

And remember that calcium is only part of the equation for strong bones: exercise, a healthy diet, and refraining from smoking are very important as well.

Jan now maintains her bone strength by eating calcium-rich foods, doing yoga with her husband, and walking to the grocery store instead of driving. She can focus her attention on her book club and adult children knowing that she’s doing everything she can to prevent another fracture.

Are you dealing with or at risk of osteoporosis? We'd love to know what you're doing to manage your health and keep your bones strong. Please share with us in the genneve Community Forums!

 Meet writer Helen Pitlick! A seasoned communicator with a master's degree in digital media to back it all up, Helen loves to create content that helps women feel more confident at all stages of their lives. When she's not in front of her laptop, Helen enjoys pottery, pretending to play soccer, and hanging out with her dog.


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