- Calcium carbonate
- Calcium citrate
- Calcium gluconate
For Patients & Caregivers
Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.
What is it?
Calcium is a mineral that you need for many bodily functions. It also helps build and maintain healthy bones. It’s found in foods such as dairy products, dark greens, legumes, nuts, and fish.
If you don’t get enough calcium from food alone, your healthcare provider may recommend you take calcium supplements. Calcium supplements come as tablets or capsules.
What is it used for?
Calcium is used to:
- Prevent cancer
- Lower high blood pressure
- Decrease risk of heart disease
- Prevent bone loss (osteoporosis)
Calcium also has other uses that haven’t been studied by doctors to see if they work.
Calcium that you get from food is safe. Talk with your healthcare provider before taking supplements. Supplements are stronger than the calcium you get from food. They can also interact with some medications and affect how they work. For more information, read the “What else do I need to know?” section below.
What are the side effects?
Side effects of using calcium may include:
- Constipation (having fewer bowel movements than usual)
- Chalky taste in the mouth
- Dry mouth
- Higher risk of urinary stones (in long-time users)
- Nausea (feeling like you’re going to throw up)
- Increases risk of stroke when taking high-dose calcium supplements
What else do I need to know?
- Talk to your healthcare provider before taking calcium supplements if you have hypothyroidism (less thyroid hormone in the blood), high blood calcium levels, or low blood phosphate levels. Calcium can worsen these conditions.
- Talk to your doctor before taking calcium supplements if you’re taking medications such as digoxin (Lanoxin®) to treat a heart condition. Calcium may increase the risk of irregular heartbeat.
- Talk to your healthcare provider if you’re taking tamoxifen (Nolvadex or Soltamox™) as part of your cancer treatment. Calcium may increase the risk of abnormally high levels of calcium in the blood. This can increase the risk of kidney stones.
For Healthcare Professionals
Calcium is an essential mineral responsible for many physiological functions in the body. It is stored in the bones and helps maintain bone structure. Calcium also plays an important role in cell signaling and muscle contraction. Dietary sources of calcium include dairy products, dark greens, legumes, nuts and fish. Natural supplements are derived from minerals, oyster shells and occasionally corals.
The effects of calcium have been studied for a range of conditions including cardiovascular disease (1) (2) (3) (4) (5), osteoporosis (6), bone density loss (7), fracture prevention (8), premenstrual syndrome (9), pre-eclampsia (10) (11) (87), lead poisoning (12), and various cancers (13) (14) (15).
Long-term calcium supplement use was reported to be associated with an increased risk of coronary artery calcification (77). Some studies suggest that supplementation could lead to cardiovascular disease (CVD) (1) (2) (3) (5), but findings remain debatable (16) (17) (18). In a Women’s Health Initiative sub-study, calcium plus vitamin D supplementation and hormone therapy yielded greater reductions in LDL-C than either intervention alone or placebo (81); but supplementation did not always modify the effects of hormonal therapy on CVD events (88). Calcium and vitamin D supplementation may also benefit postmenopausal women who do not have pre-existing risk factors such as coronary heart disease, diabetes, or hypertension (19); and large long-term studies in women did not find adverse cardiovascular associations with calcium supplementation (4) (20), but a meta analysis reported an increase in the risk of CVD (94). High intake of supplements also increased cardiovascular mortality in men (21). Another study found supplementation to be associated with dementia in women following stroke (75), but dietary intake of vitamin D and calcium were reported useful in maintaining cognitive performance in older females (90).
There is also conflicting evidence surrounding the benefits of calcium or calcium plus vitamin D supplements for bone health (22) (23) (24) (42) (53) (82). The US Preventive Services Task Force reports did not find any associations between calcium plus vitamin D supplementation and reduced falls or fracture incidence in community-dwelling older adults without known deficiencies, osteoporosis, or history of fracture (83) (84). In postmenopausal women, neither dietary calcium (25) nor calcium plus vitamin D supplements (26) reduced risk of hip fracture, although the latter study found significant reductions at 7 years (27). Subgroup analysis further suggested that supplementation along with estrogen therapy conferred additive protection against hip fractures (28). However, there appears to be no preventive benefits with calcium and vitamin D supplementation for bone mineral density loss in breast cancer patients (7), in older adults (78), or in healthy men (79). But in a study of pediatric cancer survivors, hypocalcemia induced by standard osteoporotic medication was treated with continuous calcium supplementation (91). Calcium plus vitamin D were also reported to mitigate bone density loss associated with antiretroviral therapy in HIV patients (72) (92).
Definitive data are needed to determine the role of calcium in cancer prevention and treatment. Both dietary and supplemental forms were found to be linked with lower risk of colorectal cancer (13) (29) (93), with dietary calcium shown to be beneficial in reducing the risk of incidence and recurrence of colorectal and advanced adenomas (95). For men, calcium intake is associated with increased risk for prostate cancer (30) (31); a genetic disposition for high intestinal absorption of calcium among African-American men has also been noted (32) (33). Long-term studies suggest risks associated with calcium in prostate cancers are less strong when phosphorus intake is also considered (34) (35).
In women, studies on calcium plus vitamin D supplements for reduced risk yielded conflicting data for colorectal cancers (38) (85), all cancer types (36) (86), and mortality (26) (37). Other trials suggest benefits against hematologic (80) but not invasive cancers (39).
In general, the evidence is insufficient to assess benefits of calcium plus vitamin D supplementation for those receiving androgen deprivation therapy, aromatase inhibitors, or undergoing chemotherapy-induced menopause (7) (43) (44). Patients should consult with their oncologists or oncology healthcare teams, especially since calcium supplements can interact with a number of prescription medications.
A proper diet to achieve a balance among nutrients including sodium, potassium, magnesium, calcium and vitamin D is important to affect risks for hypertension as well as cardiovascular and cerebrovascular events (40). The risk-benefit ratio of supplementation is likely to vary, depending on dietary calcium intake, sex, age, ethnicity, and individual risks for cardiovascular disease and osteoporosis (41) (73). In individuals with normal calcium levels, genetic predisposition to higher serum levels does not affect bone mineral density nor protect against fractures (89). Intake of high-dose calcium supplements (>1 g/day) can also increase the risk of ischemic stroke (76), and calcium plus vitamin D supplementation may elevate the risk for kidney stones (42) (48) (53) (84).
Mechanism of Action
Calcium plays an important role in a variety of muscular, vascular, neurological, hormonal, and enzymatic reactions throughout the body. Calcium reserves are found mostly in the bones, helping to maintain skeletal structure.
The association of supplemental but not dietary calcium with increased cardiovascular risk could be related to their differing, acute effects on serum calcium (45). Calcium supplementation may fail to compensate for renal calcium loss, resulting in increased circulatory calcium that could lead to coronary artery deposits (46). Reduced dietary calcium may cause calcium depletion in membrane storage sites resulting in less stability of vascular smooth muscle cell membranes, as optimal concentrations stabilize these membranes, inhibit calcium entry into cells, and reduce vasoconstriction (47). Other researchers suggest that gastrointestinal events associated with calcium supplements may account for an increase in self-reported cardiovascular events (18).
Observed associations of dairy with overall prostate cancer risk may be related to the modulation of vitamin D metabolism by calcium and phosphorus (15) (31). Saturated fat in whole dairy correlating with higher C-peptide concentrations, along with obesity and hyperinsulinemia are proposed for associations of whole milk with fatal prostate cancer (31). Other suggested mechanisms include increasing levels of ionized calcium in the blood, as prostate cancer cells express both calcium-sensing receptors and calcium-dependent voltage-gated channels, the stimulation of which by extracellular calcium increases prostate cancer cell growth (44) (35). In African American men, positive associations between calcium and aggressive prostate cancer have been linked to single-nucleotide polymorphisms in the CDX-2 binding site of the VDR gene (32).
- Calcium may interfere with the absorption of iron, magnesium, and zinc (48) (49).
- High consumption of calcium has been associated with an increased risk of prostate cancer (30) (31) (32) (34) (49) (50) and milk-alkali syndrome (51).
- For those with chronic kidney disease, there is an increased risk of cardiovascular disease associated with calcium supplements (52).
- Calcium and vitamin D supplementation may increase the risk for kidney stones (42) (48) (53) (84). Increasing calcium via diet rather than supplements may lower the risk (54). For those who must take calcium in supplement form, adequate fluid intake is important to help reduce this risk (55).
Common: Constipation, flatulence, chalky taste and dry mouth; hypercalciuria and hypercalcemia in older women (58)
Excessive intake: Constipation, vascular and soft-tissue calcification, nephrolithiasis, hypercalciuria, hypercalcemia, increased risk for prostate cancer (48) (32) (34). Intake of high dose calcium supplements (>1 g/day) can increase the risk of ischemic stroke (76).
- Life-threatening hypercalcemia/milk-alkali syndrome: Confusion, nausea, vomiting, and weakness in a 64-year-old cancer survivor who took calcium-containing antacid tablets for chronic epigastric pain (60).
- Hypercalcemia-induced pancreatitis: Due to oral calcium supplementation in a 42-year-old female (61).
- Proton Pump Inhibitors: May significantly reduce calcium absorption (62).
- Cardiac glycosides: Calcium may increase risk of cardiac arrhythmia, although this is based on intravenous calcium, early case reports, and animal models (64).
- Quinolones: Calcium may reduce absorption of quinolones (65).
- Tamoxifen: Calcium may increase the risk of hypercalcemia (66).
- Tetracyclines: Calcium may reduce absorption of tetracyclines (67).
- Levothyroxine (to treat hypothyroidism): Taking calcium carbonate within 4 hours of this drug may decrease its absorption by nearly one-third (68).
- Estrogen therapy (for osteoporosis; positive interaction): Supplemental calcium and vitamin D may have additive benefits on bone health (28).
- Iron, zinc, or magnesium: Calcium can compete or interfere with their absorption (48) (49).