Purported Benefits, Side Effects & More


Purported Benefits, Side Effects & More

Common Names

  • 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 are the potential uses and benefits?

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)
  • Gas
  • 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

Brand Name
Oscal®, Tums®, Caltrate®, Citracal®
Clinical Summary

Calcium is an essential mineral responsible for many physiological functions. It helps maintain bone structure and 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.

Calcium has 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 supplement use was associated with an increased risk of coronary artery calcification (77) and may lead to cardiovascular disease (CVD) (1) (2) (3) (5), although 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 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 appear to be no preventive benefits with 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 also reduced bone density loss associated with antiretroviral therapy in HIV patients (72) (92).

In cancer settings, both dietary and supplemental calcium were linked with lower risk of colorectal cancer (13) (29) (93) (99), with dietary calcium more beneficial in reducing the risk of incidence and recurrence of colorectal and advanced adenomas (95). Calcium intake was associated with increased risk for prostate cancer (30) (31); notably a genetic disposition for high intestinal absorption of calcium was reported in African-American men (32) (33). Long-term studies suggest risks associated with calcium in prostate cancers are less strong when phosphorus intake is also considered (34) (35). Data also suggest benefits against cutaneous metastases (100).

In women, studies on calcium plus vitamin D supplements for reduced risk reported positive association with ductal carcinoma in situ (DCIS)  (96) but conflicting data for colorectal cancers (38) (85), all cancer types (36) (86), and mortality (26) (37) (101). Other trials suggest benefits against hematologic (80) but not invasive cancers (39)

Available 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) (97) (98). Patients should consult with their oncologists or oncology healthcare teams, especially since calcium supplements can interact with a number of prescription medications.

A balanced diet containing sodium, potassium, magnesium, calcium and vitamin D is important to reduce risks for hypertension as well as cardiovascular and cerebrovascular events (40). But 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 adults 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) may actually increase the risk of ischemic stroke (76), and calcium plus vitamin D supplementation may elevate the risk for kidney stones (42) (48) (53) (84).

Food Sources

Milk, yogurt, cheese, egg, bread, salmon, prawns, sardines, shrimp, broccoli, spinach, kale, collards, spring greens, baked beans, chickpeas, lentils, kidney beans, soya beans, tofu, orange, almonds, sesame seeds and fortified cereals, orange juice and soy milk

Purported Uses and Benefits
  • Cancer prevention
  • Hypertension
  • Cardiovascular disease
  • Osteoporosis
Mechanism of Action

Calcium plays an important role in a variety of muscular, vascular, neurological, hormonal, and enzymatic reactions. 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). Supplementation may fail to compensate for renal calcium loss, resulting in increased circulatory calcium that could lead to coronary artery deposits (46). Reduced dietary intake may cause calcium depletion in membrane storage sites decreasing stability of vascular smooth muscle cell membranes, as optimal concentrations stabilize these membranes, inhibit calcium entry into cells, and reduce vasoconstriction (47). Gastrointestinal events associated with calcium supplements may also 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 hyper-insulinemia, are proposed for associating 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).

Patients who have hypothyroidism (56), low serum phosphate levels (57), or high serum calcium levels associated with sarcoidosis, hyperparathyroidism, hypervitaminosis D, and certain cancers (49) should consult their physicians before taking calcium supplements.


Adverse Reactions

Common: Constipation, flatulence, chalky taste and dry mouth; hypercalciuria and hypercalcemia in older women (58)

Rare: Nausea (14); modest elevation in urinary tract stone formation with long-term use (27) (58) (59)

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).

Case reports

  • Life-threatening hypercalcemia/milk-alkali syndrome: In a 64-year-old cancer survivor after taking calcium-containing antacid tablets for chronic epigastric pain (60).
  • Hypercalcemia-induced pancreatitis: In a 42-year-old female, due to oral calcium supplementation  (61).
Herb-Drug Interactions
  • 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).
Herb Lab Interactions
Dosage (OneMSK Only)
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