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Calcium is a mineral found naturally in foods.  It is vitally important to several functions in the body, especially bone formation, but also for maintaining a normal heart beat, regulating blood pressure, and promoting a healthy nervous system.  In addition, calcium binds to other minerals such as phosphate and helps expel them from the body. 


Older individuals and women are most prone to calcium deficiencies because their bodies’ demand for calcium is higher than other adults.  While the average adult requires around 1000 mg of calcium daily, menopausal women require close to 1500 mg per day. 

As the body ages it loses its ability to reform bone tissue.  Calcium supplements are needed to provide the body with the necessary resources to fight this condition.  Because of the role which estrogen plays for women in forming bones, older women are particularly at risk for calcium deficiency as their hormone levels change.

 

Calcium supplements are available in a wide variety of compounds called salts, including calcium carbonate, calcium citrate, calcium gluconate, and calcium phosphate.  Calcium carbonate contains a higher concentration of calcium per dosage (40% calcium); however, it is difficult for the body to absorb this compound, and it can cause some digestive side effects.  

Calcium gluconate contains the lowest concentration of calcium per dosage (only 9% calcium) and is therefore not practical for supplying the body with a healthy supplement of calcium.  Calcium phosphate is even more difficult for the body to absorb than calcium carbonate, so it is also not very effective as a dietary supplement. 

Calcium citrate, on the other hand, performs more efficiently than any other calcium salt because it contains a relatively high concentration of calcium (21% calcium) and is also easy for the body to absorb.  Taking calcium citrate pills as a dietary supplement is the best way to add calcium to your diet.

Who should not take calcium citrate?

            •Before taking this medication, tell your doctor if you

            •Have had kidney stones;
            •Have parathyroid gland disease;
            •Take antacids or other calcium supplements; or

•  Take a tetracycline antibiotic such as tetracycline (Sumycin, Achromycin V, and others), demeclocycline (Declomycin), doxycycline (Vibramycin, Monodox, Doxy, and others), minocycline (Minocin, Dynacin, and others), or oxytetracycline (Terramycin, and others).

• You may not be able to take calcium citrate, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions, or take any of the medications, listed above.

• Talk to your doctor before taking calcium citrate if you are pregnant. In general, calcium is important for the development of an unborn baby.

• Talk to your doctor before taking calcium citrate if you are breast-feeding. Calcium is important for the development of a breast-feeding baby.

Summary from the National Institutes of Health:

Calcium supplements are taken by individuals who are unable to get enough calcium in their regular diet or who have a need for more calcium. They are used to prevent or treat several conditions that may cause hypocalcemia (not enough calcium in the blood). The body needs calcium to make strong bones. Calcium is also needed for the heart, muscles, and nervous system to work properly.

The bones serve as a storage site for the body's calcium. They are continuously giving up calcium to the bloodstream and then replacing it as the body's need for calcium changes from day to day. When there is not enough calcium in the blood to be used by the heart and other organs, your body will take the needed calcium from the bones. When you eat foods rich in calcium, the calcium will be restored to the bones and the balance between your blood and bones will be maintained.

Pregnant women, nursing mothers, children, and adolescents may need more calcium than they normally get from eating calcium-rich foods. Adult women may take calcium supplements to help prevent a bone disease called osteoporosis. Osteoporosis, which causes thin, porous, easily broken bones, may occur in women after menopause, but may sometimes occur in elderly men also. Osteoporosis in women past menopause is thought to be caused by a reduced amount of ovarian estrogen (a female hormone). However, a diet low in calcium for many years, especially in the younger adult years, may add to the risk of developing it. Other bone diseases in children and adults are also treated with calcium supplements.

Calcium supplements may also be used for other conditions as determined by your health care professional.

 “Getting the proper amount of calcium in the diet every day and participating in weight-bearing exercise (walking, dancing, bicycling, aerobics, jogging), especially during the early years of life (up to about 35 years of age) is most important in helping to build and maintain bones as dense as possible to prevent the development of osteoporosis in later life.” National Institutes of Health

Other Recommendations for Calcium Citrate:

Pregnancy—It is especially important that you are receiving enough calcium when you become pregnant and that you continue to receive the right amount of calcium throughout your pregnancy. The healthy growth and development of the fetus depend on a steady supply of nutrients from the mother. However, taking large amounts of a dietary supplement during pregnancy may be harmful to the mother and/or fetus and should be avoided.

Breast-feeding—It is especially important that you receive the right amount of calcium so that your baby will also get the calcium needed to grow properly. However, taking large amounts of a dietary supplement while breast-feeding may be harmful to the mother and/or baby and should be avoided.

Children—Problems in children have not been reported with intake of normal daily recommended amounts. Injectable forms of calcium should not be given to children because of the risk of irritating the injection site.

Older adults—Problems in older adults have not been reported with intake of normal daily recommended amounts. It is important that older people continue to receive enough calcium in their daily diets. However, some older people may need to take extra calcium or larger doses because they do not absorb calcium as well as younger people. Check with your health care professional if you have any questions about the amount of calcium you should be taking in each day.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
From drugs.com:

What is the most important information I should know about calcium citrate?
• Do not take calcium citrate or antacids containing calcium without first talking to your doctor
if you take other medications. Calcium can decrease the effects of many other medicines by
binding to them or by changing the acidity of the stomach or the urine.

• Take calcium with meals to increase its absorption by the body.

What is calcium citrate?
• Calcium is a mineral that is found naturally in foods. Calcium is necessary for many
normal functions of your body, especially bone formation and maintenance. Calcium can also
bind to other minerals (such as phosphate) and aid in their removal from the body.
• Calcium citrate is used to prevent and to treat calcium deficiencies.
• Calcium citrate may also be used for purposes other than those listed in this
medication guide.

What are the possible side effects of calcium citrate?
• Stop taking calcium citrate and seek emergency medical attention if you experience
a rare allergic reaction (difficulty breathing; closing of your throat; swelling of your lips,
tongue, or face; or hives).

• Other, less serious side effects may be more likely to occur. Continue to take
calcium citrate and notify your doctor if you experience
            •nausea or vomiting;
            •decreased appetite;
            •constipation;
            •dry mouth or increased thirst; or
            •increased urination.
            •Side effects other than those listed here may also occur.
Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Specific Studies on the Benefits of Calcium and Calcium Citrate:

Comparison of the effects of calcium loading with calcium citrate or calcium carbonate on bone turnover in postmenopausal women.
Authors:         Kenny,-A-M; Prestwood,-K-M; Biskup,-B; Robbins,-B; Zayas,-E; Kleppinger,-A; Burleson,-J-A; Raisz,-L-G
Citation:         Osteoporos-Int. 2004 Apr; 15(4): 290-4
Abstract:        Calcium supplementation is known to increase bone mineral density and decrease fractures, but the relative efficacy of different forms of calcium supplementation is not established. We compared the effects of calcium carbonate and calcium citrate on markers of bone resorption in older postmenopausal women in an open-labeled crossover study. Forty women were randomized to receive 1000 mg/day of either calcium citrate or calcium carbonate for 12 weeks, followed by a 2-week washout without calcium supplements and 12 weeks treatment with the alternate calcium supplement. All women received vitamin D (900 IU/day). Thirty-four women (25 Caucasian, nine Hispanic) completed the study. No significant differences in the decrease in parathyroid hormone (PTH) or bone specific alkaline phosphatase or the increase in urinary calcium/creatinine were detected between the two treatments. However, calcium citrate supplementation decreased the collagen cross-link resorption markers, urinary N-telopeptide (-30%), C-telopeptide ( -31%), free deoxypyridinoline (19%) and serum N-telopeptide (-8%), compared to no significant change following calcium carbonate supplementation (+2%, +3%, +2% and +2%, respectively; Pless than 0.05). Calcium citrate decreased markers of bone resorption significantly more than calcium carbonate in postmenopausal women, although no differences in their effects in calcium excretion or PTH were detected.

Relative bioavailability of calcium from calcium formate, calcium citrate, and calcium carbonate.
Author:                       Hanzlik,-R-P; Fowler,-S-C; Fisher,-D-H
Citation:         J-Pharmacol-Exp-Ther. 2005 Jun; 313(3): 1217-22
Abstract:        Calcium is an essential nutrient required in substantial amounts, but many diets are deficient in calcium making supplementation necessary or desirable. The objective of this study was to compare the oral bioavailability of calcium from calcium formate, a new experimental dietary calcium supplement, to that of calcium citrate and calcium carbonate. In a four-way crossover study, either a placebo or 1200 mg of calcium as calcium carbonate, calcium citrate, or calcium formate were administered orally to 14 healthy adult female volunteers who had fasted overnight. After calcium carbonate, the maximum rise in serum calcium (approximately 4%) and the fall in serum intact parathyroid hormone 1-84 (iPTH)(approximately 20-40%) did not differ significantly from placebo. After calcium citrate, the changes were modestly but significantly (p < 0.05) greater, but only at 135 to 270 min after ingestion. In contrast, within 60 min after calcium formate serum calcium rose by approximately 15% and serum iPTH fell by 70%. The mean increment in area under the plasma concentration-time curve (0-270 min) for serum calcium after calcium formate (378 mg . min/dl) was double that for calcium citrate (178 mg . min/dl; p < 0.01), whereas the latter was only modestly greater than either placebo (107; p < 0.05) or calcium carbonate (91; p less than 0.05). In this study, calcium formate was clearly superior to both calcium carbonate and calcium citrate in ability to deliver calcium to the bloodstream after oral administration. Calcium formate may offer significant advantages as a dietary calcium supplement.

Stone forming risk of calcium citrate supplementation in healthy postmenopausal women.
Author:                       Sakhaee,-K; Poindexter,-J-R; Griffith,-C-S; Pak,-C-Y
Citation:         J-Urol. 2004 Sep; 172(3): 958-61
Abstract:        PURPOSE: We evaluated the effect of calcium citrate supplementation alone or in combination with potassium citrate on the stone forming propensity in healthy postmenopausal women. MATERIALS AND METHODS: A total of 18 postmenopausal women without stones underwent a randomized trial of 4 phases comprised of 2 weeks of treatment with placebo, calcium citrate (400 mg calcium twice daily), potassium citrate (20 mEq twice daily), and calcium citrate and potassium citrate (at same doses). During the last 2 days of each phase urine was collected in 24-hour pools for complete stone risk analysis. RESULTS: Compared to placebo, calcium citrate increased urinary calcium and citrate but decreased urinary oxalate and phosphate. Urinary saturation of calcium oxalate, brushite and undissociated uric acid did not change. Potassium citrate decreased urinary calcium, and increased urinary citrate and pH. It decreased urinary saturation of calcium oxalate and undissociated uric acid, and did not change the saturation of brushite . When calcium citrate was combined with potassium citrate, urinary calcium remained high, urinary citrate increased even further and urinary oxalate remained reduced from the calcium citrate alone, thereby marginally decreasing the urinary saturation of calcium oxalate. Urinary pH increased, decreasing urinary undissociated uric acid. The increase in pH increased the saturation of brushite despite the decrease in urinary phosphorus. CONCLUSIONS: Calcium citrate supplementation does not increase the risk of stone formation in healthy postmenopausal women. The co-administered potassium citrate may provide additional protection against formation of uric acid and calcium oxalate stones.

Effects of calcium supplementation on serum lipid concentrations in normal older women: a randomized controlled trial.
Author:           Reid, Ian R : Mason, Barbara : Horne, Anne : Ames, Ruth : Clearwater, Judith : Bava, Usha : Orr Walker, Brandon : Wu, Fiona : Evans, Margaret C : Gamble, Gregory D
Citation:         Am-J-Med. 2002 Apr 1; 112(5): 343-7
Abstract:        PURPOSE: To determine the effect of supplementation with calcium citrate on circulating lipid concentrations in normal older women. SUBJECTS AND METHODS: As part of a study of the effects of calcium supplementation on fractures, we randomly assigned 223 postmenopausal women (mean [+/- SD] age, 72 +/- 4 years), who were not receiving therapy for hyperlipidemia or osteoporosis, to receive calcium (1 g/d, n = 111) or placebo (n = 112) for 1 year. Fasting serum lipid concentrations, including high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol, were obtained at baseline, and at 2, 6, and 12 months. RESULTS: After 12 months, HDL cholesterol levels and the HDL cholesterol to LDL cholesterol ratio had increased more in the calcium group than in the placebo group (mean between-group differences in change from baseline: for HDL cholesterol, 0.09 mmol/L (95% confidence interval [CI]: 0.02 to 0.17; P = 0.01); for HDL/LDL cholesterol ratio, 0.05 (95% CI: 0.02 to 0.08; P = 0.001). This was largely due to a 7% increase in HDL cholesterol levels in the calcium group, with a nonsignificant 6% decline in LDL cholesterol levels. There was no significant treatment effect on triglyceride level (P = 0.48). CONCLUSION: Calcium citrate supplementation causes beneficial changes in circulating lipids in postmenopausal women. This suggests that a reappraisal of the indications for calcium supplementation is necessary, and that its cost effectiveness may have been underestimated.


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