Mineral Review

Which calcium is better absorbed in old age?

This information will help you learn about calcium supplements and how to take them. Calcium is a mineral that is essential for building and maintaining healthy bones. If you don’t get enough calcium from food, your body will take it from your bones. As a result, osteoporosis may develop.


  • lean physique;
  • Northern European or Asian origin;
  • bright skin;
  • early onset of menopause (before 45 years);
  • taking certain steroid medications for more than 3 months;
  • insufficient level of physical activity;
  • insufficient calcium in the diet (or supplements);
  • smoking;
  • excessive alcohol consumption (more than 2 drinks per day for women and more than 3 drinks per day for men);
  • taking aromatase inhibitors (medicines that block estrogen production and are used to treat breast cancer);

Vitamin D

Vitamin D is a vitamin that helps the body absorb calcium. Vitamin D is produced in the body under the influence of sunlight. It is also found in some foods.

Getting enough vitamin D from sun exposure and food alone can be quite difficult. Your doctor or clinical dietitian nutritionist may tell you to take a vitamin D supplement. These may be prescription or over-the-counter vitamin D tablets or calcium supplements with added vitamin D.

Recommended Daily Allowances for Calcium and Vitamin D

Getting enough calcium in your diet helps prevent osteoporosis. The amount of calcium is measured in milligrams (mg) a person needs daily.

  • Between the ages of 19 and 50, you should get 1000 mg of calcium daily.
  • Women aged 51 years and older need 1200 mg of calcium daily.
  • Men aged 51 to 70 years should get 1000 mg of calcium daily.
  • Men over the age of 70 need 1200 mg of calcium daily.

The amount of vitamin D is measured in international units (IU) that a person needs daily.

  • Between the ages of 19 and 70, you should get 600 IU of vitamin D daily.
  • Over the age of 70, you should get at least 800 IU of vitamin D daily.

If you have osteoporosis, you need to get more calcium, vitamin D, or both. Talk to your doctor or clinical dietitian dietitian about your daily intake. Do not increase your recommended daily calcium intake. Consuming more may be harmful to health.

Sources of calcium


It is best to get calcium through food. Dairy products are a good source of calcium. If you are lactose intolerant, try lactose-free dairy products or Lactaid ® tablets. You can also consume orange juice and other foods fortified with calcium. Check the amount of calcium on food labels.

The table at the end of this resource lists some foods and drinks that are high in calcium.

Calcium supplements

You may find it difficult to get enough calcium from food alone. Your doctor or clinical dietitian nutritionist may advise you to take calcium supplements. They are sold without a prescription. Your doctor or clinical dietitian dietitian will tell you how much to take.

Types of Calcium Supplements

There are several types of calcium supplements, including calcium carbonate and calcium citrate, that can be purchased without a prescription. These dietary supplements are taken orally (they must be swallowed). All calcium supplements should be taken with food.

Do not buy calcium tablets that are made from bones or dolomite. They may contain lead or other metals that are harmful to health. This also applies to some drugs sold in health food stores. However, most calcium supplements you purchase at the pharmacy have been tested for these metals.

Calcium carbonate

Calcium carbonate is best absorbed when taken with food. OsCal ® and Caltrate ® are brands of calcium carbonate supplements. Other forms of calcium carbonate:

  • Some antacids, such as Tums®. If you take Tums, it does not have to be taken with food.
  • Viactiv® soft chewable candies come in a variety of flavors.
  • A liquid form that can usually be purchased at a pharmacy, but you may need to order it in advance.

calcium citrate

Calcium citrate is another type of calcium supplement. Some people’s bodies absorb calcium citrate better than calcium carbonate. This applies to older people, as well as people with low stomach acidity (for example, those with Addison-Beermer anemia).

Calcium citrate is absorbed best when taken 30 minutes before meals. One brand of calcium citrate is Citracal ® and can be purchased at most pharmacies.

If you experience any of the following side effects after taking calcium carbonate, switch to calcium citrate:

  • abdominal (stomach) pain;
  • gases;
  • constipation (bowel movements occur less frequently than usual).

Taking calcium supplements

  • If you take more than 500 mg of calcium supplements per day, divide your intake into several doses. This way they are better absorbed by the body. For example, if you take 1000 mg of calcium daily, take 500 mg of the supplement in the morning and 500 mg in the evening.
  • Before taking calcium supplements, talk to your doctor or clinical dietitian nutritionist if:
    • you have previously been diagnosed with hypercalcemia (high calcium levels in the blood);
    • you are taking diuretics (water pills) or antacids for digestive problems;
    • you have had kidney stones;
    • you have had problems with the parathyroid glands.
    • you have previously been diagnosed with a heart condition, including a heart attack or stroke.
    • Some examples of medications that contain bisphosphonate are alendronate (Fosamax®) and risedronate (Actonel®). Remember that calcium supplements are not a substitute for other medications you take to treat osteoporosis.

    Foods and drinks rich in calcium

    The table below lists some foods and drinks rich in calcium.

    Product Serving Size Calcium per serving (mg) Calories per serving
    Parmesan cheese 1½ oz (45 g) 503 167
    cheddar cheese 1½ oz (45 g) 307 171
    Low fat milk 1 cup (8 oz (240 ml)) 305 102
    Yogurt without additives, low fat 1 cup (8 oz (240 ml)) 265 150
    Soy milk without additives, fortified with calcium 1 cup (8 oz (240 ml)) 301 80
    Sardines, canned in oil, with bones, without liquid 2 piece. 92 50
    Collards, cooked ½ cup 134 31
    Bok choy (Chinese cabbage), fresh 1 cup 74 9
    Almonds ¼ cup 96 207
    Figs, fresh 2 pcs. (average) 35 74
    Mineral water (eg San Pellegrino ® , Perrier ® ) 1 cup (8 oz (240 ml)) 33 0

    For more information about calcium-rich foods, consult a clinical dietitian dietitian.

    Additional resources

    National Institutes of Health (NIH) Osteoporosis and Related Bone Diseases National Resource Center
    800-624-BONE (800-624-2663)

    National Osteoporosis Foundation

    If you have questions or concerns, contact your healthcare provider. A member of your care team will answer Monday through Friday from 9 am to 5 pm Outside those hours, you can leave a message or talk with another MSK provider. There is always a doctor or nurse on call. If you’re not sure how to reach your healthcare provider, call .

    If you have questions or concerns, contact your healthcare provider. A member of your care team will answer Monday through Friday from 9 am to 5 pm Outside those hours, you can leave a message or talk with another MSK provider. There is always a doctor or nurse on call. If you’re not sure how to reach your healthcare provider, call .

    For more information, visit our virtual library at www.mskcc.org/pe.

    Calcium Supplements – Last updated on December 12, 2022
    All rights reserved and owned by Memorial Sloan Kettering Cancer Center

    Calcium is an essential macronutrient that the body needs to maintain the health of the musculoskeletal system, teeth, hair, nails and blood vessels. In childhood and old age, during pregnancy, and with high physical activity, the need for calcium increases. You can compensate for nutrient deficiency with the help of calcium-containing foods and calcium supplements. But is it enough to simply take calcium supplements or is something else required to absorb it? In the article we will tell you how macronutrient metabolism occurs in the body, which affects its assimilation, and what vitamins should be taken so that calcium is absorbed correctly.

    How does calcium metabolism occur in the body?

    Calcium metabolism is a complex process that includes a huge number of biochemical reactions and occurs in three stages:

    • Absorption of calcium in the digestive tract. Absorption of the macroelement in the intestine occurs in two ways – active and passive. Active absorption occurs in the duodenum and upper parts of the small intestine. Absorption activity depends on the physiological state of the body and can decrease with pathologies of the gastrointestinal tract, in old age, with hypovitaminosis D. The passive process occurs throughout the small intestine, a small amount (about 4%) of the macroelement is absorbed in the large intestine. With passive absorption, the amount of calcium absorbed depends on its content in the diet 1 .
    • The entry of calcium from the bloodstream into tissues and organs. From the gastrointestinal tract, the macroelement enters the bloodstream and spreads throughout the body. Approximately 25-40% of the nutrient is supplied to the renewable calcium pool, which consists of small amounts of calcium in body fluids and makes up about 1% of the total macronutrient in the body, the remaining 99% is found in bones and teeth. Calcium absorption by the intestines, reabsorption by the kidneys and renewal in the bones are directly regulated by parathyroid hormone, calcitonin and vitamin D 2 .
    • Removal of metabolic end products from the body. Most calcium (about 70–80%) is excreted in the intestines, but the kidneys also play a role—a small amount of the macronutrient is excreted from the body in the urine 3 .

    Many factors are involved in the regulation of calcium metabolism. A failure in at least one stage of metabolism can lead to disruption of the entire chain of reactions, decreased absorption and macronutrient deficiency in the body. That is why it is important to take responsibility for your health and control your calcium levels.

    What factors influence calcium absorption?

    Calcium is one of the hard-to-digest nutrients, since many different substances are involved in its absorption: hormones (parathyroid hormone, calcitonin, estrogens), macro- and microelements (magnesium, phosphorus, potassium, zinc, manganese, silicon, chromium), vitamins D, K , and C. Calcium homeostasis is also influenced by age, dietary habits, lifestyle and a number of other factors. Let’s look at them in more detail.


    It has been clinically proven that as muscle mass increases, bone tissue mass also increases, that is, with adequate physical activity, calcium is better absorbed and accumulates faster. In contrast, a sedentary lifestyle negatively affects macronutrient absorption 4 . However, it is important to understand that with intense physical activity, the need for calcium also increases, so if you are actively involved in fitness, you must additionally take calcium supplements.

    Alcohol consumption and smoking have a negative effect on macronutrient metabolism. Ethyl alcohol increases the excretion of water and contributes to dehydration. It reduces the absorption of vitamins B, C, D and E, magnesium and calcium and flushes nutrients from the body. Nicotine also interferes with the absorption of calcium in the intestines. Deterioration of bone mineral composition and increased risk of fractures are the most well-known negative consequences of long-term smoking 5 .


    Some foods also interfere with the absorption and accelerate the leaching of calcium. These primarily include: palm oil, foods rich in carbohydrates (baked goods, sweets, some fruits and vegetables), coffee, carbonated drinks 6 . This does not mean that these foods should be completely excluded from the diet, but it is necessary to control their consumption.

    Foods rich in vitamins D, K and C promote the absorption of calcium: fatty fish, eggs, dairy products, citrus fruits, avocado, celery, broccoli, asparagus. Their addition to the diet can have a positive effect on the balance and homeostasis of calcium in the body.


    The greatest need for calcium occurs in childhood, adolescence and old age. In children and adolescents, a high need for macronutrients is associated with rapid growth and development. Calcium at this age is quickly absorbed, but also quickly consumed, so it is important for parents to ensure that the child’s diet is balanced, monitor the level of calcium and vitamin D, and prevent hypocalcemia and hypovitaminosis D.

    In older people, calcium absorption deteriorates due to age-related changes. This is facilitated by a decrease in the synthesis of a number of hormones (we will talk about them below), changes in the composition of gastric juice, and impaired absorption in the small intestine (malabsorption) 7 . Taking medications with bioavailable calcium and vitamins D and K, which improve the absorption of the macronutrient, can help solve the problem.

    Calcium and pregnancy

    An important role in changes in calcium homeostasis during pregnancy is played by an increase in the volume of extracellular fluid, changes in the protein composition of the blood, an increase in glomerular filtration and absorption of macronutrients in the intestine, and changes in the secretion of calcium-tropic hormones 8 .

    Disorders of calcium-phosphorus metabolism in pregnant women can be associated not only with the peculiarities of hormonal regulation, but also with the presence of polyhypovitaminosis, in particular hypovitaminosis D. The body of a pregnant woman experiences an increased need for nutrients, including vitamin D and calcium, which is due their increased consumption by the developing fetus 8 . Complex dietary supplements for pregnant women, which contain all the nutrients necessary for the mother and fetus, can help prevent the development of deficiency conditions.

    Hormone levels

    The most important hormones regulating calcium homeostasis are parathyroid hormone, calcitonin, and estrogens.

    Parathyroid hormone (PTH) is produced by the parathyroid gland and maintains normal calcium homeostasis in the body. When calcium metabolism is disturbed and when the level of a macroelement in the blood decreases, PTH increases the absorption of calcium by the kidneys and the production of calcitriol, thereby promoting the mobilization of calcium from the bones. In addition, it regulates mineral metabolism and is also the main secretory substance that plays a role in the formation of vitamin D 9 .

    Calcitonin is a thyroid hormone that regulates phosphorus-calcium metabolism in the body and in its functions is an antagonist of parathyroid hormone, that is, it promotes the accumulation of calcium in the bones, thereby playing a large role in accelerating bone formation 10.

    Female sex hormones also have a significant impact on calcium metabolism. Lack of estrogen leads to calcium and vitamin D deficiency, bone tissue destruction, and slower bone formation processes. It is precisely because of the decrease in the production of sex hormones after 40 years that the risk of developing osteoporosis in women increases 11.


    Vitamins D3 and K2 have a significant effect on calcium absorption. Vitamin D3 is involved in the absorption of calcium in the intestines, from where the macroelement enters the bloodstream and is sent to organs and tissues 12. However, without vitamin K2 (menaquinone), it is unable to prevent calcium deposits in arteries and soft tissues 13 . It is vitamin K2 that is involved in the proper distribution of calcium in the body. It binds calcium in bones and also helps transport it from soft tissues. K2 takes the macronutrient from where it is not needed and transfers it to where it is needed.

    The role of vitamins D3 and K2 in the human body

    If the distribution of calcium is disturbed, its imbalance develops: for bone tissue and many other structures, a deficiency of the mineral may occur, while for the cardiovascular system there may be an excess of it (calcinosis). Due to calcium deposits in blood vessels, blood circulation becomes difficult and the risk of developing cardiovascular pathologies increases.

    If there is not enough vitamin K2 in the body, bone mineral density decreases. They become fragile, posture is impaired, bone and joint pain appears, and osteoporosis develops. In addition, if calcium is distributed incorrectly, the elasticity of tissues is impaired, the risk of stone formation in the kidneys increases, and the so-called “calcium paradox” arises – a condition in which there is a deficiency of calcium in bone tissue and an excess of the mineral in the vessels 14 . To prevent this from happening, it is important to take vitamins D3 and K2 together.

    Thus, taking vitamins K2 and D3 together can help:

    • improving the absorption and metabolism of calcium;
    • preventing calcium deposition in blood vessels and kidneys, reducing the risk of developing calcification;
    • increasing bone density, reducing the risk of fractures and osteoporosis;
    • maintaining healthy skin, hair and nails;
    • strengthening the immune system.

    Who needs additional vitamins K2 and D3?

    1. for older and middle-aged women during menopause for the prevention of osteoporosis;
    2. for people suffering from frequent colds to strengthen the immune system;
    3. those who take calcium supplements, antibiotics and statins as prescribed by a doctor (antibiotics can activate the processes of destruction of bone tissue, and they can disrupt the synthesis of vitamin K);
    4. athletes for the prevention of deficiency conditions (in combination with calcium supplements);
    5. healthy people to maintain the balance of the processes of building and destroying bone tissue, proper absorption of calcium from food.

    Which vitamin K2 to choose?

    Vitamin K2 has several forms, the most natural and bioavailable is menaquinone MK-7. In this form, vitamin K2 remains active longer, circulates in the blood for about 72 hours and during this time manages to reach all organs, including bone tissue 14.

    It is in the form of menaquinone MK-7 that vitamin K2 is contained in the dietary supplements “Natural Vitamin K2 100 mcg + D3” and “Calcium Activator”, which are produced by the Evalar company.

    “Natural Vitamin K 2 100 mcg + D 3 »

    The dietary supplement “Natural vitamin K2 100 mcg + D3” was developed by Evalar company specialists to normalize calcium metabolism, is made from high-quality raw materials from the Italian company Gnosis and can help: maintain healthy bones and teeth, the cardiovascular system;

    complete and safe absorption of calcium;

    direction and retention of calcium in bone tissue without its deposition in joints, kidneys and vascular walls;

    strengthening immunity;
    increasing bone density and vascular elasticity;
    reducing the risk of bone fractures and osteoporosis.

    Adults are recommended to take 1 capsule of the supplement per day with meals. Duration of treatment: 1 month. If necessary, the course can be repeated.

    “Calcium activator”

    The “Calcium Activator” complex is designed for complete and safe absorption of calcium; it is also made from raw materials from the Italian company Gnosis and contains calcium orthophosphate, vitamin K2 in the form of MK-7 and vitamin D3.

    Taking the complex can help:

      maintaining adequate levels of calcium in the body;

    proper distribution of calcium without deposition in the walls of blood vessels, kidneys and joints;
    formation and maintenance of dense bone structure;
    retaining calcium in bone tissue and preventing its leaching from bones;
    prevention of osteoporosis and other pathologies associated with calcium metabolism disorders.

    Adults are recommended to take 2 capsules of the complex once a day with meals. Duration of treatment: 1 month. If necessary, the course of treatment can be repeated.

    You can purchase dietary supplements “Natural vitamin K2 100 mcg + D3” and “Calcium activator” on the Evalar company website evalar.ru , in a healthy life store fitomarket.ru and online pharmacy pharmacy.ru , as well as in pharmacies in your city.

    Author of the article:

    Pronina Olesya Evgenievna
    Expert in the field of nutrition, endocrinology and gynecology. Member of the PreventAge Association.

    Education: Russian State Medical University named after. N.I. Pirogov, gynecology – Federal State Budgetary Institution National Medical Research Center of Obstetrics, Gynecology and Perinatology named after. acad. IN AND. Kulakova, endocrinology – Federal Budgetary Institution National Medical Research Center of Endocrinology, Dietetics of Clinical Nutrition and Dietetics of the Federal Scientific and Medical Institute of the Peoples’ Friendship University of Russia. Endocrinologist, nutritionist, gynecologist. Doctor of preventive medicine. Member of the Association of Integral Preventive and Anti-Aging Medicine.

    Drugs from the article:

    1 Intestinal Calcium Absorption. Wongdi K, Chanpaiseng K, Thirapornpoontakit D, Charoenphandhu N. Compr Physiol. 2021 May 31;11(3):2047-2073. doi: 10.1002 / cphy.c200014 . PMID: 34058017.

    3 Akhpolova V. O., Brin V. B. Calcium metabolism and its hormonal regulation // Journal of fundamental medicine and biology, 2017. https://cyberleninka.ru/article/n/obmen-kaltsiya-i-ego-gormonalnaya-regulyatsiya

    4 Roles of diet and physical activity in the prevention of osteoporosis. Anderson DJ, Rondano P, Holmes A. Scand J Rheumatol Suppl. 1996;103:65-74. doi: 10.3109/03009749609103752 . PMID: 8966493

    5 Cigarette smoking and musculoskeletal disorders. Abate M, Vanni D, Pantalone A, Salini V. Muscles Ligaments Tendons J. 2013 Jul 9;3(2):63-9. doi: 10.11138/mltj/2013.3.2.063. PMID: 23888288; PMCID: PMC3711704 .

    6 Tikhmeneva M. Vitamins overboard. Products that wash calcium from the body // AiF Health Magazine, No. 12 (146), December 2019. https://aif.ru/food/diet/vitaminy_za_bortom_produkty_kotorye_vymyvayut_kalciy_iz_organizma

    7 Malichenko S. B. The role of calcium and vitamin D in the development of pathology of the cardiovascular and skeletal system in the elderly // Medical scientific and practical portal Lvrach.ru, 2000. https://www.lvrach.ru/2000/05-06/4526028

    8 Shcherbavskaya E. A., Geltser B. I. Exchange of increased bone tissue during pregnancy // Journal of Osteoporosis and Osteopathy, 2002. https://cyberleninka.ru/article/n/obmen-kaltsiya-i-metabolizm-kostnoy-tkani-pri-beremennosti

    9 Physiology of the Calcium-Parathyroid Hormone-Vitamin D Axis. Holtzman D., Mannstadt M., Marcocci C. Front Horm Res. 2018;50:1-13. doi: 10.1159/000486060 . Epub 2018 Mar 29. PMID: 29597231.

    10 Calcitonin: physiology or fantasy? / Calcitonin: physiology or fantasy? Davy R, Findlay DM J Bone Miner Res. 2013 May;28(5):973-9. doi: 10.1002/jbmr.1869 . PMID: 23519892.

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