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Vitamin D and bone health -

As we age, our skin loses its ability to generate vitamin D. People who live in cities or in institutional settings like nursing homes spend too little time outdoors. Even people who spend time outdoors often use sunscreen to prevent skin cancer.

Sunscreen with an SPF as low as 8 reduces vitamin D production by 95 percent. Vitamin D is found in very few foods. Sources include fatty fish like wild-caught mackerel, salmon, and tuna.

Vitamin D is added to milk and other dairy products, orange juice, soymilk, and fortified cereals. Check the food label to see if vitamin D has been added to a particular product.

The DV is based on a total daily intake of IU of vitamin D. It is often difficult to get all the vitamin D you need from sunlight and food alone. Some people with underlying conditions may need to take vitamin D supplements to support bone health.

Healthy adults with no vitamin D deficiency should be able to get adequate amounts of vitamin D from sunlight and by consuming a well-balanced diet.

People with osteoporosis and low bone mass should discuss their vitamin D levels with their healthcare provider to ensure they are getting an optimal amount.

Before adding a vitamin D supplement, check to see if any of the other supplements, multivitamins, or medications you take contain vitamin D. Many calcium supplements also contain some vitamin D. There are two types of vitamin D supplements.

They are vitamin D2 ergocalciferol and vitamin D3 cholecalciferol. Both types are good for bone health. Vitamin D supplements can be taken with or without food and the full amount can be taken at one time.

While your body needs vitamin D to absorb calcium, you do not need to take vitamin D at the same time as a calcium supplement. If you need help choosing a vitamin D supplement, ask your healthcare provider to recommend one.

Vitamin D deficiency occurs when you are not getting the recommended level of vitamin D over time. Certain people are at higher risk for vitamin D deficiency, including:.

Talk to your healthcare provider if you have any of these risk factors. You should not consume more than mg of calcium per day total from diet plus supplements due to the risk of side effects.

Calcium in the diet — The primary sources of calcium in the diet include milk and other dairy products, such as hard cheese, cottage cheese, or yogurt, as well as green vegetables, such as kale and broccoli table 1. Some cereals, soy products, and fruit juices are fortified with calcium.

Calcium supplements — The body is able to absorb calcium contained in supplements as well as from dietary sources. If it is difficult to get enough calcium from dietary sources, your health care provider can help determine the best type, dose, and timing of calcium supplements.

The table shows the calcium and vitamin D content in commonly available supplements table 2. It is best absorbed with a low-iron meal such as breakfast. Calcium carbonate may not be absorbed well in people who also take a specific medication for gastroesophageal reflux called a proton pump inhibitor or H2 blocker , which blocks stomach acid.

See "Patient education: Gastroesophageal reflux disease in adults Beyond the Basics ". Children should not take these supplements. Calcium and vitamin D supplements alone are usually insufficient to prevent age-related bone loss, although they may be beneficial in some people older adults, those with very low intake.

In most people with or at risk for osteoporosis, the addition of medication is necessary to slow the breakdown and removal of bone ie, resorption. Underlying gastrointestinal diseases — People who do not adequately absorb nutrients from the gastrointestinal tract due to malabsorption may require more than to mg of calcium per day.

In such cases, a health care provider can help to determine the optimal dose of calcium. Medications — Your health care provider will review all of your medications to check for possible interactions with calcium.

Calcium supplements interfere with the absorption of iron and thyroid hormone, so these medications should be taken at different times. As an example, loop diuretics eg, furosemide [sample brand name: Lasix] increase the amount of calcium excreted in the urine.

On the other hand, thiazide diuretics eg, hydrochlorothiazide can reduce levels of calcium in the urine, potentially reducing the risk of bone loss and kidney stones.

If you start taking a medication that alters how the body handles calcium, your provider may recommend a change in the amount of calcium that you consume daily. See 'Kidney stones' below. Side effects of calcium — Calcium is usually easily tolerated when it is taken in divided doses several times per day.

Some people do experience side effects, including constipation and indigestion. Kidney stones — There is no evidence that consuming large amounts of calcium from foods and drinks increases the risk of kidney stones, or that avoiding dietary calcium decreases the risk.

In fact, avoiding dairy products is likely to increase the risk of kidney stones. However, use of calcium supplements may increase the risk of kidney stones in susceptible individuals by raising the level of calcium in the urine.

This is particularly true if the supplement is taken between meals or at bedtime, and this is one of the reasons it is better to get most of your daily calcium requirement through your diet.

See "Patient education: Kidney stones in adults Beyond the Basics ". Vitamin D decreases bone loss and lowers the risk of fracture, especially in older adults. Along with calcium, vitamin D also helps to prevent and treat osteoporosis.

Adequate vitamin D is needed for efficient calcium absorption. Vitamin D is normally made in the skin after exposure to sunlight.

See "Patient education: Vitamin D deficiency Beyond the Basics ". Recommendations for vitamin D — Getting adequate vitamin D is important for bone health in everyone. Experts recommend that males over 70 years of age and postmenopausal females consume at least international units 20 micrograms of vitamin D per day.

Lower amounts of vitamin D intake may not be adequate, while very high doses can be toxic, especially if taken for long periods of time.

Although the optimal intake has not been clearly established in premenopausal females or in younger males with osteoporosis, international units 15 micrograms of vitamin D daily is generally suggested.

Vitamin D is available as an individual supplement and is included in most multivitamins and some calcium supplements table 2. Milk is a relatively good dietary source of vitamin D, with approximately international units 2. Most healthy people don't need to check with their health care provider before taking standard doses of a vitamin D supplement.

Updated June 2, Accessed September 26, US Preventive Services Task Force; Grossman DC, Curry SJ, Owens DK, et al. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: US Preventive Services Task Force recommendation statement.

Updated by: Diane M. Horowitz, MD, Rheumatology and Internal Medicine, Northwell Health, Great Neck, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.

Editorial team. Calcium, vitamin D, and your bones. Bone Strength and Calcium. How Much Calcium and Vitamin D do I Need? All children ages 9 to 18 should have: mg of calcium daily IU of vitamin D daily All people age 19 to 50 should have: mg of calcium daily to IU of vitamin D daily Adults age 51 and older should have: Women: mg of calcium daily Men: mg of calcium daily Men and women: to IU of vitamin D daily.

Too much calcium or vitamin D can lead to problems such as an increased risk for kidney stones. Total calcium should not exceed mg per day Total vitamin D should not exceed IU per day. Calcium and Dairy Products. Yogurt, most cheeses, and buttermilk come in fat-free or low-fat versions.

Vitamin D helps your body use calcium , which is why vitamin D is often added to milk. Other Sources of Calcium. Other good food sources of calcium are: Salmon and sardines that are canned with their bones you can eat these soft bones Almonds, Brazil nuts, sunflower seeds, tahini sesame paste , and dried beans Blackstrap molasses Other tips to make sure your body can use the calcium in your diet: Cook high-calcium vegetables in a small amount of water for the shortest possible time.

They will retain more calcium this way. Be careful about what you eat with calcium-rich foods.

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