Menopause Mondays: Vitamin D and Calcium Controversy

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There’s a controversy brewing over your bones.

In 2013,  the United States Preventive Services Task Force recommended that postmenopausal women refrain from taking supplemental calcium and vitamin D, saying little evidence exists that these supplements prevent fractures in healthy women.

“There is a tremendous amount of confusion among not only you, but your health care providers, too,” says Diane L. Schneider, MD, MSc, author of The Complete Book of Bone Health and co-founder of 4BoneHealth.org.  Vitamin D and calcium are essential for bone health. “The real question is how much is enough?”

The answer depends on whom you ask. “The debate is far from settled. What is the right amount of vitamin D for calcium absorption, bone mineral density, muscle strength, and fracture reduction remains controversial,” says Schneider.

The U.S. Preventive Services Task Force’s  recommendation on vitamin D and calcium supplementation gave a thumbs-down to supplementation with 400 IU or less of vitamin D3 and 1,000 mg or less of calcium for the prevention of fractures in postmenopausal women. It’s important to point out that this recommendation does not apply to the treatment of those with osteoporosis or vitamin D deficiency.

Although multiple studies contributed to the latest recommendation, the results were driven from the largest study, the Women’s Health Initiative calcium and vitamin D trial that included more than 36,000 women between the ages of 50 and 79 years who were randomly assigned to take 1000 mg of calcium with 400 IU of vitamin D daily or placebo pills. At the end of seven years, the number of fractures was similar in each group. However, among the women assigned to the supplements, those who actually took the pills 80 percent or more of the time had a 29 percent lower rate of hip fractures. If you took the supplements they worked! “Long-term use of calcium and vitamin D appears to confer a reduction that may be substantial in the risk of hip fracture among postmenopausal women,” the researchers later wrote.

Whatever the verdict on supplementation and doses, the first line of defense against osteoporosis is a healthy lifestyle. Calcium is readily available through the foods we eat—or at least should eat. When it comes to vitamin D, the sun is a primary source of the nutrient. However, everything from your age, location you live, use of sunscreen to weight, can affect how much vitamin D you produce.  Most Americans fall short of meeting the recommended daily amounts of the necessary vitamin D and calcium, compounding perimenopausal and menopausal women’s already-increased risk of osteoporosis and fractures, according to Schneider.

During perimenopause and menopause, plummeting estrogen levels can cause loss of bone mass. After menopause, bone breakdown outpaces the building of new bone in women, making women over the age of 50 at the greatest risk for developing osteoporosis, according to the Cleveland Clinic.

Women older than 50 need to consume 1,200 milligrams of calcium every day to keep their bones strong, according to Schneider. As vitamin D helps your body absorb this calcium, most women need 600 IU of the vitamin a day, while women older than 70 need 800 IU. However, your individual needs may vary. Have your vitamin D level checked to know what you need. The best sources of calcium include dairy, almonds, broccoli, kale, salmon, and soy products, such as fortified tofu. If you focus on a healthy diet filled with these foods, you can hit your daily bone-fortification quota, making calcium supplements and all of their controversy a moot point. Count your food first and only use supplements to supplement your diet. Don’t take the entire recommended amount in supplements.

While the top sources of vitamin D include oily fish, egg yolks, and fortified milk, according to the National Institutes of Health, the recommended amount of vitamin D is harder to achieve with diet alone. Most likely you will need a supplement, especially during the winter months when the necessary radiation from the sun is not available. When sun is plentiful, our sunscreen blocks its production.

Calcium and vitamin D are essential to maintaining healthy bones straight through perimenopause and menopause. Luckily, if you eat a healthy diet, they are more than attainable—they are inevitable!

Learn more about bone health and menopause in my FREE eBook, MENOPAUSE MONDAYS: A Girlfriend’s Guide to Surviving and Thriving During Perimenopause and Menopause. You can download the book here! Help me spread the word!

Suffering in silence is OUT! Reaching out is IN!  

After struggling with her own severe menopause symptoms and doing years of research, Ellen resolved to share what she learned from experts and her own trial and error. Her goal was to replace the confusion, embarrassment, and symptoms millions of women go through–before, during, and after menopause–with the medically sound solutions she discovered. Her passion to become a “sister” and confidant to all women fueled Ellen’s first book, Shmirshky: the pursuit of hormone happiness. As a result of the overwhelming response from her burgeoning audiences and followers’ requests for empowering information they could trust, Ellen’s weekly blog, Menopause MondaysTM, was born.

  • linda

    This is so important on so many levels! My awsome doc who keeps a close eye on me did a bone scan 3 years ago when i started going through menapause. I had osteopinia in my left hip and osteoporosis in my spin. This all happened at the young age of 51. Being very proactive with my health i was shocked… osteoporosis?! Now im on a plant based calcium blend with strontium boost to build bone, and thankful to say osteoperosis free! I still have slight osteopinia in my left hip. It amazes me to this day how much a women goes through during menapause. Thankyou Ellen♡ i do not sell vitimens or make any money suggesting them. I do hope more women start taking calcium plant base supplements, and eating calcium rich foods. We are worth it

    • Ellen Dolgen

      Linda, thanks for sharing your story. You are very lucky that your doctor was proactive about checking your bone density! Those bone scan’s are so important. It IS so important to put yourself on your own To Do List! We ARE worth it!

    • Lisa

      I am 52 and also have bone thinning on my left hip. What is plant based calcium and how do I get it?

      • Ellen Dolgen

        Lisa, I am hoping that Linda will respond and let you know what she is taking.

  • There are so many supplements out there, it’s hard to determine which ones are best for you. This is some great advice though, so thanks for sharing!

  • Cynthia Richardson

    I’m now at the point where I have osteoporosis in my lower back and need to make a decision about medications. Has anyone tried Boniva, Fosamax, Actonel, Reclast or Prolia?

    • Ellen Dolgen

      Cynthia, I reached out to Dr. Schneider….she is going to respond to your question.

    • Cynthia- There are many options for you to find out about. The best one for you is based on many factors. You should sit down with your health care provider or osteoporosis specialist to look at the choices that are the best fit for you. For instance, if you have lower bone density in your spine, Forteo, which is parathyroid hormone that turns on the bone building cells, called osteoblasts, may be a good starting point. Also an evaluation to make sure there are not other contributing causes that lower your bone mass is important. No matter what your bone density levels are, adequate vitamin D blood level and daily calcium of 1200 milligrams is essential for healthy bones. Taking steps to lower your fracture risk beyond medicines in necessary, too, like balance training to lower your risks of falls. Wishing you a bone healthy life!

      • Ellen Dolgen

        Thank you, Dr. Schneider, for your tremendous expertise and passion for helping women!

      • Cynthia Richardson

        Thank you so much for the information! I have a lot to consider and now I know the right questions to ask.

        • Ellen Dolgen

          Cynthia, I am glad it was helpful. Good luck!