Table of ContentsView AllTable of ContentsDefinitionUsesSide EffectsCalcium DeficiencyDosageRisksSources
Table of ContentsView All
View All
Table of Contents
Definition
Uses
Side Effects
Calcium Deficiency
Dosage
Risks
Sources
Calcium citrate is an over-the-counter (OTC) calcium supplement used to promote healthy bones and teeth.Calciumis also important for blood vessels, muscles, and nerve health and supports hormone function.
Calcium supplementsare typically sold as calcium carbonate or calcium citrate. Calcium citrate is usually more easily absorbed than calcium carbonate. Your body doesn’t need stomach acid to absorb calcium citrate, making it the better choice for people who take heartburn medication or have digestive issues.
In the United States, the Food and Drug Administration (FDA) does not regulate supplements the way it regulates prescription drugs. That means some supplement products may not contain what the label says. Whenchoosing a supplement, look for independently tested products and consult a healthcare provider, registered dietitian nutritionist (RD or RDN), or pharmacist.
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What Are Calcium Citrate Supplements?
Calcium supplementsare typically available OTC as calcium carbonate or calcium citrate. Calcium citrate is typically more easily absorbed than calcium carbonate. It may be ideal for people with lower stomach acid, including the following:
Calcium citrate can be taken on a full or empty stomach.
Calcium citrate contains 21% elemental calcium. This means that 1,000 milligrams (mg) of calcium citrate contains 210 mg of elemental calcium. Surprisingly, your body will absorb higher amounts of calcium at lower doses (ex., 300 mg) if taken alone without vitamin D.
Calcium Citrate Supplement Benefits
Calcium is an essential mineral supporting multiple systems in your body. You must maintain adequate calcium levels for your heart, nervous system, and muscles to function properly.
Calcium is probably best known for makingstrong bones. But beyond bones, calcium supplementation’s possible benefits include potentially reducing the risk of the following:
It may also help some people maintain a healthy weight. Research supports some of these uses more than others.
Bone Health
Due to calcium’s known role in establishing healthy, strong bones, some research has focused on whether calcium supplementation could prevent age-related bone mineral density (BMD) loss andfractures. Unfortunately, the research has had mixed results.
For example, a 2021 study evaluated the association between dietary calcium intake and BMD in older adults using data from the National Health and Nutrition Examination Survey (NHANES, 2001-2006).In 2,904 participants, researchers found that higher dietary calcium intake was associated with greaterlumbar(vertebrae of the lower spine) BMD. Researchers found this benefit only in women but not in men.
On the other hand, a 2019 study on calcium intake and bone loss inpostmenopausalpeople withosteopenia(low bone density) found no impact on bone loss.In an analysis of observational data obtained from a randomized controlled trial, researchers compared bone mineral density (BMD) and bone mineral content (BMC) in participants who took calcium supplements and those who took a placebo. Researchers found no relationship between bone loss and calcium intake.
FDA-Approved ClaimThe FDA has approved health claims that adequate vitamin D and calcium intake may reduce the risk ofosteoporosis.
FDA-Approved Claim
The FDA has approved health claims that adequate vitamin D and calcium intake may reduce the risk ofosteoporosis.
Cancer
Due to calcium’s protective effect on cells, some research has explored its potential to reducecancerrisk. However, overall, the research is mixed.
For example, a 2017 study evaluatedcalcium and vitamin Dsupplementation’s effect on cancer incidence in older women.The four-year, double-blind, placebo-controlled, population-based randomized clinical trial split 2,303 postmenopausal participants into a treatment (2,000 IU/day ofvitamin D3and 1,500 mg/day of calcium) or placebo group. The treatment group did not have significantly lower cancer risk at four years compared with the placebo.
However, another older 2007 study suggested calcium plus vitamin D does have benefits. The randomized controlled trial compared the effect of calcium supplementation alone to calcium andvitamin D supplementationon cancer risk.Researchers randomized 1,179 postmenopausal participants into groups receiving 1,400-1,500 mg calcium/day alone, calcium plus 1,100 IU vitamin D3/day, or placebo. Cancer incidence was lowest in the calcium+D group.
Heart Disease
Calcium’s ability to reduce lipid absorption has led to some research on its ability to reduce cardiovascular disease risk. However, the results have been mixed, with some research indicating no effects.
For example, a 2015 study evaluated 1999–2010 NHANES data on calcium intake andhypertension(high blood pressure) in adults with obesity.Among 14,408 adults, researchers found that calcium intakes were 10% lower in those with hypertension and obesity.
Health Experts' PositionThe National Osteoporosis Foundation and American Society for Preventive Cardiology determined that calcium (with or without vitamin D) has no beneficial or harmful relationship to the risk of developing cardiovascular disease.
Health Experts' Position
The National Osteoporosis Foundation and American Society for Preventive Cardiology determined that calcium (with or without vitamin D) has no beneficial or harmful relationship to the risk of developing cardiovascular disease.
Hypoparathyroidism
Hypoparathyroidismis a rare condition resulting in diminished function or absence of parathyroid hormone (PTH). PTH works to maintain the body’s balance between calcium and phosphorous. Low PTH results in low levels of calcium and high levels of phosphorous. This can lead to problems involving muscles, nerve endings, bones, and skin.
Calcium supplementation may be required for this condition. A randomized trial published in 2022 suggests that calcium citrate may have more beneficial effects and cause fewer side effects (e.g., constipation) than calcium carbonate, and may be a viable supplement alternative to treat hypoparathyroidism.
Gout
According to a randomized trial published in 2022, 770 milligrams (mg) of calcium citrate per day lowered urate levels. This result suggests calcium citrate may have a protective effect against gout. Further research is needed.
Are Calcium Citrate Supplements Safe For Me?
Your healthcare provider may recommend you take calcium citrate for bone health. However, consuming a supplement like calcium citrate may have potential side effects. These side effects may be common or severe.
Common Side Effects
Common side effects from calcium include:
Precautions
Calcium supplements may interact with certain medications, including:
Ask a pharmacist if you’re unsure about possible interactions with any medications you are taking.
If you have a history of kidney disease, kidney stones, cancer, high calcium blood levels, or parathyroid gland disorder, be sure to discuss calcium citrate supplementation with your healthcare provider.
In general, people may develop a calcium deficiency when:
What Causes a Calcium Deficiency?
When you don’t get enough calcium over time or can’t absorb it, your body pulls it from your bones. Over time, this weakens bones and increases fracture risk.
People most at risk for calcium deficiency who may benefit from getting more calcium in their diet or from supplements include those with:
How Do I Know if I Have a Calcium Deficiency?
For women over age 50, abone density screeningis an excellent way to assess bone status. If you’re unsure whether you’re meeting your calcium needs, a dietitian may be able to help.
Daily Calcium Requirements
Always speak with a healthcare provider before taking a supplement to ensure that the ingredients and dosage are appropriate for your individual needs.
When it comes to calcium supplements, recognizing the exact dosage can be a challenge. Read the label to identify how much pure (elemental) calcium is provided per serving.
Therecommended dietary allowance(RDA) for calcium is as follows:
Females:
Males:
The Risks of Taking Too Much Calcium
As with any dietary supplement, taking more calcium than needed may do more harm than good. Aim to take a supplement only if:
You may want to seek medical attention if you consume more than this amount or more than your healthcare provider recommends.
Rarely, calcium supplementation is associated with more severe conditions, including:
Food Sources of Calcium
Calcium is vital for people of all ages. Children and teens are still forming their bones and should be mindful of getting sufficient calcium. Sitting down with a healthcare provider to review your dietary habits can help determine whether your intake is adequate.
Calcium is readily available in foods. Food sources are optimal because they absorb best in the body. However, supplements can also help meet daily requirements when you cannot meet your needs through food sources alone.
Most people can obtain adequate calcium through food.Foods high in calciuminclude:
Summary
Calcium is essential for strong bones, teeth, and muscles. Calcium citrate supplements can help you reach the recommended daily value, especially if you have difficulty absorbing calcium. For most people, it’s possible to get enough calcium through food alone. Some people take calcium citrate for bone health and to reduce the risk of cancer and heart disease. However, the research on those benefits is mixed.
17 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.NIH Office of Dietary Supplements.Calcium fact sheet for health professionals.NIH National Cancer Institute.Calcium citrate.Yao X, Hu J, Kong X, Zhu Z.Association between dietary calcium intake and bone mineral density in older adults.Ecol Food Nutr. 2021;60(1):89-100. doi:10.1080/03670244.2020.1801432Bristow SM, Horne AM, Gamble GD, Mihov B, Stewart A, Reid IR.Dietary calcium intake and bone loss over 6 years in osteopenic postmenopausal women [published correction appears in J Clin Endocrinol Metab. 2020 Jan 1;105(1):].J Clin Endocrinol Metab. 2019;104(8):3576-3584. doi:10.1210/jc.2019-00111U.S. Food and Drug Administration.Small Entity Compliance Guide: Health Claims on Calcium and Osteoporosis; and Calcium, Vitamin D, and Osteoporosis.Lappe J, Watson P, Travers-Gustafson D, et al.Effect of vitamin D and calcium supplementation on cancer incidence in older women: A randomized clinical trial.JAMA. 2017;317(12):1234-1243. doi:10.1001/jama.2017.2115Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP.Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial [published correction appears in Am J Clin Nutr. 2008 Mar;87(3):794].Am J Clin Nutr. 2007;85(6):1586-1591. doi:10.1093/ajcn/85.6.1586Chen Y, Strasser S, Cao Y, Wang KS, Zheng S.Calcium intake and hypertension among obese adults in United States: associations and implications explored.J Hum Hypertens. 2015;29(9):541-547. doi:10.1038/jhh.2014.126Myung SK, Kim HB, Lee YJ, Choi YJ, Oh SW.Calcium supplements and risk of cardiovascular disease: A meta-analysis of clinical trials.Nutrients. 2021;13(2):368. Published 2021 Jan 26. doi:10.3390/nu13020368Kopecky SL, Bauer DC, Gulati M, et al.Lack of evidence linking calcium with or without vitamin D supplementation to cardiovascular disease in generally healthy adults: A clinical guideline from the National Osteoporosis Foundation and the American Society for Preventive Cardiology.Ann Intern Med. 2016;165(12):867-868. doi:10.7326/M16-1743Naciu AM, Tabacco G, Bilezikian JP, et al.Calcium Citrate Versus Calcium Carbonate in the Management of Chronic Hypoparathyroidism: A Randomized, Double-Blind, Crossover Clinical Trial.J Bone Miner Res. 2022;37(7):1251-1259. doi:10.1002/jbmr.4564Cândido FG, Alves RDM, Freitas DMO, Bittencourt JM, Rocha DMUP, Alfenas RCG.Urate-lowering effect of calcium supplementation: Analyses of a randomized controlled trial.Clin Nutr ESPEN. 2022;49:86-91. doi:10.1016/j.clnesp.2022.02.121Ghishan FK, Kiela PR.Vitamins and Minerals in Inflammatory Bowel Disease.Gastroenterol Clin North Am. 2017;46(4):797-808. doi:10.1016/j.gtc.2017.08.011Falchetti A, Cavati G, Valenti R, et al.The effects of vegetarian diets on bone health: A literature review.Front Endocrinol (Lausanne). 2022;13:899375. Published 2022 Aug 5. doi:10.3389/fendo.2022.899375DiNicolantonio JJ, Mehta V, Zaman SB, O’Keefe JH.Not Salt But Sugar As Aetiological In Osteoporosis: A Review.Mo Med. 2018;115(3):247-252.Homik J, Suarez-Almazor ME, Shea B, Cranney A, Wells G, Tugwell P.Calcium and vitamin D for corticosteroid-induced osteoporosis.Cochrane Database Syst Rev. 2000;1998(2):CD000952. doi:10.1002/14651858.CD000952Li K, Wang XF, Li DY, et al.The good, the bad, and the ugly of calcium supplementation: a review of calcium intake on human health.Clin Interv Aging. 2018;13:2443-2452. Published 2018 Nov 28. doi:10.2147/CIA.S157523
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.NIH Office of Dietary Supplements.Calcium fact sheet for health professionals.NIH National Cancer Institute.Calcium citrate.Yao X, Hu J, Kong X, Zhu Z.Association between dietary calcium intake and bone mineral density in older adults.Ecol Food Nutr. 2021;60(1):89-100. doi:10.1080/03670244.2020.1801432Bristow SM, Horne AM, Gamble GD, Mihov B, Stewart A, Reid IR.Dietary calcium intake and bone loss over 6 years in osteopenic postmenopausal women [published correction appears in J Clin Endocrinol Metab. 2020 Jan 1;105(1):].J Clin Endocrinol Metab. 2019;104(8):3576-3584. doi:10.1210/jc.2019-00111U.S. Food and Drug Administration.Small Entity Compliance Guide: Health Claims on Calcium and Osteoporosis; and Calcium, Vitamin D, and Osteoporosis.Lappe J, Watson P, Travers-Gustafson D, et al.Effect of vitamin D and calcium supplementation on cancer incidence in older women: A randomized clinical trial.JAMA. 2017;317(12):1234-1243. doi:10.1001/jama.2017.2115Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP.Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial [published correction appears in Am J Clin Nutr. 2008 Mar;87(3):794].Am J Clin Nutr. 2007;85(6):1586-1591. doi:10.1093/ajcn/85.6.1586Chen Y, Strasser S, Cao Y, Wang KS, Zheng S.Calcium intake and hypertension among obese adults in United States: associations and implications explored.J Hum Hypertens. 2015;29(9):541-547. doi:10.1038/jhh.2014.126Myung SK, Kim HB, Lee YJ, Choi YJ, Oh SW.Calcium supplements and risk of cardiovascular disease: A meta-analysis of clinical trials.Nutrients. 2021;13(2):368. Published 2021 Jan 26. doi:10.3390/nu13020368Kopecky SL, Bauer DC, Gulati M, et al.Lack of evidence linking calcium with or without vitamin D supplementation to cardiovascular disease in generally healthy adults: A clinical guideline from the National Osteoporosis Foundation and the American Society for Preventive Cardiology.Ann Intern Med. 2016;165(12):867-868. doi:10.7326/M16-1743Naciu AM, Tabacco G, Bilezikian JP, et al.Calcium Citrate Versus Calcium Carbonate in the Management of Chronic Hypoparathyroidism: A Randomized, Double-Blind, Crossover Clinical Trial.J Bone Miner Res. 2022;37(7):1251-1259. doi:10.1002/jbmr.4564Cândido FG, Alves RDM, Freitas DMO, Bittencourt JM, Rocha DMUP, Alfenas RCG.Urate-lowering effect of calcium supplementation: Analyses of a randomized controlled trial.Clin Nutr ESPEN. 2022;49:86-91. doi:10.1016/j.clnesp.2022.02.121Ghishan FK, Kiela PR.Vitamins and Minerals in Inflammatory Bowel Disease.Gastroenterol Clin North Am. 2017;46(4):797-808. doi:10.1016/j.gtc.2017.08.011Falchetti A, Cavati G, Valenti R, et al.The effects of vegetarian diets on bone health: A literature review.Front Endocrinol (Lausanne). 2022;13:899375. Published 2022 Aug 5. doi:10.3389/fendo.2022.899375DiNicolantonio JJ, Mehta V, Zaman SB, O’Keefe JH.Not Salt But Sugar As Aetiological In Osteoporosis: A Review.Mo Med. 2018;115(3):247-252.Homik J, Suarez-Almazor ME, Shea B, Cranney A, Wells G, Tugwell P.Calcium and vitamin D for corticosteroid-induced osteoporosis.Cochrane Database Syst Rev. 2000;1998(2):CD000952. doi:10.1002/14651858.CD000952Li K, Wang XF, Li DY, et al.The good, the bad, and the ugly of calcium supplementation: a review of calcium intake on human health.Clin Interv Aging. 2018;13:2443-2452. Published 2018 Nov 28. doi:10.2147/CIA.S157523
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
NIH Office of Dietary Supplements.Calcium fact sheet for health professionals.NIH National Cancer Institute.Calcium citrate.Yao X, Hu J, Kong X, Zhu Z.Association between dietary calcium intake and bone mineral density in older adults.Ecol Food Nutr. 2021;60(1):89-100. doi:10.1080/03670244.2020.1801432Bristow SM, Horne AM, Gamble GD, Mihov B, Stewart A, Reid IR.Dietary calcium intake and bone loss over 6 years in osteopenic postmenopausal women [published correction appears in J Clin Endocrinol Metab. 2020 Jan 1;105(1):].J Clin Endocrinol Metab. 2019;104(8):3576-3584. doi:10.1210/jc.2019-00111U.S. Food and Drug Administration.Small Entity Compliance Guide: Health Claims on Calcium and Osteoporosis; and Calcium, Vitamin D, and Osteoporosis.Lappe J, Watson P, Travers-Gustafson D, et al.Effect of vitamin D and calcium supplementation on cancer incidence in older women: A randomized clinical trial.JAMA. 2017;317(12):1234-1243. doi:10.1001/jama.2017.2115Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP.Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial [published correction appears in Am J Clin Nutr. 2008 Mar;87(3):794].Am J Clin Nutr. 2007;85(6):1586-1591. doi:10.1093/ajcn/85.6.1586Chen Y, Strasser S, Cao Y, Wang KS, Zheng S.Calcium intake and hypertension among obese adults in United States: associations and implications explored.J Hum Hypertens. 2015;29(9):541-547. doi:10.1038/jhh.2014.126Myung SK, Kim HB, Lee YJ, Choi YJ, Oh SW.Calcium supplements and risk of cardiovascular disease: A meta-analysis of clinical trials.Nutrients. 2021;13(2):368. Published 2021 Jan 26. doi:10.3390/nu13020368Kopecky SL, Bauer DC, Gulati M, et al.Lack of evidence linking calcium with or without vitamin D supplementation to cardiovascular disease in generally healthy adults: A clinical guideline from the National Osteoporosis Foundation and the American Society for Preventive Cardiology.Ann Intern Med. 2016;165(12):867-868. doi:10.7326/M16-1743Naciu AM, Tabacco G, Bilezikian JP, et al.Calcium Citrate Versus Calcium Carbonate in the Management of Chronic Hypoparathyroidism: A Randomized, Double-Blind, Crossover Clinical Trial.J Bone Miner Res. 2022;37(7):1251-1259. doi:10.1002/jbmr.4564Cândido FG, Alves RDM, Freitas DMO, Bittencourt JM, Rocha DMUP, Alfenas RCG.Urate-lowering effect of calcium supplementation: Analyses of a randomized controlled trial.Clin Nutr ESPEN. 2022;49:86-91. doi:10.1016/j.clnesp.2022.02.121Ghishan FK, Kiela PR.Vitamins and Minerals in Inflammatory Bowel Disease.Gastroenterol Clin North Am. 2017;46(4):797-808. doi:10.1016/j.gtc.2017.08.011Falchetti A, Cavati G, Valenti R, et al.The effects of vegetarian diets on bone health: A literature review.Front Endocrinol (Lausanne). 2022;13:899375. Published 2022 Aug 5. doi:10.3389/fendo.2022.899375DiNicolantonio JJ, Mehta V, Zaman SB, O’Keefe JH.Not Salt But Sugar As Aetiological In Osteoporosis: A Review.Mo Med. 2018;115(3):247-252.Homik J, Suarez-Almazor ME, Shea B, Cranney A, Wells G, Tugwell P.Calcium and vitamin D for corticosteroid-induced osteoporosis.Cochrane Database Syst Rev. 2000;1998(2):CD000952. doi:10.1002/14651858.CD000952Li K, Wang XF, Li DY, et al.The good, the bad, and the ugly of calcium supplementation: a review of calcium intake on human health.Clin Interv Aging. 2018;13:2443-2452. Published 2018 Nov 28. doi:10.2147/CIA.S157523
NIH Office of Dietary Supplements.Calcium fact sheet for health professionals.
NIH National Cancer Institute.Calcium citrate.
Yao X, Hu J, Kong X, Zhu Z.Association between dietary calcium intake and bone mineral density in older adults.Ecol Food Nutr. 2021;60(1):89-100. doi:10.1080/03670244.2020.1801432
Bristow SM, Horne AM, Gamble GD, Mihov B, Stewart A, Reid IR.Dietary calcium intake and bone loss over 6 years in osteopenic postmenopausal women [published correction appears in J Clin Endocrinol Metab. 2020 Jan 1;105(1):].J Clin Endocrinol Metab. 2019;104(8):3576-3584. doi:10.1210/jc.2019-00111
U.S. Food and Drug Administration.Small Entity Compliance Guide: Health Claims on Calcium and Osteoporosis; and Calcium, Vitamin D, and Osteoporosis.
Lappe J, Watson P, Travers-Gustafson D, et al.Effect of vitamin D and calcium supplementation on cancer incidence in older women: A randomized clinical trial.JAMA. 2017;317(12):1234-1243. doi:10.1001/jama.2017.2115
Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP.Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial [published correction appears in Am J Clin Nutr. 2008 Mar;87(3):794].Am J Clin Nutr. 2007;85(6):1586-1591. doi:10.1093/ajcn/85.6.1586
Chen Y, Strasser S, Cao Y, Wang KS, Zheng S.Calcium intake and hypertension among obese adults in United States: associations and implications explored.J Hum Hypertens. 2015;29(9):541-547. doi:10.1038/jhh.2014.126
Myung SK, Kim HB, Lee YJ, Choi YJ, Oh SW.Calcium supplements and risk of cardiovascular disease: A meta-analysis of clinical trials.Nutrients. 2021;13(2):368. Published 2021 Jan 26. doi:10.3390/nu13020368
Kopecky SL, Bauer DC, Gulati M, et al.Lack of evidence linking calcium with or without vitamin D supplementation to cardiovascular disease in generally healthy adults: A clinical guideline from the National Osteoporosis Foundation and the American Society for Preventive Cardiology.Ann Intern Med. 2016;165(12):867-868. doi:10.7326/M16-1743
Naciu AM, Tabacco G, Bilezikian JP, et al.Calcium Citrate Versus Calcium Carbonate in the Management of Chronic Hypoparathyroidism: A Randomized, Double-Blind, Crossover Clinical Trial.J Bone Miner Res. 2022;37(7):1251-1259. doi:10.1002/jbmr.4564
Cândido FG, Alves RDM, Freitas DMO, Bittencourt JM, Rocha DMUP, Alfenas RCG.Urate-lowering effect of calcium supplementation: Analyses of a randomized controlled trial.Clin Nutr ESPEN. 2022;49:86-91. doi:10.1016/j.clnesp.2022.02.121
Ghishan FK, Kiela PR.Vitamins and Minerals in Inflammatory Bowel Disease.Gastroenterol Clin North Am. 2017;46(4):797-808. doi:10.1016/j.gtc.2017.08.011
Falchetti A, Cavati G, Valenti R, et al.The effects of vegetarian diets on bone health: A literature review.Front Endocrinol (Lausanne). 2022;13:899375. Published 2022 Aug 5. doi:10.3389/fendo.2022.899375
DiNicolantonio JJ, Mehta V, Zaman SB, O’Keefe JH.Not Salt But Sugar As Aetiological In Osteoporosis: A Review.Mo Med. 2018;115(3):247-252.
Homik J, Suarez-Almazor ME, Shea B, Cranney A, Wells G, Tugwell P.Calcium and vitamin D for corticosteroid-induced osteoporosis.Cochrane Database Syst Rev. 2000;1998(2):CD000952. doi:10.1002/14651858.CD000952
Li K, Wang XF, Li DY, et al.The good, the bad, and the ugly of calcium supplementation: a review of calcium intake on human health.Clin Interv Aging. 2018;13:2443-2452. Published 2018 Nov 28. doi:10.2147/CIA.S157523
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