HEALTH Q&A
Taking the proper doses of calcium, vitamin D
By Richard Harkness

QUESTION: I'm confused about how much calcium one should take. I'm 77 years
old and in good health. I have always exercised and taken calcium, but I was
diagnosed with osteoporosis three years ago and placed on Fosamax 70
milligrams, one tablet a week.

I now use the Fosamax product that includes vitamin D. The nurse
practitioner recommended I take 1,200 milligrams daily of a calcium
supplement that also includes vitamin D. My bone density test six months ago
showed marked improvement. My only other medication is Prinivil/HCTZ. Am I
taking too much calcium or too much vitamin D?

ANSWER: Fosamax is prescribed to prevent and treat osteoporosis. It slows
bone breakdown and increases bone density. Adequate amounts of calcium and
vitamin D are needed for the drug to work properly.

It's possible your calcium intake might be too high, but unlikely that
you're getting too much vitamin D.

It's generally recommended that postmenopausal women get 1,200 to 1,500
milligrams of calcium daily. Your situation, however, is different.
Prinivil/HCTZ, the high blood pressure medication you take, contains
hydrochlorothiazide, a diuretic that causes the body to retain calcium. For
this reason, you may need to limit your daily calcium intake to about 500 to
800 milligrams. Getting more than that might push your calcium blood levels
too high. Discuss this with your doctor.

You can easily get 500 to 800 milligrams of daily calcium from either
supplements or diet.

High dietary sources of calcium include milk, cheese and yogurt. Nonfat or
skim milk contains about 300 milligrams of calcium per 8-ounce glass.

Your once-weekly Fosamax Plus D provides vitamin D. This product comes in
two formulations, one with 2,800 IU of vitamin D-3 and one with 5,600 IU of
vitamin D-3 per tablet. The latter version was only recently approved, so
you're probably taking the former, which means you're getting 400 IU of D-3
daily (2,800 divided by 7).

Current vitamin D recommendations may be too low. Recent research suggests
that most adults could benefit from 800 to 1,000 IU daily, so you may want
more.

Most calcium supplements now include vitamin D, so you can add to your
vitamin D intake this way. And milk is fortified with 100 IU of vitamin D
per 8-ounce glass.

Vitamin D-only supplements are available if you need more. Look for products
with D-3 (cholecalciferol), the most potent form.

With supplements on the mind, it's easy to forget that the best source of
vitamin D-3 is sunshine. The body synthesizes D-3 when skin is exposed to
the sun's UV radiation.

Exposing the face and arms for just 10 to 15 minutes two to three times a
week revs up production of D-3. Dark-skinned people need longer exposures.

People living in northern latitudes don't get adequate year-round sunlight,
so they may need supplemental D-3 to make up for the shortfall.
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Richard Harkness is a consultant pharmacist, natural medicines specialist
and author of eight books. Write him at 1224 King Henry Drive, Ocean
Springs, MS 39564