The Importance of Calcium During Menopause for Bone Health

Meeting the body’s calcium needs is of the utmost importance during menopause. Calcium supports healthy muscle function, nerve communication, circulation, and hormone secretion. However, it’s predominantly known for its role in maintaining bone health, which can significantly decline during the menopause transition.⁽¹⁾

Why Calcium Matters More Than Ever During Menopause

Hormonal changes during menopause directly influence women’s bone health. The decline in estrogen causes a decrease in bone mineral density (BMD), which can result in weaker bones as women age.⁽²⁾ 

Research shows that accelerated bone loss occurs primarily during the late perimenopause and early postmenopause stages. This decline begins approximately one year before a woman gets her final period and continues through the first two years of postmenopause. However, the rate of bone loss can vary among women and may be partially influenced by factors such as body mass index (BMI) and weight.⁽³⁾⁽⁴⁾ 

These structural bone changes can make women more prone to osteoporosis and fractures as they age. Research suggests that the risk of death within one year after a hip fracture is approximately 21% for older adults in the United States, making adequate calcium intake increasingly important during this phase of life.⁽⁵⁾

How Menopause Affects Calcium Levels and Bone Health

In addition to a decline in bone mineral density, women also experience reduced calcium absorption during menopause and postmenopause. Some experts suggest this may be related to hormonal fluctuations that affect calcium diffusion and transport in the gut. Changes in estrogen levels can also cause the body to lose more calcium through urination.⁽⁶⁾⁽⁷⁾

Research also suggests that the gastrointestinal tract becomes increasingly resistant to vitamin D absorption as the body ages. Vitamin D plays an essential role in calcium absorption, and its deficiency has been linked to certain bone disorders.⁽⁶⁾⁽⁷⁾

How much calcium do menopausal women really need?

Recommendations for how much calcium perimenopausal and postmenopausal women need have largely been informed by research on osteoporosis prevention.⁽⁸⁾ Although there are no official recommendations specific to different menopausal stages, the following are the average daily amounts of calcium recommended for women based on age:⁽⁷⁾

• Women aged 19 to 50: 1,000 milligrams (mg)

• Women aged 51 to 70: 1,200 mg

• Women aged 71 and older: 1,200 mg

Because of vitamin D’s role in calcium absorption, it’s also recommended in the following daily amounts:⁽⁹⁾

• Women aged 19 to 50: 15 micrograms (mcg)

• Women aged 51 to 70: 15 mcg

• Women aged 71 and older: 20 mcg

In addition to age and sex, lifestyle factors, health conditions, and medication use can all influence how much calcium and vitamin D a woman needs.

Best Sources of Calcium for Menopause

The best source of calcium for menopause is food. However, some foods allow for greater nutrient absorption than others. The calcium in certain plant foods may not be absorbed as effectively as the calcium in dairy products due to their phytate and oxalate content. These compounds can create indigestible calcium salts in the gastrointestinal tract. To compare, spinach has a calcium absorption rate of 5%, while milk has a 27% absorption rate.⁽⁷⁾ 

Calcium-Rich Foods

Dairy products are some of the richest sources of calcium, including the following:⁽¹⁾

• Milk

• Cheese

• Yogurt

Other dietary sources of calcium are as follows:⁽¹⁾⁽⁷

• Fortified cereal

• Kale 

• Spinach

• Broccoli

• Bok choy

• Pinto beans

• Soybeans

• Canned sardines and salmon (with bones intact) 

• Fortified tofu

Calcium is also sometimes added to certain beverages, such as the following:⁽¹⁾⁽⁷⁾

• Orange juice

• Soy milk

• Almond milk

In some cases, a doctor may recommend calcium supplements for individuals with certain health conditions or nutritional deficiencies, especially if their diet alone is insufficient to meet their calcium intake needs.

Calcium Supplements for Women

There are many forms of calcium supplements, but the most common are calcium carbonate and calcium citrate. The mineral can also be found in multivitamins or in combination with vitamin D. Multivitamins generally contain lower amounts of calcium, ranging from 200 mg to 300 mg, while calcium-only supplements or those combined with vitamin D typically have between 500 and 600 mg.⁽⁷⁾ 

While higher doses are available over-the-counter (OTC), more calcium isn’t necessarily better. The body absorbs the most calcium from doses of 500 mg or less. In fact, the percentage of absorption decreases with doses over 500 mg, and this is influenced by the amount of elemental calcium the supplement contains.⁽⁷⁾ 

Calcium carbonate and calcium citrate contain different amounts of elemental calcium, which is the portion the body absorbs for use. Calcium carbonate is made up of 40% elemental calcium, while calcium citrate contains 21% elemental calcium.⁽⁷⁾ It’s recommended that women consult with their doctor to determine which form of calcium is best suited to their supplementation needs. 

Warning Signs and Risks: High Calcium Levels or Calcium Deficiency

Calcium levels that are either too high or too low can pose certain health risks, which is why it’s important for menopausal women to recognize the signs of hypercalcemia and hypocalcemia.

Hypercalcemia 

Hypercalcemia occurs when a person has too much calcium in the blood. It’s typically caused by a health condition, such as hyperparathyroidism, in which the body releases too much parathyroid hormone. Hypercalcemia is known to affect women after menopause.⁽¹⁰⁾ Health risks associated with high calcium levels include the following:⁽⁷⁾

• Decreased muscle tone

• Renal insufficiency

• Constipation

• Nausea

• Fatigue

• Weight loss

• Cardiac arrhythmias

• Increased risk of death from cardiovascular disease

Research findings are mixed, but people who consume excess calcium may be at an increased risk for cardiovascular disease or kidney stones.⁽⁷⁾ 

Hypocalcemia and Calcium Deficiency

Hypocalcemia is characterized by abnormally low levels of calcium in the blood. Like hypercalcemia, it’s often related to a health condition, such as hypoparathyroidism or a vitamin D deficiency. Mild cases may not produce any symptoms, while some people may experience tingling sensations, numbness, or muscle spasms.⁽⁷⁾ 

Warning signs of severe hypocalcemia include the following:^(7)(11) 

• A buildup of calcium deposits (calcification) in the kidneys

• Brain calcification

• Brittle nails

• Dry skin

• Depression

• Cataracts

• Congestive heart failure

• Seizures

• Coma

Calcium deficiency can make women more susceptible to osteoporosis, falls, and fractures. Because fluctuating estrogen levels can accelerate bone loss, postmenopausal women are at an increased risk of calcium deficiency.⁽⁷⁾ 

How to Increase Calcium Levels in the Female Body

The best way for women to increase calcium levels in the body is by prioritizing calcium-rich food sources. In some cases, a doctor may recommend calcium supplements for women with certain health conditions. However, supplements can come with side effects, such as constipation or gastrointestinal discomfort. If this occurs, a healthcare provider may suggest taking multiple smaller doses throughout the day, taking the supplement with food, or trying a different form of calcium.⁽¹⁾

Building Strong Bones for the Future

A doctor can develop a tailored approach to help women meet their individual calcium needs, which may include supplementation during menopause. 

Along with eating a healthy diet, women can take additional steps to preserve bone health as they age. This includes boosting vitamin D levels through safe sun exposure, engaging in resistance training and weight-bearing exercises, avoiding smoking, and reducing alcohol consumption.⁽¹²⁾ Prioritizing bone health during the reproductive years can help maintain bone strength as women approach menopause