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Reviewed by the Scan Dose Research Team and Clinical Advisory Board

Calcium

STRONG EVIDENCEMineralLast updated April 2026

SCAN DOSE SUMMARY

Calcium is the most abundant mineral in the human body — 99% stored in bones and teeth. Our research confirms supplementation prevents bone loss in postmenopausal women but raises legitimate cardiovascular concerns at doses above 1,000mg/day from supplements. The form matters (citrate > carbonate for absorption), timing matters (never with thyroid medication), and the cardiovascular risk signal means food-based calcium is preferred over pills when possible.

EVIDENCE GRADES

Bone mineral density (postmenopausal)Strong — Cochrane review (PMID: 26174298)
A
Fracture prevention (with vitamin D)Strong when combined with D
B+
Blood pressure reductionModest effect in hypertensive populations
B-
Colorectal cancer preventionModerate — large observational data
B-
Cardiovascular riskMeta-analyses show possible 20-30% increased MI risk with supplements >1,000mg/day (PMID: 21505219)
⚠️ CONCERN

WHAT IT DOES

Calcium is essential for bone mineralization, muscle contraction, nerve transmission, blood clotting, and enzyme function. Bone constantly remodels — osteoblasts build, osteoclasts resorb. After menopause, resorption outpaces formation, leading to osteoporosis. Calcium supplementation + vitamin D slows this imbalance.

Supplemental forms differ:

  • Calcium carbonate: 40% elemental calcium, requires stomach acid for absorption. Take with food. Cheapest.
  • Calcium citrate: 21% elemental calcium, absorbed independent of stomach acid. Take anytime. Better for PPI users and older adults.
  • Calcium phosphate, lactate, gluconate: Lower elemental calcium percentages. Less commonly used.
  • Hydroxyapatite: Bone-derived form with accompanying phosphorus and trace minerals. Theoretical advantage for bone health.

OPTIMAL DOSAGE

  • Total daily calcium (food + supplement): 1,000-1,200mg/day
  • Supplement dose: ≤500mg per dose (absorption saturates above 500mg)
  • Split doses at least 4 hours apart
  • ALWAYS co-supplement with vitamin D (1,000-4,000 IU) and consider K2 (100-200mcg MK-7) to direct calcium to bones, not arteries
Scan a supplement containing Calcium

DRUG INTERACTIONS

Levothyroxine (Synthroid)Severe

Chelation — reduces thyroid hormone absorption by up to 60%. Separate by ≥4 HOURS.

Fluoroquinolone antibiotics (cipro)Severe

Chelation — reduces antibiotic absorption. Separate by ≥2 hours.

Tetracycline antibioticsSevere

Chelation. Separate by ≥2 hours.

Bisphosphonates (alendronate)Severe

Chelation. Separate by ≥2 hours.

Iron supplementsModerate

Competitive absorption. Separate by ≥2 hours.

Thiazide diureticsModerate

Reduce calcium excretion + calcium supplementation → hypercalcemia risk

DigoxinModerate

Hypercalcemia increases digoxin toxicity risk

ZincModerate

Competitive absorption at high doses

SAFETY PROFILE

Drug Interactions

⚠️ Cardiovascular Concern

A 2011 meta-analysis of 11 RCTs found calcium supplements (without co-administered vitamin D) increased myocardial infarction risk by approximately 27% (PMID: 21505219). The proposed mechanism: calcium supplements cause acute spikes in serum calcium that may accelerate vascular calcification. This risk signal is NOT seen with dietary calcium.

Our recommendation: Get calcium primarily from food. If supplementing, keep supplement dose ≤500mg/day, always co-administer vitamin D + K2, and prefer calcium citrate.

Pregnancy & Lactation

  • Recommended during pregnancy (1,000-1,300mg/day total). WHO recommends calcium supplementation in populations with low dietary calcium intake to reduce preeclampsia risk.

WADA Status

Not Prohibited

HOW SCAN DOSE SCORES THIS

Products >1,000mg calcium per serving: flag cardiovascular concern
Products without vitamin D co-formulation: recommend adding D + K2
Calcium carbonate in products for PPI users: flag — they need citrate form
Levothyroxine/antibiotic users: automatic 4-hour/2-hour separation alert
≤500mg per dose maximum: flag products exceeding this
Hydroxyapatite form: score minor bonus for bone health applications

CLINICAL REFERENCES

1.

Tai V et al. Calcium intake and bone mineral density: systematic review and meta-analysis.

PMID: 26174298

2.

Bolland MJ et al. Calcium supplements with or without vitamin D and risk of cardiovascular events.

PMID: 21505219

3.

Heaney RP. Calcium supplementation and incident kidney stone risk.

PMID: 17720017

4.

Burt LA et al. Effect of high-dose vitamin D supplementation on bone density.

PMID: 29072163

RELATED RESEARCH

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Scan Your Calcium SupplementBrowse all ingredients

Reviewed by the Scan Dose Research Team and Clinical Advisory Board | Last updated: April 2026

Not medical advice. Based on published clinical research and systematic reviews.

Safety

Calcium: Drug Interactions

Use with caution

Moderate interactions. Monitoring, timing separation, or dose adjustment may be required.

  • Levothyroxine (Synthroid)

    Calcium binds levothyroxine in the gut.

    RiskSubtherapeutic thyroid hormone. Hypothyroid symptoms may return.
    ActionSeparate by 4 or more hours.

    Source: FDA label

  • Tetracycline and doxycycline

    Calcium chelates the antibiotic.

    RiskAntibiotic treatment failure.
    ActionSeparate by 2 to 3 hours.

    Source: FDA label

  • Fluoroquinolones (Cipro)

    Calcium chelates the antibiotic.

    RiskAntibiotic treatment failure.
    ActionTake 2+ hours before or 6+ hours after the antibiotic.

    Source: FDA label

  • Iron supplements

    Calcium blocks iron absorption.

    RiskIron deficiency.
    ActionTake at different meals.

    Source: Clinical consensus

  • Bisphosphonates (Fosamax)

    Calcium blocks bisphosphonate absorption.

    RiskReduced bone drug efficacy.
    ActionTake bisphosphonate on an empty stomach; calcium later.

    Source: FDA label

  • Thiazide diuretics (HCTZ)

    Both increase serum calcium.

    RiskHypercalcemia.
    ActionMonitor calcium levels.

    Source: Clinical pharmacology

Timing Separation Rules

  • Levothyroxine4 hours
  • Tetracycline / fluoroquinolone antibiotics2 to 3 hours
  • Bisphosphonates2+ hours after bisphosphonate

Educational information only. This is not medical advice. These statements have not been evaluated by the FDA. Talk to your prescriber before starting, stopping, or combining any supplement with prescription medication.

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