As a nutrition support pharmacist, people are asking you if they should take MORE vitamin D and LESS calcium. This follows some recommendations by many experts...
According to Vitamin D, some experts recommend that adults get 1000 IU/day of vitamin D instead of just 400 IU/day. They say that vitamin D is MORE important than calcium for bone health and has other important benefits. Most people are getting less vitamin D these days, due to less sun exposure. And milk contains only 100 IU per cup. Recommend at least 400 to 800 IU/day of vitamin D, especially for those at higher latitudes or who don't get much sun. Suggest using D3 (cholecalciferol) instead of D2 (ergocalciferol). Some fortified foods and multivitamins contain D2, but D3 is more active and it's the form that has been shown to prevent fractures. Advise people that up to 2000 IU/day of vitamin D3 is safe.
According to calcium, they are also advising women to LIMIT calcium supplements to 700 mg daily, and men NOT to take them at all. Most people get 600 mg/day of calcium from their diet. This means that women can still get 1200 mg/day with diet plus supplements. But they say that the 600 mg men get from food is enough as long as they get enough vitamin D. There's a concern that higher amounts of calcium MIGHT increase the risk of prostate cancer. But this hasn't been proven. Tell people it's too soon to tell if these lower amounts of calcium are adequate and there's probably no harm from taking more. Suggest sticking with the latest Canadian osteoporosis recommendations 1000 mg/day for men up to age 50 and premenopausal women, then 1500 mg/day for men over 50 and postmenopausal women. Tell patients that a cup of yogurt, milk, or fortified juice provides about 300 mg of calcium. But if they're not getting enough from diet, suggest making up the difference with supplements. Get our notes, "Vitamin D deficiency in adults" & "Using calcium supplements safely" and "Clinical points on vitamin D supplements in adults" for more information.
REFERENCES
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Hathcock JN, Shao A, Vieth R, Heaney R. Risk assessment for vitamin D. Am J Clin Nutr. 2007 Jan;85(1):6-18. Available at: https://www.sciencedirect.com/science/article/pii/S0002916523278594?via%3Dihub
Shea B, Wells G, Cranney A, Zytaruk N, Robinson V, Griffith L, Hamel C, Ortiz Z, Peterson J, Adachi J, Tugwell P, Guyatt G; Osteoporosis Methodology Group; Osteoporosis Research Advisory Group. Calcium supplementation on bone loss in postmenopausal women. Cochrane Database Syst Rev. 2004;(1):CD004526. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004526.pub2/full
Boonen S, Lips P, Bouillon R, Bischoff-Ferrari HA, Vanderschueren D, Haentjens P. Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab. 2007 Apr;92(4):1415-23. Available at: https://academic.oup.com/jcem/article/92/4/1415/2597489?login=false