Calcium deficiency

All Calcium Preparations are not same

The calcium an essential element which is required in diet. The normal person require 1000 to 1500 mg calcium per day in his diet. This requirement increase further in pregnancy and breast feeding. There are various salts available in market as calcium supplement. They efficacy of them varied a lot. So let us try to find out effectiveness of these salts.

Daily suggested calcium intake for adults 

(https://my.clevelandclinic.org/health/articles/15049-osteoporosis-prevention-with-calcium-treatment)

  • Adults 19-50 years: 1,000 mg.
  • Adult men 51-70 years: 1,000 mg.
  • Adult women 51-70 years: 1,200 mg.
  • Adults 71 years and older: 1,200 mg.
  • Pregnant and breastfeeding teens: 1,300 mg.
  • Pregnant and breastfeeding adults: 1,000 mg.

Elemental Calcium  

Elemental calcium is what the body absorbs for bone growth and other health benefits; therefore, the actual amount of calcium in the supplement is very important. The label on calcium supplements is helpful in determining how much calcium is contained in one serving (number of tablets). For example, 1,250 mg of calcium carbonate contains 500 mg of elemental calcium (40%). (https://www.uspharmacist.com/article/pros-and-cons-of-calcium-supplements)

The absorption of elemental calcium is 20-30% depending on the salt and various other factors.

Calcium Carbonate Tablets

This is the most common form of calcium used as calcium supplement. The calcium carbonate require acidic medium in stomach to get absorbed, thus absorption in people taking PPI or other medication for acid suppression decreases a lot.  Over-the-counter (OTC) antacid products contain calcium carbonate. These sources of calcium do not cost much. Each pill or chew provides 200 mg or more of calcium. However the bio-availability (elemental calcium) is 40% only. Of this, around 20% is absorbed in body, thus from a tablet of 1250 mg about 200 mg reaches blood. The most common side effect of calcium carbonate is constipation. Coral calcium is a salt of calcium derived from fossilized coral reefs. Coral calcium is composed of calcium carbonate and trace minerals. Few popular brands of calcium carbonate tablets in India are as follows. 

CIPCAL

Cipcal 500 mg tablet is marketed by Cipla limited. It contains elemental calcium 500 mg with Vitamin D 3 250 IU. The recommended daily dose is two tablets per day or as directed by physician.

SHELCAL 

Shecal 500 mg tablet is marketed by Elder Pharma which is now taken over by Torrent Pharmaceuticals Pvt Ltd. It also contains calcium carbonate 1250 mg which is equivalent to elemental calcium 500 mg. It also contains Vitamin D 3 250 IU.

Calcium Citrate and Calcium Citrate maleate

The main advantage of Calcium Citrate and Maleate is that, its absorption is not dependent on acid in stomach. So the people on acid suppressant can also take this. However the elemental calcium provided by it is 21%. But its absorption is 20% more than Calcium Carbonate. Calcium citrate preparations are more expensive than calcium carbonate. Few popular brands of calcium citrate and Calcium Citrate maleate tablets in India are as follows. 

GOLDCAL HD

Goldcal HD tablet is marketed by Ronyd Healthcare Pvt Ltd in India. It contains Calcium Citrate maleate 1000 mg along with Vitamin D 3 1000 IU.

SUPRACAL Tablet

Supracal Tablet is marketed by Pharmed in India. It contains Calcium Citrate 1000 mg along with vitamin D 3 200 IU, Magnesium 100 mg and Zinc 4 mg.

Calcium Lactate has similar absorption as calcium carbonate but is more expensive. Calcium lactate and calcium gluconate are less concentrated forms of calcium and are not practical oral supplements

Calcium Phosphate costs more than calcium carbonate, but less than calcium citrate. microcrystalline hydroxyapatite (MH) is one of several forms of calcium phosphate used as a dietary supplement. Hydroxyapatite is about 40% calcium.

The various health authorities across the world now made it mandatory that oral calcium tablets must contain vitamin D 3 , because vitamin D 3 is must for proper utilisation of calcium in body. Various oral calcium preparation with vitamin D 3 available in India can be found here. The composition and cost of various formulations can also be compared.

Some forms of Calcium supplements may contribute to the development of kidney stones.

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