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Dear Doctor: Strengthening your bones

I've heard that calcium tablets can cause heart disease, so what other way can I build up bone strength?

I have been taking calcium tablets to build up my bones, but was told that doing this can cause heart disease. Is this true?

A recent trial suggested that calcium supplements might slightly increase the risk of heart attack in healthy older women. Millions of women take calcium supplements in the hope of improving bone density. But some experts have said the benefits of calcium supplements in lowering the risk for bone fractures is far from convincing.

As calcium supplements alone do not prevent fractures, any level of heart risk associated with them needs to be taken seriously. It is thought that the calcium supplements may rapidly raise blood calcium levels which can contribute to heart disease.

I have osteoporosis. Should I continue taking my calcium tablets, which also have vitamin D?

If you have osteoporosis you should be taking prescribed medications for this condition, not relying on supplements. This particular study looked at calcium supplements only. We can't say whether taking calcium and vitamin D supplements combined is also linked to a higher risk of a heart attack. There are other treatments that work better than calcium to improve bone strength and reduce risk of bone fracture such as bisphosphonates. Talk to your doctor about what's best for you.

Should I also cut out calcium-rich foods from my diet? I don't take much dairy products anyway as I find I'm intolerant of them.

Calcium from food sources is absorbed much more slowly and so there is no increased risk of heart disease. People often don't always realise how much calcium they are getting in their diet and keeping to a calcium-rich diet will help in the fight against osteoporosis.

Non-dairy sources of calcium include broccoli, kale, Chinese cabbage, tinned salmon and sardines, almonds, fortified cereals and fruit juices. For people who can take dairy products, stick to the low-fat versions of milk, cheese and yoghurt products.

Can you prevent osteoporosis developing, or is everybody at risk regardless of their lifestyle?

The five main factors essential for keeping bones healthy throughout your life are: not smoking or drinking alcohol excessively (more than two drinks/day), getting regular exercise, and adequate amounts of calcium and vitamin D.

No matter when you start, exercise will help you build strong bones and slow bone loss. Although most people get adequate amounts of vitamin D from sunlight, this may not be a good source if you're housebound, avoid the sun entirely or regularly use sunscreen. Vitamin D is found in oily fish such as tuna, sardines and egg yolks, but most people don't eat these on a daily basis. Vitamin D supplements (between 400-1,000IU daily) are a good alternative.