My doctor says get calcium from food, my sister's cardiologist says the tablets are bad for your heart. What are the rest of you actually doing?

I've been going round in circles on this since my scan and I'd like to hear what real women are doing rather than what the internet says, because the internet says everything.

My doctor's line was "food first, and only supplement if you can't get there." Fine. Then my sister repeats what her cardiologist told her, which is that calcium tablets can end up in your arteries instead of your bones and she should stay off them. Then a friend at quilting says her rheumatologist put her straight onto a calcium and vitamin D combination without any of this agonising, and now I don't know whether the tablet in my cupboard is helping my bones or clogging my heart.

What I can't work out is whether the worry applies to supplements only or to calcium in general, because nobody warns you off yogurt. And whether vitamin D is a separate question or part of the same one. I'm 63, osteopenia on my last DEXA, no fractures, no heart trouble that anyone knows about.

I did the actual arithmetic on my food after my own scan and it was the most useful hour I've spent on this. Wrote down everything for a week, looked up the calcium in each thing, added it up. I was nowhere near where I assumed I was, but I was also not at zero, and it turned out I needed to close a gap rather than start from nothing.

That changed the conversation with my doctor completely. Instead of "should I take a supplement," it was "here's my usual intake, here's the gap, what do you want to do about it." She had an actual opinion once she had a number.

Yogurt, sardines with the bones in, the fortified orange juice, and greens. That's my whole strategy and my last two scans have held steady. I'm not saying that proves anything, plenty else changed too, but I stopped buying the big tub of tablets and nothing bad happened.

What I would say is don't let the calcium argument eat all your attention. My doctor was far more interested in my vitamin D level, which was low, and in whether I was doing anything with weights. Those two got fixed. The calcium was the least interesting part of the appointment.

My sister-in-law takes a supplement she bought because a woman on television recommended it and she has no idea what's in it or how much. That's the version of this I'd worry about, not the one where you've thought about it and asked somebody.

quiltingsue said:

What I can't work out is whether the worry applies to supplements only or to calcium in general, because nobody warns you off yogurt.

Sue, that instinct is the right one and it is the distinction most of the coverage blurs. The concern that gets discussed is about high-dose supplements, not about calcium from food, which is exactly why "food first" is the standard advice. The evidence on supplements and cardiovascular risk has genuinely gone back and forth over the years, and I am not going to tell you it is settled, because it is not. What has stayed consistent through all of it is that food is the preferred source and that supplements are there to close a gap rather than to be taken on principle.

Our guide to osteoporosis and bone health after 50 sets out the general targets for calcium and vitamin D that most guidance lands on, with the caveat that the exact numbers vary by country and by person, and that yours are a question for your own doctor rather than for me or for a quilting group. Vitamin D is a related but separate matter: it governs how well you absorb the calcium you eat, and it is one of the few things here that can actually be measured in your blood rather than argued about.

Linda's approach is the one I'd copy, and I say that as someone who spent two years vaguely worrying about calcium without ever once writing down what I ate. A week of honest counting turns a philosophical debate into a gap you can do something about. And if you ever do end up on a bone medication, adequate calcium and vitamin D are assumed as the foundation underneath it, which is covered in the article on what to expect from osteoporosis medication.

One practical note from my own file: my doctor wanted to know about every supplement I was taking, including the ones I thought were too trivial to mention. Bring the actual bottles.

Did Linda's exercise. Seven days of writing down every dairy thing and every leafy thing, which was tedious and slightly embarrassing.

Result: I'm decently close on the days I eat properly and miles off on the days I don't, which is more days than I'd like to admit. Doctor's take was that the fix is the bad days rather than a tablet, and she's checking my vitamin D at my next bloods because nobody ever has. So I'm eating more yogurt and I've quietly retired the big tub.

Still don't feel like anyone has actually answered my sister's cardiologist, mind you. I don't think anyone can.