Worried About Bone Loss in Menopause? Start with Calcium and Vitamin D

If there is one piece of bone health advice most women have heard, it’s this:

“Make sure you’re getting enough calcium and vitamin D.”

That advice is still true—especially after menopause. But what often gets lost is:

• How much you actually need
• Where it should come from
• And why you need both

Let’s break it down in a way that’s simple, practical, and actually useful.

Bone Loss After Menopause

Before menopause, estrogen plays a quiet but powerful role in protecting your bones. It helps keep the normal process of bone breakdown and rebuilding in balance.

After menopause, that balance shifts:

• Bone is broken down faster than it’s rebuilt
• Calcium is pulled out of the skeleton more quickly
• Bone density slowly declines

This doesn’t happen overnight. It’s gradual. And that’s exactly why steady daily nutrition matters.

What Calcium Actually Does for Your Bones

Calcium is the main mineral that gives bones their strength and structure. Think of it as the building material your skeleton is constantly using for repairs.

Calcium isn’t just for your bones. It’s also essential for things like muscle contraction (including your heart), nerve signaling, and blood clotting. Because of that, your body will always work very hard to keep blood calcium levels stable.

If there isn’t enough calcium coming in from food (or supplements when needed), your body will still meet those vital needs—but it may do that by pulling calcium out of your bones to keep your blood levels steady.

After menopause, when bone breakdown is already happening faster, low calcium intake can speed that process along.

This is why getting enough calcium really matters at this stage of life.

How Much Calcium Do You Actually Need?

For women aged 51 and older, the general recommendation is:

1,200 mg of elemental calcium per day (from food and supplements combined)

Whenever possible, I recommend getting most—if not all—of your calcium from food. It’s more easily absorbed, it’s safer long-term, and it comes with other nutrients that also support bone health.

Here are a few common foods and what they contribute in a typical serving:

• Milk (1 cup): ~300 mg
• Yogurt (¾–1 cup): ~250–400 mg (depending on brand/type)
• Cheese (1½ oz, about two slices): ~300 mg
• Sardines with bones (½ can): ~250–325 mg
• Canned salmon with bones (½ cup): ~180–200 mg
• Fortified plant milk (1 cup): ~300 mg (check the label—this varies)
• Kale or bok choy (1 cup cooked): ~150–180 mg
• Broccoli (1 cup cooked): ~60 mg

You’ll often see spinach listed as “high in calcium,” but the type of calcium in spinach isn’t absorbed very well. It’s still a very nutritious food—just not a strong calcium source for bones.

This means you don’t need huge portions to make meaningful progress toward that 1,200 mg daily target. A couple of calcium-rich choices spread through the day can take you a long way.

If you’re curious how all of this adds up for you, a calcium calculator can be helpful.

Looking for more non-dairy sources of calcium? Check out this post: Calcium without the Cow.

Do I Need a Calcium Supplement?

This is one of the most common questions I get in practice.

My general approach is supplements should fill the gap — not replace food. If someone is consistently falling short of the 1,200 mg target, a supplement can be useful.

But I generally recommend aiming for no more than about 600 mg per day from supplements.

Your body has a limited ability to absorb calcium at once. Once you go much above 500–600 mg in a single dose, absorption becomes less efficient.

And higher-dose calcium supplements have been linked to:

• A greater risk of kidney stones
• Possible concern with heart health (the research here is still evolving and somewhat mixed)

More is not better. Moderate, targeted doses make the most sense.

When reading the label look for the amount of elemental calcium. This is the portion your body can actually use.

Calcium carbonate

• About 40% elemental calcium
• The cheapest and most common type
• Must be taken with food for absorption
• More likely to cause gas or constipation

• Calcium citrate
  • About 21% elemental calcium
  • Can be taken with or without food
  • A better choice if you have low stomach acid or take acid-reducing medications

Other forms (like calcium gluconate or lactate) contain very little usable calcium and aren’t ideal for bone support.

Why Vitamin D Is Important for Bone Health

If calcium is the building material, vitamin D is what helps your body actually use it.

Vitamin D:

• Helps your gut absorb calcium
• Helps move calcium into bone
• Supports muscle strength and balance, which lowers fall risk

I often see women who get plenty of calcium but still have low vitamin D levels. In that situation, the calcium simply isn’t being used as effectively as it could be.

How Much Vitamin D Do You Need in Menopause?

Most guidelines suggest: 800–1,000 IU per day for women over 50

This range supports both:

• Bone mineralization
• Muscle function and balance

Some women may need more, especially if their blood levels are low, but that’s something best guided by testing and individual discussion.

Why Vitamin D Supplements Are So Common in Midlife

We can get vitamin D from:

• Sun exposure
• Fatty fish
• Fortified foods (milk, yogurt, margarines)

But as we age:

• Our skin makes vitamin D less efficiently
• We spend more time indoors
• In Canada and other Northern climates, sun exposure is limited for much of the year

This is why vitamin D is one supplement I routinely recommend even with a balanced diet.

Why Calcium and Vitamin D Go Together

This part is important:

• Calcium without enough vitamin D doesn’t work as well
• Vitamin D without enough calcium doesn’t protect bones on its own

They work as a pair. One supplies the building material. The other helps your body use it.

If you’re concerned about bone loss in menopause, you don’t need a long list of products to get started. Begin with the basics you can repeat: enough calcium from food, enough vitamin D, and sensible supplement use when it truly fills a gap.

Once you have the basics mastered you might also want to consider:

• protein
• Vitamin K2
• Magnesium and zinc