An HIV Information & Educational Resource Site

calcium supplementation

General Information Osteoporosis or osteopenia is a common bone disorder that causes a progressive loss in bone density and mass.  As a result bone can become thin and weakened.  This type of bone is easily broken or fractured.   HIV infection and antiviral medications especially tenofovir (Viread) and other medications that contain tenofovir like Atripla and Truvada may increase the risk of osteoporosis.  Other things that can increase osteoporosis include smoking, a family history of osteoporosis, and menopause in women.

Calcium supplementation is one way to prevent bone weakening.  There are several other treatments available for osteoporosis.  Calcium in the diet is helpful but there is controversy as to how much calcium is absorbed from foods including dairy products.
Specifics Calcium comes in several forms.  Calcium carbonate is the most common form of calcium supplementation.  Many calcium supplements also include vitamin D which is also important for bone strength also.

Calcium carbonate 400-600 mg tablets, usually with vitamin D 400 units in each tablet, should be taken three times per day with food.  It is difficult to absorb more than this amount so higher doses are likely ineffective.

(this refers to your willingness, ability, and actual performance in taking your medications)

For further information and tips on adherence, go to the Adherence section of this site.

It is strongly recommended that you consider using weekly pill boxes and arrange all of your doses a week in advance.  Buy a small pill box so that you can carry a dose or two of your medicines with you in case you are away from home. 

Possible Side Effects
We have summarized the important and more common problems here.

Many people take calcium without many side effects. 

The most common side effect of calcium is constipation.  This can be overcome in many cases by taking a stool softener such as docusate 100 mg 1-3 per day.  There is one study that indicates an increased chance of heart attack for persons that take calcium supplements.

This refers to the way that calcium affects other medications
Calcium interacts with several medications.  Dosing of calcium should be separated from gabapentin by at least two hours.  Calcium may not be absorbed well if someone also takes omeprazole, lansoprazole (Prevacid and others,) esomeprazole (Nexium), pantoprazole (Protonix and others), and rabeprazole (Aciphex).  All of these medications dramatically lower stomach acid which is important for calcium absorption.  Rarely diuretics such as hydrochlorothiazide or furosemide (Lasix and others) may cause your blood calcium to be excessively high.
Report to you healthcare provider or go to an Emergency Room if you have severe side effects, increasing side effects, shortness of breath, uncontrollable diarrhea, back pain, groin pain, fever, weakness, jaundice (eyes and skin turn yellow,) muscle pain, nausea and vomiting so that you cannot hold down your food and liquids.
You can download this handout in PDF format by clicking HERE.