Calcium, Zinc and Vitamin D: Do Middle-Aged Men Need Supplements?

Many people believe osteoporosis is a disease of women after menopause. In reality, about 1 in 5 men over 50 will break a bone because of thinning bones during the rest of their lives, and when a man breaks a hip, his chance of dying within the first year is even higher than a woman's. But the answer is not to take every supplement on the market. This article will help you sort out what you really need.

Why middle-aged men should care about their bones

From the late 30s, bone mass slowly declines every year. Factors that speed this up in men include:

• Low testosterone (see Symptoms of low testosterone)
• Long-term oral steroids or certain other medicines, such as anti-seizure drugs and hormone-blocking treatment for prostate cancer
• Smoking, heavy drinking, low body weight and lack of exercise
• Kidney disease, liver disease, an overactive thyroid or problems absorbing food

Symptoms like back pain or cramps do not tell you that your bones are thin. Most osteoporosis is silent until a bone breaks, so it has to be assessed from risk factors and testing.

Calcium: food first

Good food sources include milk or yogurt (one glass has about 250–300 mg), firm tofu made with calcium salts, small fish eaten with their bones, dried shrimp, black sesame, green leafy vegetables such as Chinese kale (kana) and broccoli, and calcium-fortified soy milk.

Calcium tablets suit people who genuinely can't get enough from food. Things to know:

• Take no more than 500 mg at a time for better absorption. Calcium carbonate should be taken with food.
• Common side effects are constipation and bloating, and some studies have found a higher risk of kidney stones.
• Whether calcium tablets increase heart disease is still unsettled, but there is no reason to take more than you need.
• Calcium interferes with the absorption of some medicines, such as thyroid medication, certain antibiotics and iron, so take them at different times.

Vitamin D: important, but not a miracle

Adults up to age 70 need 600 IU a day, and those over 70 need 800 IU. The body makes vitamin D from sunlight, and it is also found in oily sea fish, egg yolk and vitamin D-fortified milk. Don't take more than 4,000 IU a day long term unless a doctor prescribes it, because it can cause high blood calcium and kidney stones.

The latest evidence worth knowing: the VITAL study in more than 25,000 healthy adults found that taking 2,000 IU of vitamin D a day for about 5 years did not reduce fractures, heart disease or cancer in any clear way. The Endocrine Society's 2024 guideline does not recommend routine vitamin D blood testing for healthy adults without a specific reason, but does suggest supplementing some groups, such as people aged 75 and over. Read more in Vitamin level testing: is it necessary?

Groups where supplementing makes more sense are people who get almost no sun, the very elderly, people with bowel conditions that impair absorption, and people already diagnosed with deficiency or osteoporosis.

Zinc: essential, but more doesn't mean better

Men need about 11 mg of zinc a day. Good sources are oysters, red meat, chicken, beans and pumpkin seeds. Zinc supports the immune system, wound healing and sperm production. Men who are truly zinc-deficient can have low testosterone, but in men who aren't deficient, supplements do not improve hormones or sexual performance. Don't exceed 40 mg a day long term, because it can cause copper deficiency. The details are in Zinc and men's health.

What helps your bones more than pills

1. Strength training and weight-bearing exercise at least 2–3 days a week, such as squats, brisk walking and climbing stairs
2. Balance training to reduce falls, which cause most fractures
3. Enough protein, especially from age 50; see Nutrition after 50
4. Quit smoking and cut down on alcohol

Who should have a bone density scan, and when to see a doctor

A bone density scan (DXA) in men is usually recommended from age 70, or at age 50–69 with risk factors such as low testosterone, steroid use, a previous fracture from a minor fall, a clear loss of height, or a chronic disease that affects bone.

At Dr. Kris Clinic I can assess your osteoporosis risk, review the supplements you take to check for overlap or excess, test hormones when you have symptoms, and refer you for a bone density scan when there is a reason. If you have broken a bone easily after a fall, have sudden back pain after lifting something, or have lost several centimetres in height, see a doctor soon.