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Not Enough Calcium? EEK! Not Enough DEXA?!

When I was a younger person (long ago … like last week, in my mind), I was taught about men needing to make sure they get enough calcium, especially if they were on androgen deprivation therapy (ADT) for prostate cancer. I reiterated that mantra for years and I was excited to teach others about all the different forms of calcium pills on the market and the pros and cons of each one of them. However, something funny happened over time and I began to realize, like anything in life, when something is good then some folks want to believe that a ton of that something is better than a moderate amount of that something (kind of like ice cream and reality TV shows).

Straw on Top of Glass of Milk with walnuts

Calcium started showing up in all sorts of foods over the past 10 years. For example, many plant-based milks today have more calcium than dairy products, or real “milk.” Heck, I had more than two cups of macadamia nut milk this morning in my bran cereal before I wrote this column, and that provided about 1000 mg of calcium! Just that one source! 


What I am trying to say is that calcium has become a ubiquitous (man I love that word almost as much as the word “onomatopoeia”- MOO!) mineral. It also suggests that, like with any other nutrient, you need to do your homework to determine if you really need to take a pill, including one with extra amounts of calcium. A dietician or nutritionist can help you determine, through a food diary or interview, how much you are getting daily, and how to increase, or even decrease, your calcium consumption if needed. There are also numerous websites that can help you calculate your average daily intake.

Yet, keep in mind the average calcium recommendation is approximately 1000-1200 mg per day based on your adult age, and that may seem like a lot, but the average daily dietary intake in adult men is almost 1100 mg per day (per USDA), and that is without taking a single supplement. (Women average close to 900 mg/day of calcium from dietary sources alone.) Part of the reason is due to the greater caloric intakes, which increases the chances you are getting more calcium. 

Now, after the age of 60 the average dietary calcium intake is almost 1000 mg (slightly less, but still impressive)! If I load up on many vegetables (bok choy, broccoli, kale, etc.) I also get a lot of calcium, and on and on it goes. I also like my morning coffee with some plant-based milk, and plain yogurt and BAM (onomatopoeia strikes again)! More calcium and more onomatopoeia! Still, it appears there are some suggesting we need to be ingesting more and more calcium since we absorb less with greater intakes. Yikes! If your calcium intake is low and you cannot find foods to bring it near the average, then perhaps you could take a low-dose calcium supplement, but that is a BIG IF!

I have a “friend” who was taking two calcium pills on ADT, and when we calculated his daily calcium intake coming just from his foods and beverages, it was already 1500 mg! Yikes! Getting too much calcium from pills when you do not need them can quickly increase your risk of two not so nice things … constipation and kidney stones. In the past few years, there are also other concerns that flooding the body with calcium it does not really need can increase the risk of different parts of the body becoming more calcified/injured (I am trying not to be alarmist). Still, bone health is not just about calcium or even vitamin D. A variety of healthy nutrients appear to impact bone health, as does what you do to your body in terms of resistance and other exercises. Basically, most heart healthy behaviors are bone healthy behaviors.

Your healthcare team has a variety of methods to determine how your bones are doing, for example getting a DEXA imaging test if you are starting, or have been on ADT, because that is the real deficiency going on in prostate cancer (not calcium, my friends). In the most recent preliminary study, LESS THAN 10% OF MEN RECEIVED A DEXA IMAGING TEST WITHIN 12 MONTHS BEFORE AND 6 MONTHS AFTER THEIR FIRST EXPOSURE TO ADT!1,2 LESS THAN 10%! EEK (onomatopoeia? Yup.)!

Look, I like calcium supplements just like I like many other pills, but I just do not think anyone should take a pill unless they know for sure that they qualify for that pill. And, if it is possible to avoid another pill by improving your diet then that makes me say “WHOOP WHOOP” (double repeat onomatopoeia)!


  1. Suarez-Almazor ME, et al. JAMA Netw Open 2022; doi:10.1001/jamanetworkopen.2022.5432
  2. Kishan AU, et al. JAMA Netw Open 2022; doi: 10.1001/jamanetworkopen.2022.5439