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Calcium Requirements — SCE Rheumatology MCQ

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EasyMetabolic Bone DiseaseCalcium RequirementsSCE Rheumatology

A 55-year-old woman with osteoporosis is starting oral bisphosphonate treatment. Dietary assessment shows that her calcium intake is below the recommended level. Which advice about her total daily calcium intake is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Target 1000 mg daily in total; prioritise dietary calcium and add an oral supplement only to make up any shortfall.

The correct answer is D. The baseline UK adult calcium requirement is at least 700 mg daily, but approximately 1000 mg daily is recommended when receiving antiresorptive treatment. Calcium should preferably come from dietary sources, such as dairy products, calcium-fortified alternatives, calcium-set tofu and fish eaten with bones. Because her assessed intake is inadequate, an oral supplement should provide only the shortfall; it should be taken separately from an oral bisphosphonate because calcium impairs bisphosphonate absorption. A total of 500 mg is inadequate, whereas routine intake of 3000 mg is unnecessary and potentially harmful. A normal serum calcium does not establish adequate dietary intake because serum calcium is tightly regulated. Intravenous calcium is reserved for specific acute indications, not routine osteoporosis care.

Reference: Nottinghamshire Area Prescribing Committee. Osteoporosis and fracture prevention guideline v3.4, section 7: Calcium and vitamin D. Updated March 2026. https://www.nottsapc.nhs.uk/media/rcwdeffe/osteoporosis-guidelines.pdf