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Calcium Deficiency: Causes, Symptoms & Treatment
Calcium deficiency (hypocalcemia) means the level of calcium in the blood is too low. It can affect bones, muscles and nerves and should be evaluated by a doctor.
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Calcium deficiency (hypocalcemia) means the level of calcium in the blood is too low. It can affect bones, muscles and nerves and should be evaluated by a doctor.
What is Calcium Deficiency?
Calcium deficiency, medically known as hypocalcemia, occurs when the level of calcium in the blood falls below the normal range of approximately 2.2 mmol/l. Calcium is an essential mineral required not only for building and maintaining strong bones and teeth, but also for muscle function, nerve transmission, blood clotting, and heart health.
Causes
Calcium deficiency can result from a variety of causes:
- Vitamin D deficiency: Vitamin D is essential for calcium absorption in the intestine. A lack of vitamin D commonly leads to calcium deficiency.
- Hypoparathyroidism: Underactive parathyroid glands produce insufficient parathyroid hormone (PTH), which regulates calcium levels in the blood.
- Kidney disease: Impaired kidney function can reduce the reabsorption of calcium.
- Poor diet: A prolonged low-calcium diet, for example when dairy products are avoided without adequate substitutes, can lead to deficiency.
- Malabsorption: Conditions such as celiac disease or Crohn's disease can reduce calcium absorption in the gut.
- Medications: Certain drugs, including proton pump inhibitors, corticosteroids, and bisphosphonates, may affect calcium levels.
- Magnesium deficiency: Low magnesium levels can suppress PTH secretion, indirectly causing calcium deficiency.
Symptoms
The symptoms of calcium deficiency vary depending on severity and may include:
- Muscle cramps, twitching, and weakness (particularly in the hands, feet, and face)
- Numbness and tingling in the extremities
- Tetany (involuntary muscle contractions)
- Palpitations and irregular heartbeat
- Increased irritability, anxiety, and depression
- Brittle nails, dry skin, and hair loss
- Tooth decay and dental problems
- Long-term: osteoporosis (bone loss)
Diagnosis
Calcium deficiency is primarily diagnosed through a blood test measuring total serum calcium and ionized calcium levels. Additional laboratory values are often assessed, including:
- Vitamin D (25-OH vitamin D)
- Parathyroid hormone (PTH)
- Magnesium and phosphate
- Kidney function markers (creatinine, urea)
If osteoporosis is suspected, a bone density scan (DXA) may also be recommended.
Treatment
Diet
A calcium-rich diet is the foundation of treatment. Good dietary sources of calcium include:
- Milk and dairy products (cheese, yogurt)
- Green leafy vegetables (broccoli, kale, bok choy)
- Sesame seeds and almonds
- Calcium-fortified plant-based milks and juices
- Mineral water with a high calcium content (above 150 mg/l)
Supplementation
In confirmed cases of deficiency, supplementation with calcium preparations (e.g., calcium carbonate or calcium citrate) may be recommended. The World Health Organization (WHO) and national health authorities generally recommend a daily calcium intake of 1000 mg for adults, and 1000–1200 mg for adults over the age of 65. Excessive calcium intake should be avoided, as it may increase the risk of kidney stones and cardiovascular problems.
Treating the Underlying Cause
When calcium deficiency is caused by an underlying condition, that condition must be addressed directly, for example through vitamin D supplementation in cases of vitamin D deficiency, or through hormone therapy in hypoparathyroidism.
At-Risk Groups
Certain groups of people are at a higher risk of developing calcium deficiency:
- Older adults, as intestinal calcium absorption decreases with age
- Postmenopausal women (increased risk of osteoporosis)
- Individuals with lactose intolerance or those following a vegan diet
- Pregnant and breastfeeding women
- People with chronic gastrointestinal conditions
References
- World Health Organization (WHO): Calcium supplementation in pregnant women. WHO Guidelines, 2013.
- Bilezikian JP et al. - Hypoparathyroidism. New England Journal of Medicine, 2022.
- Weaver CM et al. - Calcium. In: Ross AC et al. (eds.), Modern Nutrition in Health and Disease, 11th ed., Wolters Kluwer, 2014.
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