Introduction

Calcium is a vital mineral that is essential for maintaining strong bones and proper functioning of the body. An average adult has about 2% calcium, with the majority of it stored in the skeleton and teeth and the remainder in tissues or blood. Inadequate calcium intake can lead to a range of health problems, including osteoporosis, a condition in which bones become fragile and brittle. Unfortunately, many people are not getting enough calcium in their diets, particularly females and children. 

Let us explore the importance of calcium, the role it plays in the body, and the signs and symptoms of calcium deficiency.^1,2

Importance of Calcium 

• Calcium is an essential mineral that is necessary for maintaining healthy bones and teeth, regulating muscle and heart function, blood clotting, and nerve transmission.
• The majority of calcium is stored in bones and teeth, providing structure and hardness.
  Calcium is necessary for muscle movement, nerve communication, regulating blood flow, and releasing hormones.
• To meet the recommended daily intake of calcium, it is important to consume a variety of calcium-rich foods.

Here are some foods that are great sources of calcium:

• Dairy products like milk, yoghurt, and cheese
• Canned sardines and salmon with bones 
• Vegetables like kale, broccoli, and Chinese cabbage.
• Soy and almond beverages, and certain brands of tofu and ready-to-eat cereals, also contain calcium.
• Grains like bread, pasta, and unfortified cereals do not have high amounts of calcium, but they still contribute to overall calcium intake.^1,2

Early Signs and Symptoms of Calcium Deficiency

Here are some signs and symptoms to look out for, that may indicate calcium deficiency:

Signs:

• Mild hypocalcemia may not have any symptoms (asymptomatic).
• Poor oral health: Calcium helps keep our teeth strong and anchored in the jawbone. When the body is deficient in calcium, the teeth become more susceptible to decay and gum disease.
• Abnormal heart rhythm: Calcium is crucial for proper heart function. A severe deficiency can cause ventricular arrhythmias, which can be life-threatening.

Symptoms:

• Fatigue: One of the most common early symptoms of calcium deficiency is fatigue. The cells become undernourished, leading to fatigue and body aches.
• Muscle pain and spasms: Calcium is essential for proper muscle function, and a deficiency can lead to muscle pain, stiffness, and spasms.
• Cognitive issues: Calcium deficiency can impact cognitive function, causing symptoms such as brain fog, confusion, and dizziness.
• Numbness and tingling in the extremities: Calcium plays a crucial role in the central nervous system. When deficient, it can impact nerve function and cause numbness and tingling in the fingers, hands, feet, and toes.
• Seizures: In rare cases, calcium deficiency can trigger seizures.
• Mild hypocalcemia symptoms may include muscle cramps (particularly in the back and legs), dry and scaly skin, brittle nails, and coarser-than-normal hair.
• Severe hypocalcemia can lead to neurological and psychological symptoms such as confusion, memory problems, irritability or restlessness, depression and hallucinations.
• Severe hypocalcemia can also cause physical symptoms like tingling in lips, tongue, fingers, and feet, muscle aches, muscle spasms in the throat making breathing difficult, stiffening and spasms of muscles (tetany), seizures, abnormal heart rhythms (arrhythmia), and congestive heart failure.

It’s important to note that if you experience chest pain along with other symptoms like shortness of breath or fainting, you should seek emergency medical attention right away. A healthcare provider can assess your risk for calcium deficiency and determine the safest dose for you.^3,4

Based on my observations, calcium plays an important role in many bodily functions including hormonal regulation. Some studies show that calcium might help in reducing the intensity of pre-menstrual symptoms which include mood changes, water retention, anxiety, depression, etc.

Dr. Siddharth Gupta, B.A.M.S, M.D (Ayu)

When to See a Doctor?

If you suspect that you may have calcium deficiency based on the symptoms, it is recommended to consult a healthcare provider before taking any supplements. A healthcare provider will assess your risk of calcium deficiency and determine the appropriate and safe dose for you. Calcium deficiency is a treatable condition, and seeking medical advice can help you manage it effectively.³

I came across some studies which imply that calcium deficiency may lead to weight gain. I would recommend taking dietary supplementation of calcium regularly. It has been observed that a daily increment of 300 mg of dietary supplementation might help in reducing approximately 1 kg of body fat in children.

Dr. Rajeev Singh, BAMS

Causes of Calcium Deficiency

Calcium deficiency or hypocalcemia can be caused by various health conditions and disorders. Here are a few of the causes of calcium deficiency:

• Hypoparathyroidism: When your body doesn’t make enough of a hormone called parathyroid hormone, it can lead to low levels of calcium in your blood. This can happen because of an inherited problem or after surgery to remove one or more of your parathyroid or thyroid glands.
• Vitamin D deficiency: A lack of vitamin D in the body can cause low levels of calcium in the blood because vitamin D helps the body absorb calcium properly. This deficiency can be caused by an inherited disorder, insufficient exposure to sunlight or can also be caused by factors such as limited sunlight exposure due to geographical location or skin coverage, reduced generation of vitamin D by the skin, and certain medical conditions that impair vitamin D absorption.
• Renal failure: Chronic renal failure increases the level of phosphorus in the blood and decreases the production of a type of vitamin D, leading to hypocalcemia.
• Certain medications: Bisphosphonates, corticosteroids, rifampin, calcitonin, and other drugs can cause hypocalcemia.
• Pseudohypoparathyroidism: It is a hereditary condition in which the body does not respond normally to normal levels of parathyroid hormone.
• Hypomagnesemia: Low levels of magnesium in the body can decrease the production of parathyroid hormone, resulting in lower blood calcium levels.
• Pancreatitis: Hypocalcemia occurs in approximately 15% to 88% of people with acute pancreatitis.
• Certain rare genetic disorders: Genetic mutations such as DiGeorge syndrome can cause hypocalcemia.⁴

Complications of Calcium Deficiency

Complications of calcium deficiency can be severe and wide-ranging, affecting both bone health and overall health. These include:

• Osteoporosis which increases the risk of fractures and falls.
• Rickets in children, which can lead to irreversible skeletal changes.
• Osteomalacia that results in softening of the bones in adults and children.
• Increased risk of hypertension, arteriosclerosis, diabetes mellitus, neurodegenerative diseases, malignancy, and degenerative joint disease in older adults.
• Hypocalcemia, which can result from various causes including vitamin D or magnesium deficiency, impaired parathyroid hormone production, critical illness, or certain medications.
• Mild or chronic hypocalcemia may be asymptomatic, but more severe cases can cause a range of symptoms such as perioral numbness, tingling, muscle spasms, seizures, and even coma.
• Life-threatening complications such as seizures and congestive heart failure can occur if severe hypocalcemia is left untreated.

It is important to seek medical attention if experiencing symptoms and to go to the nearest hospital if experiencing severe symptoms.^2,4,5

Treatment of Calcium Deficiency 

The following medications and treatments are commonly used to treat calcium deficiency:

• Oral calcium supplements: Calcium pills or supplements are often used to increase calcium levels in the body and restore them to normal levels.
• Vitamin D supplements: Chronic hypocalcemia patients may require vitamin D supplements along with calcium pills to help with proper calcium absorption.
• Synthetic parathyroid hormone (PTH): Patients with hypoparathyroidism causing hypocalcemia may be given a synthetic form of PTH.
• IV calcium gluconate: In severe cases of hypocalcemia causing muscle cramps or spasms (tetany), patients may receive an intravenous infusion of calcium gluconate.
• Other medications: Depending on the underlying cause of hypocalcemia, additional medications may be prescribed to manage the cause.⁴

Also Read: Osteomalacia: Understanding the Causes, Symptoms, and Treatments

Frequently Asked Questions (FAQs)

Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.

Links and product recommendations in the information provided here are advertisements of third-party products available on the website. PharmEasy does not make any representation on the accuracy or suitability of such products/services. Advertisements do not influence the editorial decisions or content. The information in this blog is subject to change without notice. The authors and administrators reserve the right to modify, add, or remove content without notification. It is your responsibility to review this disclaimer regularly for any changes.

References

1. Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, Reid IR. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. Bmj. 2010 Jul 29;341:c3691. Available from: https://www.bmj.com/content/341/bmj.c3691 
2. Office of dietary supplements – calcium [Internet]. NIH Office of Dietary Supplements. U.S. Department of Health and Human Services; [cited 2023May5]. Available from: https://ods.od.nih.gov/factsheets/calcium-HealthProfessional/ 
3. Milnea. Telltale signs that you’re not getting enough calcium [Internet]. Cleveland Clinic. Cleveland Clinic; 2023 [cited 2023May5]. Available from: https://health.clevelandclinic.org/are-there-any-telltale-signs-that-youre-not-getting-enough-calcium/ 
4. Goyal A, Anastasopoulou C, Ngu M, et al. Hypocalcemia. [Updated 2022 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430912/ 
5. Fujita T. Calcium paradox: consequences of calcium deficiency manifested by a wide variety of diseases. Journal of Bone and Mineral Metabolism. 2000 Jun;18:234-6. Available from: https://pubmed.ncbi.nlm.nih.gov/10874605/