osteoporosis, calcium supplements and calcium paradox

@crbarefoot she recommended 1000-1200 mgs a day, mostly from food and supplementing the difference. I am lowering my calcium hydroxyapatite from 500 to 250mgs as I have added another servings of yogurt and too much calcium upsets my electrolytes.

@dreamjean1958

@crbarefoot Hello everyone! My quick update:
I did meet with my cardiologist who also specializes in oncology (I have breast cancer). She reminds me that cancer itself is cardio-toxic meaning cancer and some of the treatments like chemotherapy can be tough on the heart. Since I already have pre-existing afib and am age 75, she reels me in when I suggest going off my Eliquis. I wanted to do this following my heart ablation in the fall of 2025. She, however, says NO and that I should remain on Eliquis.

Surprisingly, she did not assume one of her stern looks at me when I asked about taking MK-4. She said she does not know anything about it and I should send her a message about it on MyChart and she will forward it to the hospital pharmacy folks to see if they have an informed opinion

In the process of getting ready to send something to her. I fear it won't have enough solid research behind it, but will go with what I can quickly pull together.

Current guidelines for osteoporosis treatment (like alendronic acid + vitamin D3) still include calcium, but the key point is total daily intake (diet + supplements), usually around 1000–1200 mg/day, not high-dose supplementation alone. The “calcium paradox” (bone loss + vascular calcification) is real as an observation, but studies haven’t clearly shown that normal calcium supplementation causes arterial calcification in most people. Cardiovascular risk is driven much more by factors like age, cholesterol, diabetes, smoking, kidney function, and inflammation. Most doctors therefore recommend getting calcium mainly from food and using supplements only to fill the gap, rather than avoiding calcium altogether—because under-supply increases fracture risk, which is a proven and immediate problem in osteoporosis.

@prarysky thanks for the update. Looking forward to hearing what the hospital pharmacist says about mk4! Ty

@crbarefoot If anyone is interested in what I presented to my cardiologist re: MK-4, send me a private message and I can share. I omitted a lot of the information we share on this Mayo discussion that I value but figured my clinicians would dismiss as non-authoritative.

NO ONE should take calcium without having blood tests, especially if they have heart disease. I have gone thru this for years - with docs telling me to take calcium and then calling me and saying I can't (shouldn't take it). Please talk to your doctor. You are no longer kids who are growing and need that calcium "to build strong bones." It doesn't work that way. You need a delivery system like "hormones" to get things where they need to go!
I'm taking the icky bone meds and am very happy that my bones are improving along the way. Many of you are at the age where you have multiple considerations for anything you do. One person's answer is not your problem. It is complicated.

My cardiologist asked her hospital pharmacy team my question about the safety of MK-4 if you are on Eliquis. According to the pharmacist,
"Vitamin K2, found in the MK-4 supplement, is fine to take with apixaban and does not impact its' anticoagulant activity."

@prarysky
I checked with my cardiologist and he said the same thing, that it is safe to take with Eliquis.