Can You Take Calcium and Phosphorus Together?
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Medically reviewed by Kayla Girgen, RD
Calcium and phosphorus are two minerals important for bone health. The minerals also help with a variety of other functions. While calcium plays a role in blood clotting as well as muscle, heart, and nerve function, phosphorus helps the body store energy. Both calcium and phosphorus are essential minerals, meaning you must ingest them regularly through the diet.
Low intake of calcium can contribute to health problems, such as low bone density, leading to osteoporosis. Low phosphorus intake is uncommon but can cause problems like low bone strength, muscle weakness, and low blood counts (anemia).
In general, most people should aim to get nutrients through the diet rather than supplements. But some people might need to take supplements. Females who've gone through menopause and people who don't get the recommended amount of calcium in their diet may need to increase calcium intake. It's uncommon to need phosphorus supplementation, but people with severe malnutrition or certain rare genetic conditions may need to boost their intake.
Calcium and phosphorus come in a variety of supplement forms. They can be taken together as individual supplements, and there's a supplement—calcium phosphate—that's a combination of the two minerals.
Here's what you should know about the benefits of taking calcium and phosphorus supplements together, as well as considerations to keep in mind before or while taking the combination.
Benefits of Calcium
Calcium is an essential mineral your body relies on for several important processes. Most of the calcium in the body is in the bones. Your circulatory system also has some calcium, which is critical for blood clotting as well as blood vessel, nerve, muscle, and heart function.
People who don't eat enough calcium-rich foods, such as those who don't eat dairy products, may have calcium deficiency and need to boost their calcium intake with supplements. Calcium supplements may be able to help with the following:
May improve bone health: Calcium is a major component of bones and teeth and helps keep them strong. After menopause, the drop in the hormone estrogen can increase the risk of osteoporosis, especially in people who don't get enough calcium. However, more evidence is needed to support claims that taking calcium supplements can improve bone strength and prevent fractures.
May lower lower high blood pressure: If you have low calcium intake and high blood pressure (hypertension), your blood pressure may improve with calcium supplementation. However, the blood pressure-lowering effect does not seem to occur for those with normal calcium intake.
May lower the risk of preeclampsia: Preeclampsia is a blood pressure condition that occurs during or shortly after pregnancy. People with low calcium intake are at higher risk for preeclampsia, and increasing calcium through diet or supplements might lower this risk.
Some evidence suggests that proper calcium intake can lower the risk of colorectal cancer, but this is not conclusive.
Benefits of Phosphorus
Phosphorus is an essential mineral that, like calcium, is mostly in the bones and teeth. It's also in adenosine triphosphate (ATP), the molecule the body uses for energy.
Besides bone and teeth formation and ATP production, phosphorus is believed to help with the following:
Body's use of carbohydrates and fats
Protein production for healthy cells and tissue
Kidney function
Muscle contractions
Normal heartbeat
Nerve signaling
Body's use of B vitamins
Phosphorus is found in lots of different foods, and so it's uncommon to have a deficiency in phosphorus. However, people with severe malnutrition or certain genetic conditions may need phosphorus supplements.
Some athletes take phosphorus-containing supplements to try to improve athletic performance, but this is not a proven strategy. Any effect a phosphorus-containing supplement has had on improved athletic performance seems to apply only to elite athletes, not athletes who are a more moderate level.
Benefits of Calcium and Phosphorus Together
Taking calcium and phosphorus together provides two nutrients that are needed for bone health. In fact, the main mineral substance of bones is calcium phosphate. Phosphate is the naturally occurring form of phosphorus in the body.
If you need to raise or maintain levels of both minerals, a healthcare provider may determine you can benefit from taking supplements. They might recommend you take a calcium and phosphorus supplement separately or that you take calcium phosphate—a supplement that contains both minerals.
Taking the supplement together in the form of calcium phosphate can help you better maintain levels of both minerals. The combined supplement might also positively affect your gut microbiota (the make-up of organisms living in your intestines) and lipid (fat) levels.
If you need to increase your phosphorus levels, it might be beneficial to take a calcium supplement as well. Alone, phosphorus supplementation might negatively impact calcium metabolism—especially if your calcium intake is low. Taking calcium with your phosphorus in the form of calcium phosphate can help keep your mineral levels balanced.
However, if you primarily need to increase or maintain your calcium levels, calcium phosphate might not be the best option. The combination supplement has less calcium than other types of calcium, such as calcium carbonate or calcium citrate.
How To Take Calcium With Phosphorus
When starting any supplement, be sure to talk with a healthcare provider about whether it's safe for you.
If you need to take both calcium and phosphorus, you can do it by taking a supplement of each mineral or by taking a combined supplement. A healthcare provider can help you decide which option is best for you.
If taking calcium and phosphorus separately, read the directions and follow the instructions of your healthcare provider for when to take them—whether together or at separate times.The label on the phosphorus supplement will likely say phosphate rather than phosphorus. Phosphorus in supplements is usually in the form of phosphate salts (like dipotassium phosphate and disodium phosphate) or phospholipids (like phosphatidylcholine and phosphatidylserine).
If taking the minerals in a combined supplement, know that calcium phosphate comes as a powder or pill form. It's best to take calcium phosphate supplements with food and water for better absorption. Your body also absorbs these minerals better when you space taking your supplements throughout the day rather than all at once.
Dosage
If you and your healthcare provider decide that taking both calcium and phosphorus is right for you, discuss what dosage of each you should be taking. When deciding on dosages, they might consider factors like how low your levels are and how much of each mineral you take in through your diet.
Depending on your age, sex, and pregnancy or breastfeeding status, recommended daily limits for calcium in adults range from 1,000-1,300 milligrams (mg) per day. This includes all sources of calcium, including your diet and supplements.
Calcium supplements usually contain around 500 mg of calcium per tablet. It's a good idea to start with a low dose, such as one tablet per day for a week, and increase to no more than two tablets per day with the advice of a healthcare provider.
In general, avoid taking more than 500 mg of calcium at one time. Don't take more than the recommended dose, unless otherwise instructed by your healthcare provider.
The recommended daily limit of phosphorus for adults 19 or over is 750 mg. This includes dietary intake of phosphorus. Usually, supplements provide 10% or less of the recommended daily value for phosphorus.
Is It Safe to Take Calcium and Phosphorus Together?
It's generally safe for people to take calcium and phosphorus together. Some multivitamins contain both of the minerals. The two minerals are also both found in the supplement calcium phosphate.
There's typically no added risk of taking calcium phosphate compared to other types of calcium supplements. However, people with chronic kidney disease, kidney stones, or hyperparathyroidism (too much parathyroid hormone) should generally avoid taking calcium phosphate.
If you're thinking of starting a supplement, be sure to discuss it with your healthcare provider first to ensure it's safe for you. This is particularly true for people who are pregnant, breastfeeding, taking other medications, or have other health conditions.
Potential Drug Interactions
Always talk with a healthcare provider before starting a supplement, particularly if you take other medications since interactions are possible.
Medications with potential interactions with calcium include:
Antibiotics: Taking calcium supplements with quinolone antibiotics like Cipro (ciprofloxacin) or Avelox (moxifloxacin) can reduce how well the body absorbs the quinolones. To avoid the effect, you should take the medication and supplements two hours apart.
Levothyroxine: Sold under brand names like Levoxyl and Synthroid, the absorption of the thyroid hormone used to treat underactive thyroid (hypothyroidism) and thyroid cancer can be affected by calcium carbonate supplementation. You should take the drug and supplement four hours apart.
Tivicay (dolutegravir): Calcium supplements can reduce your levels of the HIV medication. You should take the medication two hours before or six hours after taking calcium supplements.
Lithium: Taking the bipolar disorder medication with calcium supplement could increase your risk of higher-than-normal calcium levels (hypercalcemia).
Medications with potential interactions with phosphorus include:
Laxatives: Laxatives that contain sodium phosphate, such as Fleet saline laxative enemas, can increase your levels of phosphorus. Taking more than the recommended dose can harm your health.
Antacids: Certain stomach acid-neutralizing medications used to treat heartburn or indigestion can interact with phosphorus. Long-term use of antacids that contain aluminum hydroxide, such as Maalox HRF and Rulox, can cause low phosphorus levels. Meanwhile, antacids that contain calcium carbonate, such as Tums and Rolaids, can interfere with phosphorus absorption.
What To Look For
Supplements are not regulated by the U.S. Food and Drug Administration in the same way as medications. Consider looking for a supplement that's been independently tested by a third party to ensure that only the ingredients listed are the ingredients in the supplement. Third-party testers include United States Pharmacopeia (USP), UL, and NSF International.
Consider in which form you can best tolerate taking the supplement, and decide whether you want to purchase separate products or a combination product.
Can You Take Too Much Calcium or Phosphorus?
It's possible to take too much calcium or phosphorus.
Daily upper limits of calcium for adults vary by age. For adults 19-50 years old, the limit is 2,500 mg. For adults 51 or older, the limit is 2,000 mg. After these limits, side effects might be likelier. For example, taking too much calcium supplement can lead to kidney stones and deficiencies of other nutrients like magnesium, phosphate, and zinc.
The daily upper limit for phosphorus intake is 4,000 mg for adults 18-70 and 3,000 mg for adults 71 or older. Even if you take more phosphorus than recommended, it's uncommon for people with no health issues to experience any side effects.
Side Effects from Taking a Combination of Calcium and Phosphorus
Calcium supplements, including calcium phosphate, might lead to gastrointestinal side effects like gas, bloating, and constipation. Phosphorus does not typically cause side effects.
To avoid calcium supplement side effects, take your supplement with food and keep hydrated. If you have side effects from one type of calcium supplement, you might tolerate a different type of calcium better.
A Quick Review
Calcium and phosphorus are two essential minerals. They primarily contribute to bones' structure and strength, but the two minerals also play important roles in other processes, like muscle and nerve function. It's best to get the recommended amounts of the minerals through your diet, and most people do. However, some people may need supplementation. Taking calcium and phosphorus together can help you increase levels of the minerals in your body and might also keep your levels more balanced. Supplements can cause side effects and interact with other medications, so talk with a healthcare provider before starting a calcium or phosphorus supplement.
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