If serum calcium is low, evaluate etiology

• Consider parathyroid, thyroid, malabsorption

Evaluate calcium and vitamin D intake from all sources

• Calcium: Women 50+ and Men 70+ need 1,200 mg daily. All else need 1,000 mg daily
  • Use calcium calculator or estimate (Dietary calcium estimation: Number of dairy servings x 300 mg + 300 mg in general diet (unless restrictive diet like vegan, keto, etc.)
    
• Vitamin D: All adults 50+: ~600-800 international units daily
  • Supplement to goal of 30+ ng/dL. Best evidence for empiric supplementation is for older adults living in residential care because they are more likely to be deficient.

If advanced renal disease, eGFR <30, coordinate care with nephrology to ensure risk factors for hypocalcemia are being addressed.