Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-03T05:06:06.323Z Has data issue: false hasContentIssue false
  • English
  • Français

The role of dietary calcium in bone health

Published online by Cambridge University Press:  07 March 2007

Albert Flynn
Albert Flynn*
Affiliation:
Department of Food and Nutritional Sciences, University College, Cork, Republic of Ireland
*
Corresponding author: Professor Albert Flynn, fax +353 21 4270244, [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Approximately 99% of body Ca is found in bone, where it serves a key structural role as a component of hydroxyapatite. Dietary requirements for Ca are determined by the needs for bone development and maintenance, which vary throughout the life stage, with greater needs during the periods of rapid growth in childhood and adolescence, during pregnancy and lactation, and in later life. There is considerable disagreement between expert groups on the daily Ca intake levels that should be recommended, reflecting the uncertainty in the data for establishing Ca requirements. Inadequate dietary Ca in early life impairs bone development, and Ca supplementation of the usual diet for periods of ≤3 years has been shown to enhance bone mineral status in children and adolescents. However, it is unclear whether this benefit is long term, leading to the optimisation of peak bone mass in early adulthood. In later years inadequate dietary Ca accelerates bone loss and may contribute to osteoporosis. Ca supplementation of the usual diet in post-menopausal women and older men has been shown to reduce the rate of loss of bone mineral density at a number of sites over periods of 1–2 years. However, the extent to which this outcome reduces fracture risk needs to be determined. Even allowing for disagreements on recommended intakes, evidence indicates that dietary Ca intake is inadequate for maintenance of bone health in a substantial proportion of some population groups, particularly adolescent girls and older women.

Keywords

Dietary calcium: Bone healthLife stage
Type
Meeting Report
Information
Proceedings of the Nutrition Society , Volume 62 , Issue 4 , November 2003 , pp. 851 - 858
Copyright
Copyright © The Nutrition Society 2003

References

Andon, MB, Lloyd, T & Matkovic, V (1994) Supplementation trials with calcium citrate malate: Evidence in favour of increasing the calcium RDA during childhood and adolescence. Journal of Nutrition 124, 1412S–1417S.Google Scholar
Bonjour, JP, Carrie, AL, Ferrari, S, Clavien, H, Slosman, D, Theintz, G & Rizzoli, R (1997) Calcium-enriched foods and bone mass growth in prepubertal girls – a randomized, double-blind, placebo-controlled trial. Journal of Clinical Investigation 99, 1287–1294.Google Scholar
Bonjour, JP, Chevalley, T, Ammann, P, Slosman, D & Rizzoli, R (2001) Gain in bone mineral mass in prepubertal girls 3–5 years after discontinuation of calcium supplementation: a follow-up study. Lancet 358, 1208–1212.Google Scholar
Cadogan, J, Eastell, R, Jones, N & Barker, ME (1997) Milk intake and bone mineral acquisition in adolescent girls – randomised, controlled intervention trial. British Medical Journal 315, 1255–1260.Google Scholar
Carriquiry, AL (1999) Assessing the prevalence of nutrient inadequacy. Public Health Nutrition 2, 23–33.CrossRefGoogle ScholarPubMed
Cashman, KD & Flynn, A (1999) Optimal nutrition: calcium, magnesium and phosphorus. Proceedings of the Nutrition Society 58, 477–487.Google Scholar
Cashman, KD & Flynn, A (2003) Sodium effects on bone and calcium metabolism. In Nutritional Aspects of Bone Health [New, S and Bonjour, J-P, editors]. London: Royal Society of Chemistry (In the Press)Google Scholar
Chapuy, MC, Arlot, ME, Delmas, PD & Meunier, PJ (1994) Effect of calcium and cholecalciferol treatment for three years on hip fractures in elderly women. British Medical Journal 308, 1081–1082.Google Scholar
Chapuy, MC, Pamphile, R, Paris, E, Kempf, C, Schlichting, M, Arnaud, S, Garnero, P & Meunier, PJ (2002) Combined calcium and vitamin D 3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Osteoporosis International 13, 257–264.Google Scholar
Chevalley, T, Rizzoli, R, Nydegger, V, Slosman, D, Rapin, CH, Michel, JP, Vasey, H & Bonjour, JP (1994) Effects of calcium supplements on femoral bone mineral density and vertebral fracture rate in vitamin-D-replete elderly patients. Osteoporosis International 4, 245–252.CrossRefGoogle ScholarPubMed
Cleveland, LE, Goldman, JD & Borrud, LG (1996) Data Tables: Results from USDA's 1994 Continuing Survey of Food Intakes by Individuals and 1994 Diet and Health Knowledge Survey. Beltsville, MD: Agriculture Research Service, US Department of Agriculture.Google Scholar
Cummings, SR, Black, DM, Nevitt, MC, Browner, W, Cauley, J, Ensrud, K, Genant, HK, Palermo, L, Scott, J & Vogt, TM (1993) Bone density at various sites for prediction of hip fractures. Lancet 341, 72–75.Google Scholar
Dawson-Hughes, B (1991) Calcium supplementation and bone loss: a review of controlled clinical trials. American Journal of Clinical Nutrition 54, 274S–280S.Google Scholar
Dawson-Hughes, B (2003) Interaction of dietary calcium and protein in bone health in humans. Journal of Nutrition 133, 852S–854S.Google Scholar
Dawson-Hughes, B, Dallal, GE, Krall, EA, Sadowski, L, Sahyoun, N & Tannenbaum, S (1990) A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. New England Journal of Medicine 323, 878–883.CrossRefGoogle Scholar
Dawson-Hughes, B, Harris, SS, Krall, EA & Dallal, GE (1997) Effect of calcium and vitamin D supplementation on bone, density in men and women 65 years of age or older. New England Journal of Medicine 337, 670–676.Google Scholar
De Laet, CE, Van Hout, BA, Burger, H, Hofman, A & Pols, HA (1997) Bone density and risk of hip fracture in men and women: cross-sectional analysis. British Medical Journal 26, 221–225.Google Scholar
Department of Health (1991) Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Report on Health and Social Subjects no. 41 London: H.M. Stationery Office.Google Scholar
Department of Health (1998) Nutrition and Bone Health with Particular Reference to Calcium and Vitamin D.Report on Health and Social Subjects no. 49 London: The Stationery Office.Google Scholar
Dibba, B, Prentice, A, Ceesay, M, Mendy, M, Darboe, S, Stirling, DM, Cole, TJ & Poskitt, EM (2002) Bone mineral contents and plasma osteocalcin concentrations of Gambian children 12 and 24 mo after the withdrawal of a calcium supplement. American Journal of Clinical Nutrition 76, 681–686.Google Scholar
Dibba, B, Prentice, A, Ceesay, M, Stirling, DM, Cole, TJ & Poskitt, EME (2000) Effect of calcium supplementation on bone mineral accretion in Gambian children accustomed to a low-calcium diet. American Journal of Clinical Nutrition 71, 544–549.Google Scholar
Eastell, R, Robins, SP, Colwell, T, Assiri, AM, Riggs, BL & Russell, RG (1993) Evaluation of bone turnover in type I osteoporosis using biochemical markers specific for both bone formation and bone resorption. Osteoporosis International 3, 255–260.Google Scholar
Elders, PJ, Netelenbos, JC, Lips, P, Van Ginkel, FC, Khoe, E, Leeuwenkamp, OR, Hackeng, WH & van der Stelt, PF (1991) Calcium supplementation reduces vertebral bone loss in perimenopausal women: a controlled trial in 248 women between 46 and 55 years of age. Journal of Clinical Endocrinology and Metabolism 73, 533–540.Google Scholar
Fehily, AM, Coles, RJ, Evans, WD & Elwood, PC (1992) Factors affecting bone density in young adults. American Journal of Clinical Nutrition 56, 579–586.Google Scholar
Flynn, A & Cashman, KD (1999) Calcium. In The Mineral Fortification of Foods, pp. 18–53 [Hurrell, R, editor]. Leatherhead, Surrey: Leatherhead Food Research Association.Google Scholar
Frost, HM (1973) The origin and nature of transients in human bone remodeling dynamics. In Clinical Aspects of Metabolic Bone Disease, pp. 124–137 [Frame, B, Parfitt, AM, Duncan, H, editors]. Amsterdam, The Netherlands: Excerpta Medica.Google Scholar
Garnero, P, Hauser, E, Chapuy, MC, Marcelli, C, Grandjean, H, Muller, C, Cormier, C, Breard, G, Meunier, PJ & Delmas, PD (1996) Markers of bone turnover predict hip fractures in elderly women. The EPIDOS prospective study. Journal of Bone and Mineral Research 11, 1531–1538.Google Scholar
Goulding, A, Jones, IE, Taylor, RW, Williams, SM & Manning, PJ (2001) Bone mineral density and body composition in boys with distal forearm fractures: a dual-energy x-ray absorptiometry study. Journal of Pediatrics 139, 509–515.Google Scholar
Gregory, J, Lowe, S, Bates, CJ, Prentice, A, Jackson, LV, Smitherts, G, Wenlock, R & Farron, M (2000) National Diet and Nutrition Survey: Young People Aged 4–18 years. London: The Stationery Office.Google Scholar
Hannon, E, Kiely, M, Harrington, KE, Robson, P, Strain, JJ & Flynn, A (2001) The North/South Ireland Food Consumption Survey: Mineral intakes in 18–64 year old adults. Public Health Nutrition 4, 1081–1088.Google Scholar
Hansen, M, Overgaard, K, Riis, B & Christiansen, C (1991) Role of peak bone mass and bone loss in postmenopausal osteoporosis: 12 year study. British Medical Journal 303, 961–964.Google Scholar
Heaney, RP (1997) The roles of calcium and vitamin D in skeletal health: an evolutionary perspective. Food, Nutrition and Agriculture no. 20, pp. 4–12. Rome: FAO.Google Scholar
Heikinheimo, RJ, Inkovaara, JA, Harju, EJ, Haavisto, MV, Kaarela, RH, Kataja, JM, Kokko, AM, Kolho, LA & Rajala, SA (1992) Annual injection of vitamin D and fractures of aged bones. Calcified Tissue International 51, 105–110.Google Scholar
Institute of Medicine (1997) Calcium. Dietary Reference Intakes. Calcium, Magnesium, Phosphorus, Vitamin D, and Fluoride, pp. 4/1–4/57. Washington, DC: National Academy Press.Google Scholar
Johnston, CC Jr, Miller, JZ, Slemenda, CW, Reister, TK, Hui, S, Christian, JC & Peacock, M (1992) Calcium supplementation and increases in bone mineral density in children. New England Journal of Medicine 327, 82–87.Google Scholar
Kanis, JA (1991) Calcium requirements for optimal skeletal health in women. Calcified Tissue International 49, S33–S41.Google Scholar
Kanis, JA (1999) The use of calcium in the management of osteoporosis. Bone 24, 279–290.Google Scholar
Lee, WTK, Leung, SSF, Cheng, JCY, Wang, SH, Xu, YC & Zeng, W-P (1995) Effects of calcium supplementation and subsequent withdrawal on bone acquisition of Chinese children. Proceedings of the 7th Asian Congress of Nutrition. F-61–03, p. 343. Beijing, China: Chinese Nutrition Society.Google Scholar
Lee, WTK, Leung, SSF, Leung, DMY & Cheng, JCY (1996) A follow-up study on the effects of calcium-supplement with-drawal and puberty on bone acquisition of children. American Journal of Clinical Nutrition 64, 71–77.Google Scholar
Lee, WTK, Leung, SSF, Leung, DMY, Wang, SH, Xu, YC, Zeng, WP & Cheng, JCY (1997) Bone mineral acquisition in low calcium intake children following the withdrawal of calcium supplement. Acta Paediatrica 86, 570–576.Google Scholar
Lee, WTK, Leung, SSF, Wang, SH, Xu, YC, Zeng, W-P, Lau, J, Oppenheimer, SJ & Cheng, JCY (1994) Double-blind, controlled calcium supplementation and bone mineral accretion in children accustomed to a low-calcium diet. American Journal of Clinical Nutrition 60, 744–750.Google Scholar
Lips, P, Graafmans, WC, Ooms, ME, Bezemer, PD & Bouter, LM (1996) Vitamin D supplementation and fracture incidence in elderly persons – a randomized, placebo-controlled clinical trial. Annals of Internal Medicine 124, 400–406.Google Scholar
Lloyd, T, Andon, MB, Rollings, N, Martel, JK, Landis, JR, Demers, LM, Eggli, DF, Kieselhorst, K & Kulin, HE (1993) Calcium supplementation and bone mineral density in adolescent girls. Journal of the American Medical Association 270, 841–844.Google Scholar
Lloyd, T, Martel, JK, Rollings, N, Andon, MB, Kulin, K, Demers, LM, Eggli, D, Kieselhorst, K & Chinchili, VML (1996) The effect of calcium supplementation and Tanner stage on bone density, content and area in teenage women. Osteoporosis International 6, 276–283.Google Scholar
Marshall, D, Johnell, O & Wedel, H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. British Medical Journal 312, 1254–1259.Google Scholar
Melton, LJ, Chrischilles, EA, Cooper, C, Lane, AW & Riggs, BL (1992) How many women have osteoporosis? Journal of Bone and Mineral Research 7, 1005–1010.Google Scholar
National Research Council (1989) Calcium. Recommended Dietary Allowances, 10th ed., pp. 174–184. Washington, DC: National Academy Press.Google Scholar
Nelson, ME, Fisher, EC, Dilmanian, FA, Dallal, GE & Evans, WJ (1991) A 1-y walking program and increased dietary calcium in postmenopausal women: effects on bone. American Journal of Clinical Nutrition 53, 1304–1311.Google Scholar
Nieves, JW, Komar, L, Cosman, F & Lindsay, R (1998) Calcium potentiates the effect of estrogen and calcitonin on bone mass – review and analysis. American Journal of Clinical Nutrition 67, 18–24.Google Scholar
Nordin, BEC (1997) Calcium and osteoporosis. Nutrition 13, 664–686.Google Scholar
Nowson, CA, Green, RM, Hopper, JL, Sherwin, AJ, Young, D, Kaymakci, B, Guest, CS, Smid, M, Larkins, RG & Wark, JD (1997) A co-twin study of the effect of calcium supplementation on bone density during adolescence. Osteoporosis International 7, 219–225.Google Scholar
Oleson, CV, Busconi, BD & Baran, DT (2002) Bone density in competitive figure skaters. Archives of Physical and Medical Rehabilitation 83, 122–128.Google Scholar
Parfitt, AM (1984) Age-related structural changes intrabecular and cortical bone: Cellular mechanisms and biomechanical consequences. Calcified Tissue International 36, S123–S128.Google Scholar
Prentice, A (1995) Calcium requirements in children. Nutrition Reviews 53, 37–40.Google Scholar
Prentice, A (1997) Is nutrition important in osteoporosis?. Proceedings of the Nutrition Society 56, 357–367.Google Scholar
Prentice, A (2001) The relative contribution of diet and genotype to bone development. Proceedings of the Nutrition Society 60, 1–8.Google Scholar
Prentice, A & Bates, CJ (1993) An appraisal of the adequacy of dietary mineral intakes in developing countries for bone growth and development in children. Nutrition Research Reviews 6, 51–59.Google Scholar
Prentice, A, Bonjour, J-P, Branca, F, Cooper, C, Flynn, A, Garabedian, M, Müller, D, Pannemans, D & Weber, P (2003) Process for the assessment of scientific support for claims on foods (PASS-CLAIM): Bone health and osteoporosis. European Journal of Nutrition 42, Suppl. 1 128–149.Google Scholar
Prince, R, Devine, A, Dick, I, Criddle, A, Kerr, D, Kent, N, Price, R & Randell, A (1995) The effects of calcium supplementation (milk or tablets) and exercise on bone density in postmenopausal women. Journal of Bone and Mineral Research 10, 1068–1075.Google Scholar
Recker, RR, Hinders, S, Davies, KM, Heaney, RP, Stegman, MR, Lappe, JM & Kimmel, DB (1996) Correcting calcium nutritional deficiency prevents spine fractures in elderly women. Journal of Bone and Mineral Research 11, 1961–1966.Google Scholar
Reid, IR, Ames, RW, Evans, MC, Gamble, GD & Sharpe, SJ (1993) Effect of calcium supplementation on bone loss in post-menopausal women. New England Journal of Medicine 328, 460–464.Google Scholar
Reid, IR, Ames, RW, Evans, MC, Gamble, GD & Sharpe, SJ (1995) Long-term effects of calcium supplementation on bone loss and fractures in postmenopausal women – a randomised controlled trial. American Journal of Medicine 98, 331–335.Google Scholar
Riggs, BL, Melton, LJ III & O'Fallon, WM (1996) Drug therapy for vertebral fractures in osteoporosis: Evidence that decreases in bone turnover and increases in bone mass both determine anti-fracture efficacy. Bone 18, 197S–201S.CrossRefGoogle Scholar
Riis, BJ (1995) The role of bone loss. American Journal of Medicine 98, Suppl. 2A, 29–32.Google Scholar
Scariano, JK, Vanderjagt, DJ, Thacher, T, Isichei, CO, Hollis, BW & Glew, RH (1998) Calcium supplements increase the serum levels of crosslinked N-telopeptides of bone collagen and parathyroid hormone in rachitic Nigerian children. Clinical Biochemistry 31, 421–427.Google Scholar
Shortt, C & Flynn, A (1990) Sodium–calcium inter-relationships with specific reference to osteoporosis. Nutrition Research Reviews 3, 101–115.Google Scholar
Slemenda, CW, Peacock, M, Hui, S, Zhou, L & Johnston, CC (1997) Reduced rates of skeletal remodeling are associated with increased peak bone mineral density during the development of peak skeletal mass. Journal of Bone and Mineral Research 12, 676–682.Google Scholar
Specker, BL, Beck, A, Kalkwarf, H & Ho, M (1997) Randomized trial of varying mineral intake on total body bone mineral accretion during the first year of life. Pediatrics 99, E121–E127.CrossRefGoogle ScholarPubMed
Stear, SJ, Prentice, A, Jones, SC & Cole, TJ (2003) Effect of a calcium and exercise intervention on the bone mineral status of 16–18-y-old adolescent girls. American Journal of Clinical Nutrition 77, 985–992.Google Scholar
World Health Organization (1994) Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis. Technical Report Series no. 843. Geneva: WHO.Google Scholar
World Health Organization (1999) Interim report and recommendations of the World Health Organization Task Force for Osteoporosis. Osteoporosis International 10, 259–264.Google Scholar