The role of calcium in osteoporosis

Calcium requirements may vary throughout the lifespan. During the growth years and up to age 25-30, it is important to maximize dietary intake of calcium to maintain positive calcium balance and achieve peak bone mass, thereby possibly decreasing the risk of fracture when bone is subsequently lost. The RDA for age 10-25 is 1200 mg/day. Calcium intake need not be greater than 800 mg/day during the relatively short period of time between the end of bone building and the onset of bone loss (30 to 40 years old). Starting at age 40-45, both men and women lose bone slowly, but women lose bone more rapidly around the menopause and for about 10 years after. Intestinal calcium absorption and the ability to adapt to low calcium diets are impaired in many postmenopausal women and elderly persons owing to a suspected functional or absolute decrease in the ability of the kidney to produce 1,25(OH)2D3. The bones then become more and more a source of calcium to maintain critical extracellular fluid calcium levels. Available evidence suggests that the impairments of intestinal calcium absorption observed during the menopause and aging can be overcome only by inordinately large calcium intakes (1500 to 2500 mg/day). Since this amount is difficult to derive from the diet, can cause constipation, and may not prevent trabecular bone loss, it should not be used as a substitute for sex hormone replacement. Women taking estrogen replacement should be provided the RDA for calcium of 800 mg/day at a minimum. Those who cannot or will not take estrogen should be asked to ingest at least 1000 to 1500 mg/day of calcium to delay cortical bone loss and prevent secondary hyperparathyroidism. It should be emphasized that up to 2000 mg/day of calcium is safe in teenaged children and adults. Excessive dietary intake of protein and fiber may induce significant negative calcium balance and thus increase dietary calcium requirements. It is also possible that excessive intakes of phosphate could have a deleterious effect on calcium balance in populations whose need for calcium is great (e.g. growing children) or whose ability to produce 1,25(OH)2D3 is impaired (e.g. the elderly). Moderation in the intake of these nutrients is urged. Generally, the strongest risk factors for osteoporosis are uncontrollable (e.g. sex, age, and race) or less controllable (e.g. disease and medications). However, several factors such as diet, physical activity, cigarette smoking, and alcohol use are lifestyle related and can be modified to help reduce the risk of osteoporosis.