Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-23T16:23:20.196Z Has data issue: false hasContentIssue false
  • English
  • Français

Calcium intake, calcium bioavailability and bone health

Published online by Cambridge University Press:  09 March 2007

K. D. Cashman
K. D. Cashman*
Affiliation:
Nutritional Sciences, Department of Food Science, Food Technology & Nutrition, and Department of Medicine, University College, Cork, Ireland
*
*Corresponding author: Professor K. D. Cashman, fax +353 21 4270244, email [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.

Calcium accounts for 1–2 % of adult human body weight. Over 99 % of total body Ca is found in the teeth and bones. Therefore, in addition to the obvious structural role of the skeleton, it also serves as a reservoir for Ca. Dietary Ca intake has an important impact on bone metabolism and bone health. Chronic Ca deficiency resulting from inadequate intake or poor intestinal absorption is one of several important causes of reduced bone mass and osteoporosis. It is vital, therefore, that adequate dietary Ca is consumed at all stages of life — in early life so that the genetically programmed peak bone mass can be reached and in later adulthood so that the skeletal mass can be maintained and age-related bone loss minimised. Unfortunately, there is wide variation in the estimates of daily Ca requirements made by different expert authorities. Furthermore, there is evidence that many individuals are not consuming these recommended levels. The consequence of this for bone health will be discussed in the present review. Besides the amount of Ca in the diet, the absorption of dietary Ca in foods is also a critical factor in determining the availability of Ca for bone development and maintenance. Thus, there is a need to identify food components and/or functional food ingredients that may positively influence Ca absorption in order to ensure that Ca bioavailability from foods can be optimised. This approach may be of particular value in individuals who fail to achieve the dietary recommended level of Ca.

Keywords

Calcium intakeCalcium absorption
Type
Research Article
Information
British Journal of Nutrition , Volume 87 , Issue S2 , May 2002 , pp. S169 - S177
Copyright
Copyright © The Nutrition Society 2002

References

Abrams, SA & Griffin, IJ (2001) Inulin and oligofructose and calcium absorption: Human data. In Proceedings of the 3rd ORAFTI Research Conference: Recent Scientific Research on Inulin and Oligofructose, pp. 26–27Belgium: Orafti Active Food Ingredients.Google Scholar
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.CrossRefGoogle ScholarPubMed
Armbrecht, HJ & Wasserman, RH (1976) Enhancement of Ca2+ uptake by lactose in the rat small intestine. Journal of Nutrition 106, 1265–1272.CrossRefGoogle Scholar
Berrocal, R, Chanton, S, Juillerat, MA, Scherz, JC & Jost, R (1989) Tryptic phosphopeptides from whole casein II. Physicochemical properties related to the solubilization of calcium. Journal of Dairy Research 56, 335–341.CrossRefGoogle Scholar
Bonjour, JP, Carrie, AL, Ferrari, S, Clavien, H, Slosman, D & Theintz, G (1997) Calcium-enriched foods and bone mass growth in prepubertal girls: a randomised, double-blind, placebo-controlled trial. Journal of Clinical Investigation 99, 1287–1294.CrossRefGoogle Scholar
British Nutrition Foundation (1989) Calcium. London: British Nutrition Foundation.Google Scholar
Brommage, R, Binacua, C, Antille, S & Carrié, AL (1993) Intestinal calcium absorption in rats is stimulated by dietary lactulose and other resistant sugars. Journal of Nutrition 123, 2186–2194.Google ScholarPubMed
Browner, WS, Pressman, AR, Nevitt, MC & Cummings, SR (1996) Mortality following fractures in older women. The study of osteoporotic fractures. Archives of Internal Medicine 156, 1521–1525.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Cashman, K & Flynn, A (1998) Trace elements and bone metabolism. Bibliotheca Nutrition et Dieta 54, 150–164.Google Scholar
Cashman, K & Flynn, A (1999) Optimal nutrition – calcium, magnesium and phosphorus. Proceedings of the Nutrition Society 58, 477–487.CrossRefGoogle 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.CrossRefGoogle ScholarPubMed
Chapuy, MC, Arlot, ME, Duboeuf, F, Brun, J, Crouzet, B, Arnaud, S, Delmas, PD & Meunier, PJ (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. New England Journal of Medicine 327, 1637–1642.CrossRefGoogle ScholarPubMed
Chevalley, T, Rizzoli, R, Nydegger, V, Slosman, D, Rapin, CH, Michel, J, 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
Compston, J (1993) Osteoporosis. In The Management of Common Metabolic Bone Disorders, pp. 29–62 [Campbell, G, Compston, J and Crisp, A, editors]. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Consensus Development Conference (1993) Diagnosis, prophylaxis and treatment of osteoporosis. American Journal of Medicine 95, 646–650.Google Scholar
Copper, C, Atkinson, EJ, Jacobsen, SJ & O'Fallon, WM (1993) A population-based study of survival following osteoporotic fractures. American Journal of Epidemiology 86, 247–253.Google Scholar
Coudray, C, Bellanger, J, Castíglia-Delavaud, C, Vermorel, V & Rayssignuier, Y (1997) Effect of soluble or partly soluble dietary fibres supplementation on absorption and balance of calcium, magnesium, iron and zinc in healthy young men. European Journal of Clinical Nutrition 51, 375–380.CrossRefGoogle ScholarPubMed
Dawson-Hughes, B (1991) Calcium supplementation and bone loss: a review of controlled clinical trials. American Journal of Clinical Nutrition 54, 274S–280S.CrossRefGoogle ScholarPubMed
Dawson-Hughes, B (1996) Calcium insufficiency and fracture risk. Osteoporosis International 3, S37–S41.CrossRefGoogle 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 post-menopausal women. New England Journal of Medicine 323, 878–883.CrossRefGoogle Scholar
Department of Health (1991) Calcium. In Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Report in Health and Social Subjects no. 41. pp. 150–157London: HM Stationery Office.Google Scholar
Department of Health (1998) Nutrition and Bone Health with Reference to Calcium and Vitamin D. Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Report in Health and Social Subjects no. 49. London: HM Stationery Office.Google Scholar
Dibba, B, Prentice, A, Poskitt, EME & Cole, TJ (1998) Calcium supplementation increases the bone mineral status of Gambian children. Proceedings of the Nutrition Society 57, 73A.Google Scholar
Dibba, B, Prentice, A, Stirling, D & Poskitt, EME (1999) Effect of calcium supplementation on plasma osteocalcin concentration of Gambian children. Proceedings of the Nutrition Society 58, 61A.Google Scholar
Elders, PJM, Lips, P, Netelenbos, JC, Van Ginkel, FC, Khoe, E, van der Vijgh, WJF & van der Stelt, PF (1994) Long-term effect of calcium supplementation on bone loss in perimenopausal women. Journal of Bone and Mineral Research 9, 938–970.CrossRefGoogle Scholar
Elffors, I, Allander, E, Kanis, JA, Gullberg, B, Johnell, O, Dequeker, J, Dilsen, G, Gennari, C, Lopes Vaz, AA & Lyritis, G (1994) The variable incidence of hip fracture in Southern Europe; The Medos study. Osteoporosis International 4, 253–263.CrossRefGoogle ScholarPubMed
European Commission (1993) Calcium. In Nutrient and Energy Intakes of the European Community. Report of the Scientific Committee for Food (31st series), pp. 136–145, Luxembourg: Official Publications of the European Communities.Google Scholar
European Commission (1998) Report on osteoporosis in the European Community: Action for Prevention. Office for Official Publications for the European Commission, Luxembourg.Google Scholar
Flynn, A & Cashman, K (1999) Calcium fortification of foods. In Mineral Fortification of Foods, pp. 18–53 [Hurrell, R, editor]. Surrey: Leatherhead Food RA.Google Scholar
Hansen, M, Sandström, B, Jensen, M & Sørensen, SS (1997) Effect of casein phosphopeptides on zinc and calcium absorption from bread meals. Journal of Trace Elements in Medicine and Biology 11, 143–149.CrossRefGoogle ScholarPubMed
Hansen, M, Sandström, B, Jensen, M & Sørensen, SS (1997) Casein phosphopeptides improve zinc and calcium absorption from rice-based but not from whole-grain infant cereal. Journal of Pediatric Gastroenterology and Nutrition 24, 56–62.Google Scholar
Hansen, MA, Overgaard, K, Riis, BJ & Christiansen, C (1991) Role of peak bone mass and bone loss in postmenopausal osteoporosis: 12-year study. British Medical Journal 303, 961–964.CrossRefGoogle Scholar
Heaney, RP, Saito, Y & Orimo, H (1994) Effect of casein phosphopeptides on absorbability of co-ingested calcium in normal postmenopausal women. Journal of Bone Mineral Metabolism 12, 77–81.CrossRefGoogle Scholar
Heaney, RP (1997) The roles of calcium and vitamin D in skeletal health: an evolutionary perspective. Food, Nutrition and Agriculture 20, 4–12.Google Scholar
Heseker, H, Adolf, T, Eberhardt, W, Hartmann, S, Herwig, A, Kuber, W, Matiakse, B, Moch, KJ, Schneider, R & Zipp, A (1992) Food and nutrient intakes of adults in the German Federal Republic. In VERA-Schriftenriche, vol. 3; pp. 188–189 [W Kubler, HJ Anders, W Heeschen and D Kohlmeier, editors]. Neiderkleen: Fleck VerlagGoogle Scholar
Institute of Medicine (1997) Dietary Reference Intakes: Calcium, Magnesium, Phophorus, Vitamin D, and Fluoride. Washington, DC: Food and Nutrition Board, National Academy Press.Google Scholar
Irish Nutrition and Dietetic Institute (1990) Irish National Nutrition Survey. Dublin: INDI.Google Scholar
Johnell, O, Gullberg, B, Allander, E & Kanis, JA (1992) The apparent incidence of hip fracture in Europe: A study of national register sources. Osteoporosis International 2, 298–302.CrossRefGoogle ScholarPubMed
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. The New England Journal of Medicine 327, 82–87.CrossRefGoogle ScholarPubMed
Kanders, B, Dempster, DW & Lindsay, R (1988) Interaction of calcium nutrition and physical activity on bone mass in young women. Journal of Bone Mineral Research 3, 145–149.CrossRefGoogle Scholar
Kennefick, S & Cashman, KD (2000) Investigation of an in vitro model for predicting the effect of food components on calcium availability from meals. International Journal of Food Sciences and Nutrition 51, 45–54.Google Scholar
Kitts, DD & Yuan, YV (1973) Casein phosphopeptides and calcium bioavailability. Trends in Food Science and Technology 3, 31–35.CrossRefGoogle Scholar
Lee, WTK, Leung, SSF, Leung, DMY & Cheng, JCY (1996) A follow-up study on the effects of calcium-supplement withdrawl and puberty on bone acquisition of children. American Journal of Clinical Nutrition 64, 71–77.CrossRefGoogle Scholar
Lee, WTK, Leung, SSF, Wang, SH, Xu, YC, Zeng, WP, 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.CrossRefGoogle ScholarPubMed
Lengemann, FW (1959) The site of action of lactose in the enhancement of calcium utilization. Journal of Nutrition 69, 23–27.CrossRefGoogle ScholarPubMed
Lloyd, TM, Andon, MB, Rollings, N, Martel, JK, Landis, JR, Demers, LM, Eggli, DF, Keisekhorst, K & Kulin, HE (1993) Calcium supplementation and bone mineral density in adolescent girls. Journal of the American Medical Association 270, 841–844.CrossRefGoogle ScholarPubMed
Looker, AC, Orwoll, ES, Johnston, CC Jr, Lindsay, RL, Wahner, HW, Dunn, WL, Calvo, MS, Harris, TB & Heyse, SP (1997) Prevalence of low femoral bone density in older US adults from NHANES III. Journal of Bone Mineral Research 12, 1761–1768.CrossRefGoogle ScholarPubMed
Mackerras, D & Lumley, T (1997) First-and second-year effects in trials of calcium supplementation on the loss of bone density in postmenopausal women. Bone 21, 527–533.CrossRefGoogle ScholarPubMed
Massey, LK & Whiting, SJ (1996) Dietary salt, urinary calcium and bone loss. Journal of Bone Mineral Research 11, 731–736.CrossRefGoogle ScholarPubMed
Mellander, O (1950) The physiologic importance of the casein phosphopeptide calcium salt, II: peroral calcium dosage of infants. Acta Societae Medica (Uppsala) 55, 247–255.Google Scholar
Melton, LJ, Chrischilles, EA, Cooper, C, Lane, AW & Riggs, BL (1992) How many women have osteoporosis? Journal of Bone Mineral Research 7, 1005–1010.CrossRefGoogle ScholarPubMed
Michaelsen, KF, Astrup, AV, Mosekilde, L, Richelsen, B, Schroll, M & Sorensen, OH (1994) The importance of nutrition for the prevention of osteoporosis. Ugeskr Laeger 156, 958–960.Google ScholarPubMed
Miller, DD (1989) Calcium in the diet: Food sources, recommended intakes, and nutritional bioavailability. Advances in Food and Nutrition Research 33, 103–156.CrossRefGoogle ScholarPubMed
Morrison, NA, Qi, JC, Tokita, A, Kelly, PJ, Crofts, L, Nguyen, TV, Sambrook, PN & Eisman, JA (1994) Predicators of bone density from vitamin D receptor alleles. Nature 367, 284–287.CrossRefGoogle Scholar
National Institutes of Health (1994) NIH Consensus Statement 12:4. Optimal Calcium Intake. Bethesda, MD: NIH.Google Scholar
National Institutes of Health (2000) Osteoporosis Prevention, Diagnosis, and Therapy. NIH Consensus Development Conference Statement. http://odp.od.nih.gov/consensus/cons/111/111_statement.htmGoogle Scholar
National Research Council (1989 a) Recommended Dietary Allowances: 10th edition. Report of the Subcommittee on the Tenth Edition of the RDA. Food and Nutrition Board and the Commission on Life Sciences, Washington, DC: National Academy Press.Google Scholar
National Research Council (1989 b) Diet and Health: Implications for Reducing Chronic Disease Risk. Report of the Committee on Diet and Health, Food and Nutrition Board, Commission on Life Sciences. Washington, DC: National Academy Press.Google Scholar
Nelson, ME, Fisher, EC, Dilmanian, TA, Dallal, GE & Evans, WJ (1991) A 1-year walking program and increased dietary calcium in post-menopausal women: effects in bone. American Journal of Clinical Nutrition 53, 1304–1311.CrossRefGoogle Scholar
Nordin, BE (1997) Calcium in health and disease. Food, Nutrition and Agriculture 20, 13–26.Google Scholar
Polley, KJ, Nordin, BE, Baghurst, PA, Walker, CJ & Chatterton, BE (1987) Effect of calcium supplementation on forearm bone mineral content in postmenopausal women: a prospective, sequential controlled trial. Journal of Nutrition 117, 1929–1935.CrossRefGoogle ScholarPubMed
Prentice, A (1997) Is nutrition important in osteoporosis? Proceedings of the Nutrition Society 56, 357–367.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle 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.CrossRefGoogle ScholarPubMed
Reid, DM & New, SA (1997) Nutritional influences on bone mass. Proceedings of the Nutrition Society 56, 977–987.CrossRefGoogle ScholarPubMed
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 randomized controlled trial. American Journal of Medicine 98, 331–335.CrossRefGoogle 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.CrossRefGoogle Scholar
Riis, B, Thomsen, K & Christiansen, C (1987) Does calcium supplementation prevent postmenopausal bone loss? A double-blind, controlled clinical study. New England Journal of Medicine 316, 173–177.CrossRefGoogle ScholarPubMed
Rubinacci, A, Divieti, P, Polo, RM, Zampino, M, Resimini, G & Tenni, R (1996) Effect of an oral calcium load on urinary markers of collagen breakdown. Journal of Endocrinological Investigation 19, 719–726.CrossRefGoogle ScholarPubMed
Schurch, M, Rizzoli, R, Mermillod, B, Vasey, H, Michel, J & Bonjour, J (1996) A prospective study on socioeconomic aspects of fracture of the proximal femur. Journal of Bone and Mineral Research 11, 1935–1942.CrossRefGoogle ScholarPubMed
Shortt, C & Flynn, A (1990) Sodium-calcium inter-relationships with specific reference to osteoporosis. Nutrition Research Reviews 3, 101–115.CrossRefGoogle ScholarPubMed
Smith, EL, Gilligan, C, Smith, PE & Sempos, CT (1989) Calcium supplementation and bone loss in middle-aged women. American Journal of Clinical Nutrition 50, 833–842.CrossRefGoogle ScholarPubMed
Suzuki, K, Endo, Y, Uehara, M, Yamada, H, Goto, S, Imamura, M & Shiozu, S (1985) Effect of lactose, lactulose and sorbitol on mineral utilization and intestinal flora. Journal of the Japanese Society of Nutrition and Food Science 38, 39–42.CrossRefGoogle Scholar
Teegarden, D, Proulx, WR, Martin, BR, Zhao, J, McCabe, GP, Lyle, RM, Peacock, M, Slemenda, C, Johnston, CC Jr & Weaver, CM (1995) Peak bone mass in young women. Journal of Bone Mineral Research 10, 711–715.CrossRefGoogle ScholarPubMed
Välimäki, MJ, Kärkkäinen, M & Lamberg-Allardt, C et al. , (1994) Exercise, smoking and calcium intake during adolescence and early adulthood as determinants of peak bone mass. British Medical Journal 309, 230–235.CrossRefGoogle ScholarPubMed
Van den Heuvel, EGHM, Schaafsma, G, Muys, T & Van Dokkum, W (1998) Nondigestible oligosaccharides do not interfere with calcium and nonheme-iron absorption in young, healthy men. American Journal of Clinical Nutrition 67, 445–451.CrossRefGoogle Scholar
Van den Heuvel, EGHM, Muys, T, van Dokkum, W & Schaafsma, G (1999) Oligofructose stimulates calcium absorption in adolescents. American Journal of Clinical Nutrition 69, 544–548.CrossRefGoogle ScholarPubMed
Van Dokkum, W (1995) The intake of selected minerals and trace elements in European countries. Nutrition Research Reviews 8, 271–302.CrossRefGoogle ScholarPubMed
Weaver, CM (2000) The growing years and prevention of osteoporosis in later life. Proceedings of the Nutrition Society 59, 303–306.CrossRefGoogle ScholarPubMed
Welten, D, Kemper, HCG, Post, GB & Van Staveren, W (1995) A meta-analysis of the effect of calcium and bone mass in young and middle aged females and males. Journal of Nutrition 125, 2802–2813.Google Scholar
West, DW (1991) Phosphopeptides and calcium absorption. In Proceedings of XXIII International Dairy Congress 2, pp. 1208–1216. Brussels: International Dairy Federation.Google Scholar
World Health Organisation (1994) Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis. Technical Report Series 843. Geneva: World Health Organisation.Google Scholar
Ziegler, EE & Fomon, SJ (1983) Lactose enhances mineral absorption in infancy. Journal of Pediatric Gastroenterology and Nutrition 2, 288–294.Google ScholarPubMed