Antonio Cano1, Peter Chedraui2, Dimitrios G Goulis3, Patrice Lopes4, Gita Mishra5, Alfred Mueck6, Levent M Senturk7, Tommaso Simoncini8, John C Stevenson9, Petra Stute10, Pauliina Tuomikoski11, Margaret Rees12, Irene Lambrinoudaki13. 1. Department of Pediatrics, Obstetrics and Gynecology, University of Valencia and INCLIVA, Valencia, Spain. Electronic address: Antonio.Cano@uv.es. 2. Institute of Biomedicine, Research Area for Women's Health, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador. 3. Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece. 4. Polyclinique de l'Atlantique Saint Herblain, F 44819 St Herblain France, Université de Nantes, F 44093, Nantes cedex, France. 5. School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, 4006, Australia. 6. University Women's Hospital of Tuebingen, Calwer Street 7, 72076, Tuebingen, Germany. 7. Levent M. Senturk, Istanbul University Cerrahpasa School of Medicine. Dept. of Obstetrics and Gynecology, Division of Reproductive Endocrinology, IVF Unit, Istanbul, Turkey. 8. Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy. 9. National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, SW3 6NP, UK. 10. Department of Obstetrics and Gynecology, University Women's Hospital, Bern, Switzerland. 11. University and Helsinki University Hospital, Eira Hospital, Helsinki, Finland. 12. Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK. 13. Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece.
Abstract
INTRODUCTION: Postmenopausal osteoporosis is a highly prevalent disease. Prevention through lifestyle measures includes an adequate calcium intake. Despite the guidance provided by scientific societies and governmental bodies worldwide, many issues remain unresolved. AIMS: To provide evidence regarding the impact of calcium intake on the prevention of postmenopausal osteoporosis and critically appraise current guidelines. MATERIALS AND METHODS: Literature review and consensus of expert opinion. RESULTS AND CONCLUSION: The recommended daily intake of calcium varies between 700 and 1200mg of elemental calcium, depending on the endorsing source. Although calcium can be derived either from the diet or supplements, the former source is preferred. Intake below the recommended amount may increase fragility fracture risk; however, there is no consistent evidence that calcium supplementation at, or above, recommended levels reduces risk. The addition of vitamin D may minimally reduce fractures, mainly among institutionalised people. Excessive intake of calcium, defined as higher than 2000mg/day, can be potentially harmful. Some studies demonstrated harm even at lower dosages. An increased risk for cardiovascular events, urolithiasis and even fractures has been found in association with excessive calcium intake, but this issue remains unresolved. In conclusion, an adequate intake of calcium is recommended for general bone health. Excessive calcium intake seems of no benefit, and could possibly be harmful.
INTRODUCTION: Postmenopausal osteoporosis is a highly prevalent disease. Prevention through lifestyle measures includes an adequate calcium intake. Despite the guidance provided by scientific societies and governmental bodies worldwide, many issues remain unresolved. AIMS: To provide evidence regarding the impact of calcium intake on the prevention of postmenopausal osteoporosis and critically appraise current guidelines. MATERIALS AND METHODS: Literature review and consensus of expert opinion. RESULTS AND CONCLUSION: The recommended daily intake of calcium varies between 700 and 1200mg of elemental calcium, depending on the endorsing source. Although calcium can be derived either from the diet or supplements, the former source is preferred. Intake below the recommended amount may increase fragility fracture risk; however, there is no consistent evidence that calcium supplementation at, or above, recommended levels reduces risk. The addition of vitamin D may minimally reduce fractures, mainly among institutionalised people. Excessive intake of calcium, defined as higher than 2000mg/day, can be potentially harmful. Some studies demonstrated harm even at lower dosages. An increased risk for cardiovascular events, urolithiasis and even fractures has been found in association with excessive calcium intake, but this issue remains unresolved. In conclusion, an adequate intake of calcium is recommended for general bone health. Excessive calcium intake seems of no benefit, and could possibly be harmful.