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Calcium Throughout the Life Cycle

The Later Years

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Calcium in Human Health

Part of the book series: Nutrition and Health ((NH))

Abstract

Osteoporotic fractures are common and devastating occurrences. Many lifestyle and hereditary factors contribute to fracture risk. Several components of the diet influence risk of osteoporosis in older men and women and the best studied of these are calcium and vitamin D. This chapter focuses on the role of calcium in bone health in older men and women. It includes a review of the physiology and determinants of calcium absorption and a summary of the evidence that calcium intake influences the rate of bone remodeling and bone loss in older individuals. The limited available evidence that calcium alters fracture rates will also be addressed. The National Academy of Sciences now recommends that men and women age 51 yr and older consume 1200 mg/d of calcium. Although food sources of calcium are preferred, many individuals will need supplements in order to meet their calcium requirement. Supplement absorbability and optimal dosage schedules are reviewed.

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References

  1. Heaney RP, Saville PD, Recker RR. Calcium absorption as a function of calcium intake. J Lab Clin Med 1975;85(6):881–890.

    CAS  Google Scholar 

  2. Bronner F, Harris R.S. Absorption and metabolism of calcium in human beings, studied with calcium 45. Ann NY Acad Sci 1956;64:314–325.

    Article  CAS  Google Scholar 

  3. Spencer H, Lewin I, Fowler J, Samachson J. Influence of dietary calcium intake on Ca47 absorption in man. Am J Med 1969;46(2):197–205.

    Article  CAS  Google Scholar 

  4. Heaney RP, Recker RR, Stegman MR, Moy AJ. Calcium absorption in women: relationships to calcium intake, estrogen status, and age. J Bone Miner Res 1989;4(4):469–475.

    CAS  Google Scholar 

  5. Dawson-Hughes B, Harris S, Kramich C, Dallal G, Rasmussen HM. Calcium retention and hormone levels in black and white women on high-and low-calcium diets. J Bone Miner Res 1993;8(7):779–787.

    CAS  Google Scholar 

  6. Devine A, Wilson SG, Dick IM, Prince RL. Effects of vitamin D metabolites on intestinal calcium absorption and bone turnover in elderly women. Am J Clin Nutr 2002;75(2):283–288.

    CAS  Google Scholar 

  7. Heaney RP, Dowell MS, Hale CA, Bendich A. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 2003;22(2):142–146.

    CAS  Google Scholar 

  8. Barger-Lux MJ, Heaney RP, Lanspa SJ, Healy JC, DeLuca HF. An investigation of sources of variation in calcium absorption efficiency. J Clin Endocrinol Metab 1995;80(2):406–411.

    Article  CAS  Google Scholar 

  9. Heaney RP, Barger-Lux MJ, Dowell MS, Chen TC, Holick MF. Calcium absorptive effects of vitamin D and its major metabolites. J Clin Endocrinol Metab 1997;82(12):4111–4116.

    Article  CAS  Google Scholar 

  10. Malm OJ. Calcium requirement and adaptation in adult men. Scand J Clin Lab Invest 1958;36(Suppl):1–280.

    Google Scholar 

  11. Krall EA, Dawson-Hughes B. Relation of fractional 47Ca retention to season and rates of bone loss in healthy postmenopausal women. J Bone Miner Res 1991;6(12):1323–1329.

    CAS  Google Scholar 

  12. Avioli LV, McDonald JE, Lee SW. The influence of age on the intestinal absorption of 47-Ca absorption in post-menopausal osteoporosis. J Clin Invest 1965;44(12):1960–1967.

    CAS  Google Scholar 

  13. Bullamore JR, Wilkinson R, Gallagher JC, Nordin BE, Marshall DH. Effect of age on calcium absorption. Lancet 1970;2(7672):535–537.

    Article  CAS  Google Scholar 

  14. Gallagher JC, Riggs BL, Eisman J, Hamstra A, Arnaud SB, DeLuca HF. Intestinal calcium absorption and serum vitamin D metabolites in normal subjects and osteoporotic patients: effect of age and dietary calcium. J Clin Invest 1979;64(3):729–736.

    CAS  Google Scholar 

  15. Ebeling PR, Sandgren ME, DiMagno EP, Lane AW, DeLuca HF, Riggs BL. Evidence of an age-related decrease in intestinal responsiveness to vitamin D: relationship between serum 1,25-dihydroxyvitamin D3 and intestinal vitamin D receptor concentrations in normal women. J Clin Endocrinol Metab 1992;75(1):176–182.

    Article  CAS  Google Scholar 

  16. Eastell R, Yergey AL, Vieira NE, Cedel SL, Kumar R, Riggs BL. Interrelationship among vitamin D metabolism, true calcium absorption, parathyroid function, and age in women: evidence of an agerelated intestinal resistance to 1,25-dihydroxyvitamin D action. J Bone Miner Res 1991;6(2):125–132.

    CAS  Google Scholar 

  17. Slovik DM, Adams JS, Neer RM, Holick MF, Potts JT, Jr. Deficient production of 1,25-dihydroxyvitamin D in elderly osteoporotic patients. N Engl J Med 1981;305(7):372–374.

    Article  CAS  Google Scholar 

  18. Tsai KS, Heath H, III, Kumar R, Riggs BL. Impaired vitamin D metabolism with aging in women. Possible role in pathogenesis of senile osteoporosis. J Clin Invest 1984;73(6):1668–1672.

    Article  CAS  Google Scholar 

  19. Fujisawa Y, Kida K, Matsuda H. Role of change in vitamin D metabolism with age in calcium and phosphorus metabolism in normal human subjects. J Clin Endocrinol Metab 1984;59(4):719–726.

    Article  CAS  Google Scholar 

  20. Orwoll ES, Meier DE. Alterations in calcium, vitamin D, and parathyroid hormone physiology in normal men with aging: relationship to the development of senile osteopenia. J Clin Endocrinol Metab 1986;63(6):1262–1269.

    CAS  Google Scholar 

  21. Abrams SA, O’Brien KO, Liang LK, Stuff JE. Differences in calcium absorption and kinetics between black and white girls aged 5–16 years. J Bone Miner Res 1995;10(5):829–833.

    CAS  Google Scholar 

  22. Dawson-Hughes B, Harris SS, Finneran S. Calcium absorption on high and low calcium intakes in relation to vitamin D receptor genotype. J Clin Endocrinol Metab 1995;80(12):3657–3661.

    Article  CAS  Google Scholar 

  23. Wishart JM, Horowitz M, Need AG, et al. Relations between calcium intake, calcitriol, polymorphisms of the vitamin D receptor gene, and calcium absorption in premenopausal women. Am J Clin Nutr 1997;65(3):798–802.

    CAS  Google Scholar 

  24. Morrison NA, Qi JC, Tokita A, et al. Prediction of bone density from vitamin D receptor alleles. Nature 1994;367(6460):284–287.

    Article  CAS  Google Scholar 

  25. Hustmyer FG, Peacock M, Hui S, Johnston CC, Christian J. Bone mineral density in relation to polymorphism at the vitamin D receptor gene locus. J Clin Invest 1994;94(5):2130–2134.

    CAS  Google Scholar 

  26. Krall EA, Parry P, Lichter JB, Dawson-Hughes B. Vitamin D receptor alleles and rates of bone loss: influences of years since menopause and calcium intake. J Bone Miner Res 1995;10(6):978–984.

    CAS  Google Scholar 

  27. Ames SK, Ellis KJ, Gunn SK, Copeland KC, Abrams SA. Vitamin D receptor gene Fok1 polymorphism predicts calcium absorption and bone mineral density in children. J Bone Miner Res 1999;14(5):740–746.

    Article  CAS  Google Scholar 

  28. Kinyamu HK, Gallagher JC, Prahl JM, DeLuca HF, Petranick KM, Lanspa SJ. Association between intestinal vitamin D receptor, calcium absorption, and serum 1,25 dihydroxyvitamin D in normal young and elderly women. J Bone Miner Res 1997;12(6):922–928.

    Article  CAS  Google Scholar 

  29. Gallagher JC, Riggs BL, DeLuca HF. Effect of estrogen on calcium absorption and serum vitamin D metabolites in postmenopausal osteoporosis. J Clin Endocrinol Metab 1980;51(6):1359–1364.

    CAS  Google Scholar 

  30. Gennari C, Agnusdei D, Nardi P, Civitelli R. Estrogen preserves a normal intestinal responsiveness to 1,25-dihydroxyvitamin D3 in oophorectomized women. J Clin Endocrinol Metab 1990;71(5):1288–1293.

    CAS  Google Scholar 

  31. Knox TA, Kassarjian Z, Dawson-Hughes B, et al. Calcium absorption in elderly subjects on high-and low-fiber diets: effect of gastric acidity. Am J Clin Nutr 1991;53(6):1480–1486.

    CAS  Google Scholar 

  32. Wolf RL, Cauley JA, Baker CE, et al. Factors associated with calcium absorption efficiency in pre-and perimenopausal women. Am J Clin Nutr 2000;72(2):466–471.

    CAS  Google Scholar 

  33. Whiting SJ, Draper HH. Effect of chronic high protein feeding on bone composition in the adult rat. J Nutr 1981;111(1):178–183.

    CAS  Google Scholar 

  34. Lutz J, Linkswiler HM. Calcium metabolism in postmenopausal and osteoporotic women consuming two levels of dietary protein. Am J Clin Nutr 1981;34(10):2178–2186.

    CAS  Google Scholar 

  35. Kerstetter JE, O’Brien KO, Insogna KL. Dietary protein affects intestinal calcium absorption. Am J Clin Nutr 1998;68(4):859–865.

    CAS  Google Scholar 

  36. Hegsted M, Linkswiler HM. Long-term effects of level of protein intake on calcium metabolism in young adult women. J Nutr 1981;111(2):244–251.

    CAS  Google Scholar 

  37. Heaney RP, Recker RR. Effects of nitrogen, phosphorus, and caffeine on calcium balance in women. J Lab Clin Med 1982;99(1):46–55.

    CAS  Google Scholar 

  38. Spencer H, Kramer L, Osis D, Norris C. Effect of a high protein (meat) intake on calcium metabolism in man. Am J Clin Nutr 1978;31(12):2167–2180.

    CAS  Google Scholar 

  39. Heaney RP, Recker RR. Effects of nitrogen, phosphorus, and caffeine on calcium balance in women. J Lab Clin Med 1982;99(1):46–55.

    CAS  Google Scholar 

  40. Spencer H, Kramer L, Osis D, Norris C. Effect of a high protein (meat) intake on calcium metabolism in man. Am J Clin Nutr 1978;31(12):2167–2180.

    CAS  Google Scholar 

  41. Krall EA, Dawson-Hughes B. Smoking increases bone loss and decreases intestinal calcium absorption. J Bone Miner Res 1999;14(2):215–220.

    Article  CAS  Google Scholar 

  42. Zittermann A, Sabatschus O, Jantzen S, et al. Exercise-trained young men have higher calcium absorption rates and plasma calcitriol levels compared with age-matched sedentary controls. Calcif Tissue Int 2000;67(3):215–219.

    Article  CAS  Google Scholar 

  43. Gallagher JC, Aaron J, Horsman A, Marshall DH, Wilkinson R, Nordin BE. The crush fracture syndrome in postmenopausal women. Clin Endocrinol Metab 1973;2(2):293–315.

    Article  CAS  Google Scholar 

  44. Morris HA, Need AG, Horowitz M, O’Loughlin PD, Nordin BE. Calcium absorption in normal and osteoporotic postmenopausal women. Calcif Tissue Int 1991;49(4):240–243.

    Article  CAS  Google Scholar 

  45. Nordin BE, Robertson A, Seamark RF, et al. The relation between calcium absorption, serum dehydroepiandrosterone, and vertebral mineral density in postmenopausal women. J Clin Endocrinol Metab 1985;60(4):651–657.

    CAS  Google Scholar 

  46. Francis RM, Peacock M, Taylor GA, Storer JH, Nordin BE. Calcium malabsorption in elderly women with vertebral fractures: evidence for resistance to the action of vitamin D metabolites on the bowel. Clin Sci 1984;66(1):103–107.

    CAS  Google Scholar 

  47. Ensrud KE, Duong T, Cauley JA, et al. Low fractional calcium absorption increases the risk for hip fracture in women with low calcium intake. Study of Osteoporotic Fractures Research Group. Ann Intern Med 2000;132(5):345–353.

    CAS  Google Scholar 

  48. Garnero P, Hausherr E, Chapuy MC, et al. Markers of bone resorption predict hip fracture in elderly women: the EPIDOS Prospective Study. J Bone Miner Res 1996;11(10):1531–1538.

    CAS  Google Scholar 

  49. Parfitt AM. High bone turnover is intrinsically harmful: two paths to a similar conclusion. The Parfitt view. J Bone Miner Res 2002;17(8):1558–1559.

    Article  Google Scholar 

  50. Melton LJ, III, Chrischilles EA, Cooper C, Lane AW, Riggs BL. Perspective. How many women have osteoporosis? J Bone Miner Res 1992;7(9):1005–1010.

    Google Scholar 

  51. Chapuy MC, Chapuy P, Meunier PJ. Calcium and vitamin D supplements: effects on calcium metabolism in elderly people. Am J Clin Nutr 1987;46(2):324–328.

    CAS  Google Scholar 

  52. Dawson-Hughes B, Dallal GE, Krall EA, Sadowski L, Sahyoun N, Tannenbaum S. A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med 1990;323(13):878–883.

    Article  CAS  Google Scholar 

  53. Kochersberger G, Bales C, Lobaugh B, Lyles KW. Calcium supplementation lowers serum parathyroid hormone levels in elderly subjects. J Gerontol 1990;45(5):M159–M162.

    CAS  Google Scholar 

  54. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of Calcium and Vitamin D Supplementation on Bone Density in Men and Women 65 Years of Age or Older. N Engl J Med 1997;337(10):670–676.

    Article  CAS  Google Scholar 

  55. Elders PJ, Netelenbos JC, Lips P, et al. Calcium supplementation reduces vertebral bone loss in perimenopausal women: a controlled trial in 248 women between 46 and 55 years of age. J Clin Endocrinol Metab 1991;73(3):533–540.

    CAS  Google Scholar 

  56. Riis B, Thomsen K, Christiansen C. Does calcium supplementation prevent postmenopausal bone loss? A double-blind, controlled clinical study. N Engl J Med 1987;316(4):173–177.

    Article  CAS  Google Scholar 

  57. Chevalley T, Rizzoli R, Nydegger V, et al. Effects of calcium supplements on femoral bone mineral density and vertebral fracture rate in vitamin-D-replete elderly patients. Osteoporos Int 1994;4(5):245–252.

    Article  CAS  Google Scholar 

  58. Frost HM. The origin and nature of transients in human bone remodeling dynamics. In: Frame B, Parfitt M, Duncan H, eds. Clinical Aspects of Metabolic Bone Disease. Excerpta Medica, Amsterdam: 1973: pp. 124–137.

    Google Scholar 

  59. Heaney RP. Calcium, dairy products and osteoporosis. J Am Coll Nutr 2000;19(2:Suppl):99S.

    Google Scholar 

  60. Cumming RG. Calcium intake and bone mass: a quantitative review of the evidence. Calcif Tissue Int 1990;47(4):194–201.

    Article  CAS  Google Scholar 

  61. Shea B, Wells G, Cranney A, et al. Meta-analyses of therapies for postmenopausal osteoporosis. VII. Meta-analysis of calcium supplementation for the prevention of postmenopausal osteoporosis. Endocr Rev 2002;23(4):552–559.

    Article  CAS  Google Scholar 

  62. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of withdrawal of calcium and vitamin D supplements on bone mass in elderly men and women. Am J Clin Nutr 2000;72(3):745–750.

    CAS  Google Scholar 

  63. Recker RR, Hinders S, Davies KM, et al. Correcting calcium nutritional deficiency prevents spine fractures in elderly women. J Bone Miner Res 1996;11(12):1961–1966.

    CAS  Google Scholar 

  64. Reid IR, Ames RW, Evans MC, Gamble GD, Sharpe SJ. Long-term effects of calcium supplementation on bone loss and fractures in postmenopausal women: a randomized controlled trial. Am J Med 1995;98(4):331–335.

    Article  CAS  Google Scholar 

  65. Riggs BL, O’Fallon WM, Muhs J, O’Connor MK, Kumar R, Melton LJ, III. Long-term effects of calcium supplementation on serum parathyroid hormone level, bone turnover, and bone loss in elderly women. J Bone Miner Res 1998;13(2):168–174.

    Article  CAS  Google Scholar 

  66. Cumming RG, Nevitt MC. Calcium for prevention of osteoporotic fractures in postmenopausal women. J Bone Miner Res 1997;12(9):1321–1329.

    Article  CAS  Google Scholar 

  67. Chapuy MC, Arlot ME, Delmas PD, Meunier PJ. Effect of calcium and cholecalciferol treatment for three years on hip fractures in elderly women. BMJ 1994;308(6936):1081–1082.

    CAS  Google Scholar 

  68. Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996;348(9041):1535–1541.

    Article  CAS  Google Scholar 

  69. Harris ST, Watts NB, Genant HK, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 1999;282(14):1344–1352.

    Article  CAS  Google Scholar 

  70. Ettinger BM, Black DMP, Mitlak BHM, et al. Reduction of Vertebral Fracture Risk in Postmenopausal Women With Osteoporosis Treated With Raloxifene: Results From a 3-Year Randomized Clinical Trial. JAMA 1999;282(7):637–645.

    Article  CAS  Google Scholar 

  71. Chesnut CH, III, Silverman S, Andriano K, et al. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. PROOF Study Group. Am J Med 2000;109(4):267–276.

    Article  CAS  Google Scholar 

  72. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of Parathyroid Hormone (1–34) on Fractures and Bone Mineral Density in Postmenopausal Women with Osteoporosis. N Engl J Med 2001;344(19):1434–1441.

    Article  CAS  Google Scholar 

  73. Nieves JW, Komar L, Cosman F, Lindsay R. Calcium potentiates the effect of estrogen and calcitonin on bone mass: review and analysis. Am J Clin Nutr 1998;67(1):18–24.

    CAS  Google Scholar 

  74. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary reference intakes: calcium, phosphorus, magnesium, vitamin D, and fluoride. National Academy Press, Washington, DC: 1997.

    Google Scholar 

  75. Johnson-Down L, L’Abbe MR, Lee NS, Gray-Donald K. Appropriate calcium fortification of the food supply presents a challenge. J Nutr 2003;133(7):2232–2238.

    CAS  Google Scholar 

  76. Bourgoin BP, Evans DR, Cornett JR, Lingard SM, Quattrone AJ. Lead content in 70 brands of dietary calcium supplements. Am J Pub Health 1993;83(8):1155–1160.

    Article  CAS  Google Scholar 

  77. Heaney RP, Recker RR, Weaver CM. Absorbability of calcium sources: the limited role of solubility. Calcif Tissue Int 1990;46(5):300–304.

    Article  CAS  Google Scholar 

  78. Smith KT, Heaney RP, Flora L, Hinders SM. Calcium absorption from a new calcium delivery system (CCM). Calcif Tissue Int 1987;41(6):351–352.

    Article  CAS  Google Scholar 

  79. Miller JZ, Smith DL, Flora L, Slemenda C, Jiang XY, Johnston CC, Jr. Calcium absorption from calcium carbonate and a new form of calcium (CCM) in healthy male and female adolescents. Am J Clin Nutr 1988;48(5):1291–1294.

    CAS  Google Scholar 

  80. Heaney RP, Smith KT, Recker RR, Hinders SM. Meal effects on calcium absorption. Am J Clin Nutr 1989;49(2):372–376.

    CAS  Google Scholar 

  81. Harvey JA, Zobitz MM, Pak CY. Dose dependency of calcium absorption: a comparison of calcium carbonate and calcium citrate. J Bone Miner Res 1988;3(3):253–258.

    Article  CAS  Google Scholar 

  82. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313(2):70–73.

    Article  CAS  Google Scholar 

  83. Hurwitz A, Brady DA, Schaal ES, Samloff, MI, Dedon J, Ruhl CE. Gastric acidity in older adults. JAMA 1997;278(8):659–662.

    Article  CAS  Google Scholar 

  84. Calvo MS, Eastell R, Offord KP, Bergstralh EJ, Burritt MF. Circadian variation in ionized calcium and intact parathyroid hormone: evidence for sex differences in calcium homeostasis. J Clin Endocrinol Metab 1991;72(1):69–76.

    Article  CAS  Google Scholar 

  85. Karkkainen MUM, Lamberg-Allardt CJE, Ahonen S, Valimaki M. Does it make a difference how and when you take your calcium? The acute effects of calcium on calcium and bone metabolism. Am J Clin Nutr 2001;74:335–342.

    CAS  Google Scholar 

  86. Curhan GC, Willett WC, Rimm EB, Stampfer MJ. A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med 1993;328(12):833–838.

    Article  CAS  Google Scholar 

  87. Curhan GC, Willett WC, Speizer FE, Spiegelman D, Stampfer MJ. Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Intern Med 1997;126(7):497–504.

    CAS  Google Scholar 

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Dawson-Hughes, B. (2006). Calcium Throughout the Life Cycle. In: Weaver, C.M., Heaney, R.P. (eds) Calcium in Human Health. Nutrition and Health. Humana Press. https://doi.org/10.1007/978-1-59259-961-5_24

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