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PART 4

TABLE

Nutrition for Health and Fitness

24-3

Recommended Intakes of Bone-Related


Nutrients for Adults
Per Day

Calcium
Vitamin D
Magnesium
Manganese
Zinc
Boron
Copper
Vitamin K

1500 mg/day for postmenopausal


women, 1000-1200 for younger women
600-1000 units
400-600 mg
2-5 mg
15 mg
3 mg
2-3 mg
500 mcg

nificant increases in spinal and total body BMD. A few


studies have followed up the subjects who gained BMD on
earlier supplementation, but without further supplements of
calcium the mean BMD values of the treated groups reverted back to the mean values of the control groups. These
reports suggest that the higher intakes need to be consumed
consistently to maintain any gains in BMD from calcium
supplements alone. Thus the question still remains of
whether a brief l-year gain in BMD resulting from a calcium supplement during early life (i.e., teenage years) may
translate into later protection against osteoporosis. But it
seems more likely that keeping the gains in BMD accrued
before age 20 may best be met by a combination of regular
physical activity and a reasonable consistent daily calcium
intake that approaches the current AI.

Calcium Bioavailability
have been hypothesized to improve bone mass and density
in postmenopausal women and older men, but most investigations of these dietary components have not supported
the hypothesis.
Recommendations for the intakes of calcium and several
bone-related nutrients by adults are shown in Table 24-3.

Calcium Intake
Calcium from Foods
Calcium intake in the primary prevention of osteoporosis
has received much attention. The Institute of Medicine
recommendations for calcium, vitamin D, and a few other
nutrients are given as adequate intakes (AIs), because only
the mean requirements for calcium and vitamin D during
the stages of the life cycle could be quantified. The AI for
calcium from preadolescence (age 11 years) through adolescence (up to 19 years) was increased to 1300 mg/day in the
latest report. AIs for calcium are the same for each gender
across the life cycle (see the dietary recommended intakes
on inside front cover).
Calcium intakes typically do not meet the recommended
AI for all ages beyond 11 years, especially females. According to NHANES data (NHANES, 2007), teen and adult
women consume considerably less than the current AIs.
Men are more likely to consume somewhat greater amounts
than females, but they also do not meet the recommended
levels after 50 years of age. These deficits translate, on average, into the need for roughly an additional 500 mg/day for
teenage females and adult women.
Food sources are recommended first for supplying calcium needs because of the coingestion of other essential
nutrients. Reaching AI levels of calcium from foods should
be the first goal, but if insufficient amounts of calcium from
foods are consumed, supplements of calcium should then be
ingested to reach the age-specific AI.

Calcium from Supplements


Numerous studies of calcium supplementation in all agegroups and especially in females have typically shown sig-

Calcium bioavailability from foods is generally similar to


that of supplements. Calcium bioavailability from supplements containing various anion combinations is very good;
however, a few preparations that contain citrate as the anion
may have a slightly higher bioavailability.
Calcium bioavailability from foods is generally good, but
from a few foods such as spinach it may be low and adversely
affect calcium nutrition status. Wheat bread may be a good
source of calcium for those who consume several servings of
bread a day; green leafy vegetables such as broccoli, kale,
and bok choy also have good bioavailability; and calcium
from soybeans is very well absorbed. However, spinach and
a few other high oxalate-containing vegetables have low
calcium bioavailability. The consumption of dairy products,
especially high-calcium milks, cheeses, and yogurts, appears
to be the best way for most individuals to meet their daily
calcium requirements. However, it is not the only way; nondairy sources of calcium such as almonds, tofu, calciumfortified nondairy milks and juices, and dark-green leafy
vegetables are excellent options.
Additional benefits of meeting calcium requirements
from foods alone are that the foods containing calcium are
also rich in several other nutrients needed for health in general, and for bone health in particular, and that the consumption of a calcium-rich diet from foods is also a marker
of a balanced intake with respect to practically all micronutrients. The amount of calcium in major food sources is
listed in Table 24-4.

Calcium Bioavailability from


Calcium Supplements
Calcium bioavailability from calcium supplements depends
on the anion used, but practically all calcium-containing
supplements currently on the market have good bioavailability. Calcium citrate malate supplements appear to be
absorbed slightly more efficiently than calcium carbonate
and other calcium supplements, but the difference is typically only a couple of percentage points. Calcium carbonate
can have a constipating effect that may be minimized by
dividing the dose and taking more fluids and fiber. Highdose calcium supplements may reduce the absorption of

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