Skip to main content
SpringerLink
Log in

Calcium intake, bone mineral density, and fragility fractures: evidence from an Italian outpatient population

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Summary

This study was performed in 1000 adult Italian subjects to focus on the effects of dietary calcium intake on bone health. A higher fracture risk appears to be associated with a reduced calcium intake. An adequate daily calcium intake is recommended to counteract osteoporotic fractures.

Purpose

The principal aim of the present study was to focus on the effects of dietary calcium intake on bone mineral density (BMD) and fragility fractures in a representative sample of an adult Italian outpatient population.

Methods

The study group consisted of 1000 consecutive adult Italian subjects [838 women (F) and 162 men (M)] referred to the Bone Metabolic Diseases Unit for the evaluation of their bone metabolism. Daily dietary calcium intake was assessed using a specific food frequency questionnaire (FFQ). Other evaluations included fracture risk, lumbar and femoral BMD, heel ultrasound, fragility fractures, plasma concentration of parathyroid hormone ([PTH]) and 25-hydroxy-vitamin D ([25(OH)D]), and urinary calcium.

Results

Only 10.4% of the subjects (n = 104; 71 F and 33 M) had a daily calcium intake adequate for adults (≥1000 mg/day). No correlation was found between calcium intake and BMD. The transition from a daily dietary calcium intake <400 mg/day to a daily dietary calcium intake ≥400 mg/day was associated with a reduced fracture probability ratio at any site [from 42 to 21% (p < 0.05)]. Subjects with one or more vertebral fractures had a significantly lower dietary calcium intake (<400 mg/day) than did subjects without vertebral fractures, and they practiced physical activity only occasionally (p = 0.030).

Conclusions

Daily dietary calcium intake is lower than the recommended daily intake in an Italian ambulatory population, and a higher fracture risk appears to be associated with a reduced calcium intake. An age-adequate daily calcium intake, combined with regular physical activity, is strongly recommended in order to counteract fragility fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Article Open access 01 July 2023

Enisa Shevroja, Jean-Yves Reginster, … Nicholas C. Harvey

References

  1. Mitchell PJ, Cooper C, Dawson-Hughes B, Gordon CM, Rizzoli R (2015) Life-course approach to nutrition. Osteoporos Int 26:2723–2742

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Burckhardt P (2013) Calcium revisited: part I. Bonekey Rep 2:433. doi:10.1038/bonekey.2013.167 Review

    Article  PubMed  PubMed Central  Google Scholar 

  3. Institute of Medicine (2003) Dietary reference intakes: applications in dietary planning. National Academies Press (US), Washington (DC)

    Google Scholar 

  4. Rozenberg S, Body JJ, Bruyère O, Bergmann P, Brandi ML, Cooper C, Devogelaer JP, Gielen E, Goemaere S, Kaufman JM, Rizzoli R, Reginster JY (2016) Effects of dairy products consumption on health: benefits and beliefs—a commentary from the Belgian bone Club and the European Society for Clinical and Economic Aspects of osteoporosis, osteoarthritis and Muscoloskeletal Diseases. Calcif Tissue Int 98:1–17 Review

    Article  CAS  PubMed  Google Scholar 

  5. Burckhardt P (2015) Calcium revisited, part III: effect of dietary calcium on BMD and fracture risk. Bonekey Rep 4:708. doi:10.1038/bonekey.2015.77. eCollection Review

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Sahni S, Tucker KL, Kiel DP, Quach L, Casey VA, Hannan MT (2013) Milk and yogurt consumption are linked with higher bone mineral density but not with hip fracture: the Framingham offspring study. Arch Osteoporos 8:119. doi:10.1007/s11657-013-0119-2

    Article  PubMed  PubMed Central  Google Scholar 

  7. Heaney RP (2000) Calcium, dairy products and osteoporosis. J Am Coll Nutr 19:83S–99S Review

    Article  CAS  PubMed  Google Scholar 

  8. Lamy O, Burckhardt P (2014) Calcium revisited: part II calcium supplements and their effects. Bonekey Rep 3:579. doi:10.1038/bonekey.2014.74. eCollection Review

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Bolland MJ, Barber PA, Doughty RN, Mason B, Horne A, Ames R, Gamble GD, Grey A, Reid IR (2008) Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ 336:262–266

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Kopecky SL, Bauer DC, Gulati M, Nieves JW, Singer AJ, Toth PP, Underberg JA, Wallace TC, Weaver CM (2016) Lack of evidence linking calcium with or without vitamin D supplementation to cardiovascular disease in generally healthy adults: a clinical guideline from the National Osteoporosis Foundation and the American Society for Preventive Cardiology. Ann Intern Med 165:867–868

    Article  PubMed  Google Scholar 

  11. Nieves JW, Barrett-Connor E, Siris ES, Zion M, Barlas S, Chen YT (2008) Calcium and vitamin D intake influence bone mass, but not short-term fracture risk, in Caucasian postmenopausal women from the National Osteoporosis Risk Assessment (NORA) study. Osteoporos Int 19:673–679

    Article  CAS  PubMed  Google Scholar 

  12. Kalkwarf HJ, Khoury JC, Lanphear BP (2003) Milk intake during childhood and adolescence, adult bone density, and osteoporotic fractures in US women. Am J ClinNutr 77:257–265

    CAS  Google Scholar 

  13. Kanis JA, Johansson H, Oden A, De Laet C, Johnell O, Eisman JA, Mc Closkey E, Mellstrom D, Pols H, Reeve J, Silman A, Tenenhouse A (2005) A meta-analysis of milk intake and fracture risk: low utility for case finding. OsteoporosInt 16:799–804

    Article  Google Scholar 

  14. Weinsier RL, Krumdieck CL (2000) Dairy foods and bone health: examination of the evidence. Am J ClinNutr 72:681–689 Review

    CAS  Google Scholar 

  15. Armstrong ME, Kirichek O, Cairns BJ, Green J, Reeves GK, Beral V, Collaborators MWS (2015) Relationship of height to site-specific fracture risk in postmenopausal women. J Bone Miner Res. doi:10.1002/jbmr.2742

    PubMed  PubMed Central  Google Scholar 

  16. Montomoli M, Gonnelli S, Giacchi M, Mattei R, Cuda C, Rossi S, Gennari C (2002) Validation of a food frequency questionnaire for nutritional calcium intake assessment in Italian women. Eur J ClinNutr 56:21–30

    Article  CAS  Google Scholar 

  17. Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ (1997) Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 7:439–443

    Article  CAS  PubMed  Google Scholar 

  18. Sahni S, Mangano KM, Tucker KL, Kiel DP, Casey VA, Hannan MT (2014) Protective association of milk intake on the risk of hip fracture: results from the Framingham original cohort. J Bone Miner Res 29:1756–1762

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Nakamura K, Kitamura K, Inoue M, Sawada N, Tsugane S, Japan Public Health Center-based Prospective Study Group (2014) Physical activity and 10-year incidence of self-reported vertebral fractures in Japanese women: the Japan public health center-based prospective study. OsteoporosInt 25:2565–2571

    Article  CAS  Google Scholar 

  20. Chan HH, Lau EM, Woo J, Lin F, Sham A, Leung PC (1996) Dietary calcium intake, physical activity and the risk of vertebral fracture in Chinese. Osteoporos Int 6:228–232

    Article  CAS  PubMed  Google Scholar 

  21. JJB A, Roggenkamp KJ, Suchindran CM (2012) Calcium intakes and femoral and lumbar bone density of elderly U.S. men and women: National Health and Nutrition Examination Survey 2005-2006 analysis. J Clin Endocrinol Metab 97:4531–4539

    Article  Google Scholar 

  22. Tai V, Leung W, Grey A, Reid IR, Bolland MJ (2015) Calcium intake and bone mineral density: systematic review and meta-analysis. BMJ 351:h4183. doi:10.1136/bmj.h4183 Review

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nordin BE, Polley KJ, Need AG, Morris HA, Marshall D (1987) The problem of calcium requirement. Am J ClinNutr 45:1295–1304

    CAS  Google Scholar 

  24. Wee J, Sng BY, Shen L, Lim CT, Singh G, Das De S (2013) The relationship between body mass index and physical activity levels in relation to bone mineral density in premenopausal and postmenopausal women. Arch Osteoporos 8:162

    Article  PubMed  Google Scholar 

  25. Alghadir AH, Gabr SA, Al-Eisa E (2015) Physical activity and lifestyle effects on bone mineral density among young adults: sociodemographic and biochemical analysis. J Phys Ther Sci 27:2261–2270

    Article  PubMed  PubMed Central  Google Scholar 

  26. Masi L, Ottanelli S, Berni R, Cacudi E, Giusti F, Marcucci G, Cavalli L, Fossi C, Marini F, Ciuffi S, Tanini A, Brandi ML (2014) CYP19 and ESR1 gene polymorphisms: response of bone mineral density in post-menopausal women to hormonal replacement therapy. Clin Cases Miner Bone Metab 11:36–43

    PubMed  PubMed Central  Google Scholar 

  27. Biver E, Durosier C, Chevalley T, Herrmann FR, Ferrari S, Rizzoli R (2015) Prior ankle fractures in postmenopausal women are associated with low areal bone mineral density and bone microstructure alterations. OsteoporosInt 26:2147–2155

    Article  CAS  Google Scholar 

  28. Feola M, Rao C, Tempesta V, Gasbarra E, Tarantino U (2015) Femoral cortical index: an indicator of poor bone quality in patient with hip fracture. Aging ClinExp Res 27:S45–S50. doi:10.1007/s40520-015-0423-3

    Article  Google Scholar 

  29. Harvey NC, Glüer CC, Binkley N, McCloskey EV, Brandi ML, Cooper C, Kendler D, Lamy O, Laslop A, Camargos BM, Reginster JY, Rizzoli R, Kanis JA (2015) Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice. Bone 78:216–224

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This study was supported by an unrestricted grant from F.I.R.M.O. (Fondazione Raffaella Becagli) to M. L. Brandi.

Author information

Authors and Affiliations

  1. Bone Metabolic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy

    Letizia Vannucci, Caterina Fossi, Anna Maria Carossino & Maria Luisa Brandi

  2. Bone Metabolic Diseases Unit, University Hospital AOU-Careggi, Largo Palagi 1, 50139, Florence, Italy

    Laura Masi

  3. Department of Neurosciences, Psychology, Drug Research, and Child Health (section of Psychology), University of Florence, Via di San Salvi 12, 50139, Florence, Italy

    Giorgio Gronchi

Authors
  1. Letizia Vannucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Masi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giorgio Gronchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Caterina Fossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anna Maria Carossino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Luisa Brandi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria Luisa Brandi.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vannucci, L., Masi, L., Gronchi, G. et al. Calcium intake, bone mineral density, and fragility fractures: evidence from an Italian outpatient population. Arch Osteoporos 12, 40 (2017). https://doi.org/10.1007/s11657-017-0333-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-017-0333-4

Keywords

Search

Navigation