Osteoporosis International

, Volume 7, Issue 2, pp 155–161 | Cite as

A high dietary calcium intake is needed for a positive effect on bone density in Swedish postmenopausal women

  • K. Michaëlsson
  • R. Bergström
  • L. Holmberg
  • H. Mallmin
  • A. Wolk
  • S. Ljunghall
Original Article


The importance of dietary calcium for bone health is unclear, partly since most investigations have dealt only with a fairly narrow range of calcium intake. In the present population-based observational study with longitudinal dietary assessment, we investigated women with a mean age of 60 years and with a consistently high (range 1417–2417, mean 1645 mg,n=40), intermediate (800–1200, mean 1006 mg,n=35) or low (400–550, mean 465 mg,n=40) estimated daily consumption of calcium. Measurements of bone mineral density (BMD) of the lumbar spine, femoral neck and total body were performed by dual-energy X-ray absorptiometry, as well as ultrasound of the heel. In a multivariate analysis, with adjustment for energy intake the risk factors for osteoporosis (age, body mass index, physical activity, menopausal age, use of estrogens, smoking and former athletic activity), the group with the highest calcium intake had higher values for BMD than the others at all measured sites. The average mean difference compared with the low and the intermediate calcium group was 11% for the femoral neck, 8–11% for the lumbar spine and 5–6% for total body BMDs. In univariate analyses and multivariate models which did not include energy intake, the differences between the groups were less pronounced. The women in the intermediate calcium group had approximately the same mean BMD values as those in the low calcium group. These findings support the view that only a high calcium intake (3% highest percentiles in the studied population) protects against osteoporosis in Swedish postmenopausal women.


Bone mineral density Calcium Osteoporosis Ultrasound 


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  1. 1.
    Schaafsma G. The scientific basis of recommended dietary allowances for calcium. J Intern Med 1992;243:187–94.Google Scholar
  2. 2.
    NIH consensus conference. Optimal calcium intake. JAMA 1994;272:1942–8.Google Scholar
  3. 3.
    Heaney RP, Recker RR, Saville PD. Calcium balance and calcium requirements in middle-aged women. Am J Clin Nutr 1977;30:1603–11.Google Scholar
  4. 4.
    Hasling C, Charles P, Jensen FT, Mosekilde L. Calcium metabolism in postmenopausal osteoporosis: the influence of dietary calcium and net absorbed calcium. J Bone Miner REs 1990;5:939–46.Google Scholar
  5. 5.
    Michaëlsson K, Bergström R, Holmberg L, Mallmin H, Wolk A, Ljunghall S. Calcium intake among women aged 40–76 in Sweden. J Epidemiol Commun Health 1996;50:577–578.Google Scholar
  6. 6.
    Michaëlsson K, Holmberg L, Mallmin H, Wolk A, Bergström R, Ljunghall S. Diet, bone mass and osteocalcin: an observational study. Calcif Tissue Int 1995;57:86–93.Google Scholar
  7. 7.
    Gluer CC, Wu CY, Jergas M, Goldstein SA, Genant HK. Three quantitative ultrasound parameters reflect bone structure. Calcif Tissue Int 1994;55:46–52.Google Scholar
  8. 8.
    Schott AM, Weill-Engerer S, Hans D, Duboeuf F, Delmas PD, Meunier PJ. Ultrasound discriminates patients with hip fracture equally well as dual energy X-ray absorptiometry and independently of bone mineral density. J Bone Miner Res 1995;10:243–9.Google Scholar
  9. 9.
    Turner CH, Peacock M, Timmersman L, Neal JM, Johnston CCJ. Calcaneal ultrasonic measurements discriminate hip fracture independently of bone mass. Osteoporos Int 1995;5:130–5.Google Scholar
  10. 10.
    Reid IR, Ames RW, Evans MC, Gamble GD, Sharpe SJ. Effect of calcium supplementation on bone loss in postmenopausal women. N Engl J Med 1993;328:460–4.Google Scholar
  11. 11.
    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;98:331–5.Google Scholar
  12. 12.
    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;323:878–83.Google Scholar
  13. 13.
    Recker RR, Saville PD, Heaney RP. Effects of estrogens and calcium carbonate on bone loss in postmenopausal women. Ann Intern Med 1977;87:649–55.Google Scholar
  14. 14.
    Prince RL, Smith M, Dick IM, et al. Prevention of postmenopausal osteoporosis: a comparative study of exercise, calcium supplementation, and hormone-replacement therapy. N Engl J Med 1991;325:1189–95.Google Scholar
  15. 15.
    Aloia JF, Vaswani A, Yeh JK, Ross PL, Flaster E, Dilmanian FA. Calcium supplementation with and without hormone replacement therapy to prevent postmenopausal bone loss. Ann Intern Med 1994;120:97–103.Google Scholar
  16. 16.
    Kanis JA. What constitutes evidence for drug efficacy in osteoporosis? Drugs Aging 1993;3:391–9.Google Scholar
  17. 17.
    McKane WR, Khosla S, Egan KS, Robins SP, Burritt MF, Riggs BL. Role of calcium intake in modulating age-related increases in parathyroid function and bone resorption. J Clin Endocrinol Metab 1996;81:1699–703.Google Scholar
  18. 18.
    Riggs BL, Wahner HW, Melton LJ III, Richelson LS, Judd HL, O'Fallon WM. Dietary calcium intake and rates of bone loss on women. J Clin Invest 1987;80:979–82.Google Scholar
  19. 19.
    Stevenson JC, Whitehead MI, Padwick M, Endacott JA, Sutton C, Banks LM. Dietary intake of calcium and postmenopausal bone loss. BMJ 1988;297:15–17.Google Scholar
  20. 20.
    Bauer DC, Browner WS, Cauley JA, et al. Factors associated with appendicular bone mass in older women. The Study of Osteoporotic Fractures Research Group. Ann Intern Med 1993;118:657–65.Google Scholar
  21. 21.
    Ward JA, Lord SR, Williams P, Anstey K, Zivanovic E. Physiologic, health and lifestyle factors associated with femoral neck bone density in older women. Bone 1995;16:373–8.Google Scholar
  22. 22.
    Wickham CAC, Walsh K, Cooper C. Dietary calcium, physical activity, and risk of hip fracture: a prospective study. BMJ 1989;299:889–92.Google Scholar
  23. 23.
    Looker AC, Harris TB, Madans JH, Sempos CT. Dietary calcium and hip fracture risk: the NHANES I Epidemiologic Follow-Up Study. Osteoporos Int 1993;3:177–84.Google Scholar
  24. 24.
    Paganini Hill A, Chao A, Ross RK, Henderson BE. Exercise and other factors in the prevention of hip fracture: the Leisure World study. Epidemiology 1991;2:16–25.Google Scholar
  25. 25.
    Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 1995;332:767–73.Google Scholar
  26. 26.
    Michaëlsson K, Holmberg L, Mallmin H, Sörensen S, Wolk A, Bergström R. Diet and hip fracture risk: results from a case-control study. Int J Epidemiol 1995;24:771–83.Google Scholar
  27. 27.
    Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet 1993;341:72–5.Google Scholar
  28. 28.
    Melton LJ III, Atkinson EJ, O'Fallon WM, Wahner HW, Riggs BL. Long-term fracture prediction by bone mineral assessed at different skeletal sites. J Bone Miner Res 1993;8:1227–33.Google Scholar
  29. 29.
    Block G. A review of validations of dietary assessment methods. Epidemiology 1982;115:492–505.Google Scholar
  30. 30.
    Willett W, Stampfer MJ. Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 1986;124:17–27.Google Scholar

Copyright information

© European Foundation for Osteoporosis and the National Osteoporosis Foundation 1997

Authors and Affiliations

  • K. Michaëlsson
    • 1
  • R. Bergström
    • 2
  • L. Holmberg
    • 3
  • H. Mallmin
    • 1
  • A. Wolk
    • 4
  • S. Ljunghall
    • 5
  1. 1.Department of OrthopaedicsUniversity HospitalUppsalaSweden
  2. 2.Department of StatisticsUppsala UniversityUppsala
  3. 3.Department of SurgeryUniversity HospitalUppsala
  4. 4.Department of Cancer EpidemiologyUniversity HospitalUppsala
  5. 5.Department of Internal MedicineUniversity HospitalUppsalaSweden

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