The Role of Calcium, Phosphorus, and Macronutrients in the Maintenance of Skeletal health

  • John J. B. Anderson
Part of the Current Clinical Practice book series (CCP)


Dietary calcium intakes by females in the US typically average considerably below the RDAs for calcium, starting at age 11 yr. The RDAs for females (and males) are 1200 mg of calcium/d from 11 through 24 yr and 800 from 25 and onward (1). The NIH Consensus Conference on Calcium in 1994 suggested that calcium intakes should be 1000 mg/d for women beginning at menopause and 1500 for postmenopausal women who are not receiving any form of estrogen replacement therapy (2)Probably most nutritionists are not in agreement with the NIH recommendation of 1500 mg/d because it is practically impossible to obtain compliance with such a high intake from a combination of food consumption plus additional calcium via supplements. Furthermore, the scientific evidence of skeletal benefits in support of a daily recommendation of 1500 mg of calcium alone is not convincing. (Calcium plus vitamin D may be more effective.) No harm, of course, would be anticipated from an intake of 1500 mg/d or even as high as 2000, a value now considered the upper limit of safe intake. (Neither the FDA nor the RDA Committee has published specific amounts of calcium consumption beyond which the safety of consumers would be a concern.)


Bone Mineral Density Bone Mass Calcium Intake Calcium Supplementation Animal Protein 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Subcommittee on Dietary Allowances, Food and Nutrition Board, National Research CouncilRecommended Dietary Allowances10th ed., Washington, DC: National Academy Press, 1989.Google Scholar
  2. 2.
    NIH Consensus ConferenceOptimal Calcium Intake.Bethesda, MD, 1995; 272: 1942–1948 (Also see JAMA, Dec. 31, 1994).Google Scholar
  3. 3.
    Tylaysky FA, Anderson JJB, Talmage RV, Taft T. Are calcium intakes and physical activity patterns during adolescence related to radial bone mass of white college-age females?Osteoporosis Int1992; 2: 232.CrossRefGoogle Scholar
  4. 4.
    Ito M, Yamada M, Hayashi K, Ohki M, Uetani M, Nakamura T. Relation of early menarche to high bone mineral density.Calcif Tissue Int1995; 57: 11–14. PubMedCrossRefGoogle Scholar
  5. 5.
    Bonjour JP, Theintz G, Buchs B, Slosman D, Rizzoli R. Critical years and stages of puberty for spinal and femoral bone mass accumulation during adolescence-1Clin Endocrinol Metab1991; 73: 555.CrossRefGoogle Scholar
  6. 6.
    Theintz G, Buchs B, Rizzoli R, Bonjour J-P. Longitudinal monitoring of bone mass accumulation in healthy adolescents: evidence for a marked reduction after 16 years of age at levels of lumbar spine and femoral neck in female subjects.J Clin Endocrinol Metab1992; 75:1060.PubMedCrossRefGoogle Scholar
  7. 7.
    Matkovic V, Heaney RP. Calcium balance during human growth: evidence for threshold behavior.Am J Clin Nutr1992;55:992.PubMedGoogle Scholar
  8. 8.
    Johnston CC Jr, Miller JZ, Slemenda CW, Reister TK, Christian JC, Peacock M. Calcium supplementation and increases in bone mineral density in children.NEngl JMed1992; 327: 82.CrossRefGoogle Scholar
  9. 9.
    Matkovic V, Fontana D, Tomineac C, Goel P, Chesnut CH III. Factors that influence peak bone mass formation: a study of calcium balance and the inheritance of bone mass in adolescent females.Am J Clin Nutr1990; 52: 878.PubMedGoogle Scholar
  10. 10.
    Lloyd T, Andon MB, Rollings N, Martel JK, Landis JR, Demers LM, Eggli DF, Kieselhorst K, Kulin HE. Calcium supplementation and bone mineral density in adolescent girls.JAMA1993; 270: 841.PubMedCrossRefGoogle Scholar
  11. 11.
    Katzman DK, Bachrach L, Carter DR, Marcus R. Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls.J Clin Endocrinol Metab1991; 73: 1332–1339.PubMedCrossRefGoogle Scholar
  12. 12.
    Anderson JJB. The role of nutrition in the functioning of skeletal tissue.Nutr Rev1992; 50: 388.PubMedCrossRefGoogle Scholar
  13. 13.
    Recker RR, Davies M, Hinders SM, Heaney RP, Stegman MR, Kimmel DB. Bone gain in young adult women.JAMA1992; 268: 2403.Google Scholar
  14. 14.
    Baran D, Sorensen A, Grimes J, Lew R, Karellas A, Johnson B, Roche J. Dietary modification with dairy products for preventing vertebral bone loss in premenopausal women: a three-year study.J Clin Endocrinol Metab1989; 70: 264.CrossRefGoogle Scholar
  15. 15.
    Kanders B, Dempster DW, Lindsay R. Interaction of calcium nutrition and physical activity on bone mass in young women.J Bone Miner Res1988; 3: 145.PubMedCrossRefGoogle Scholar
  16. 16.
    Halioua L, Anderson JJB. Lifetime calcium intake and physical activity habits: independent and combined effects on the radial bone of healthy premenopausal Caucasian women.Am J Clin Nutr1989; 49: 534.PubMedGoogle Scholar
  17. 17.
    Fehily AM, Coles RJ, Evans WD, Elwood PC. Factors affecting bone density in young adults.Am J Clin Nutr1992; 56: 579.PubMedGoogle Scholar
  18. 18.
    Metz J, Anderson JJB, Gallagher PN Jr. Intakes of calcium, phosphorus, protein and level of physical activity are related to radial bone mass in young adult women.Am J Clin Nutr1993; 58: 537.PubMedGoogle Scholar
  19. 19.
    Picard D, Ste.-Marie LG, Coutu D, Carrier L, Chartrand R, Lepage R, Fugere P, D’Amour P. Premenopausal bone mineral content relates to height, weight and calcium intake during early adulthood.Bone Miner1988; 4: 299.PubMedGoogle Scholar
  20. 20.
    Tylaysky FA, Bortz AD, Hancock RL, Anderson JJB. Familial resemblance of radial bone mass between premenopausal mothers and their college-age daughters.Calcif Tissue Int1989; 45: 265.CrossRefGoogle Scholar
  21. 21.
    Welten, DC, Kemper HCG, Post GB, Van Mechelen W, Twisk J, Lips P, Teule GJ. Weight-bearing activity during youth is a more important factor for peak bone mass than calcium intake.JBone Miner Res1994; 9: 1089.CrossRefGoogle Scholar
  22. 22.
    Rosenthal DI, Mayo-Smith W, Hayes CW, Khurana JS, Biller BMK, Neer RM, Klibanski A. Age and bone mass in premenopausal women.J Bone Miner Res1989; 4: 533–538.PubMedCrossRefGoogle Scholar
  23. 23.
    Riggs BL, Wahner HW, Melton LJ Jr, Richelson LS, Judd AJ, O’Fallon WM. Dietary calcium intake and rates of bone loss in women.J Clin Invest1987; 80: 979.PubMedCrossRefGoogle Scholar
  24. 24.
    Lindsay R, Hart DM, Aitken JM, MacDonald EB, Anderson JB, Claeke AC. Long-term prevention of postmenopausal osteoporosis by oestrogen.Lancet1976; I: 1038–1041.CrossRefGoogle Scholar
  25. 25.
    Riffs B, Thomsen K, Christiansen C. Does calcium supplementation prevent postmenopausal bone loss?NEngl JMed1987; 316: 173.CrossRefGoogle Scholar
  26. 26.
    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.NEngl JMed1990; 323: 878–888.CrossRefGoogle Scholar
  27. 27.
    Ettinger B, Genant HK, Cann CE. Postmenopausal bone loss is prevented by low-dose estrogen with calcium.Ann Int Med1987; 106: 40.PubMedGoogle Scholar
  28. 28.
    Ooms ME, Lips L, Van Lingen A, Valkenburg HA. Determinants of bone mineral density and risk factors for osteoporosis in healthy elderly women.J Bone Miner Res1993; 8: 669–676.PubMedCrossRefGoogle Scholar
  29. 29.
    van Beresteijn ECH, Dekker PR, van der Heiden-Winkeldermaat Hi, van Schaik M, Visser RM, de Waard HE. The habitual calcium intake from milk products and its significance for bone health: A longitudinal study. In: Burckhardt P, Heaney RP, eds.Nutritional Aspects ofOsteoporosisNew York: Raven, 1991, pp. 206–212.Google Scholar
  30. 30.
    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 IntMed1994; 120: 97.Google Scholar
  31. 31.
    Prince RL, Smith M, Dick IM, Price RL, Webb PG, Henderson NK, Harris MM. A comparative study of exercise, calcium supplementation, and hormone-replacement therapy.N Engl JMed1991; 325: 1189.CrossRefGoogle Scholar
  32. 32.
    Cumming RG. Calcium intake and bone mass: a quantitative review of the evidence.Calcif Tissue Int1990; 47: 194.PubMedCrossRefGoogle Scholar
  33. 33.
    Reed JA, Anderson JJB, Tylaysky FA, Gallagher PN Jr. Comparative changes of radial bone density of elderly female lactoovovegetarians and omnivores.Am J Clin Nutr1994; 59(Suppl.): 1197s-1202s.PubMedGoogle Scholar
  34. 34.
    Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier RI Vitamin D3 and calcium to prevent hip fractures in elderly women.N Engl J Med1992; 327: 1637–1642.PubMedCrossRefGoogle Scholar
  35. 35.
    Heaney RP. The bone-remodeling transient: implications for the interpretation of clinical studies of bone mass change.J Bone Miner Res1994; 4: 1515–1523.Google Scholar
  36. 36.
    Heaney RP, Weaver CM, Recker RR. Calcium absorbility from spinach.Am J Clin Nutr1988; 47: 707–709.PubMedGoogle Scholar
  37. 37.
    Weaver CM, Martin BR, Heaney RP. Calcium absorption from foods. In: Burckhardt P, Heaney RP, eds.Nutritional Aspects of OsteoporosisSerono Symposium No. 85, New York: Raven, 1991, pp. 133–139.Google Scholar
  38. 38.
    Anderson JJB, Barrett CJH. Dietary phosphorus: the benefits and the problems.Nutr Today1994; 20(No. 2): 29–34.CrossRefGoogle Scholar
  39. 39.
    Barger-Lux MJ, Heaney RP, Packard PT, Lappe JM, Recker RR. Nutritional correlates of low calcium intake.Clin Appl Nutr1992; 2(4): 39.Google Scholar
  40. 40.
    Miller GD, Jarvis JK, McBean LD.Handbook of Dairy Foods and Nutrition.Boca Raton, FL: CRC, 1995.Google Scholar
  41. 41.
    Musgrave KO, Leclerc H, Rosen CJ, et al. Validation of quantitative food frequency questionnaire for calcium consumption.JAm Diet Assoc1989; 89: 1484–1488.Google Scholar
  42. 42.
    Hertzler AH. Assessment of calcium intakes of adults and the elderly. Department of Nutrition and Foods, and Virginia Cooperative Extension, Virginia Polytechnical Institute and State University, Blacksburg, VA, 1993 (mimeograph).Google Scholar
  43. 43.
    Anderson JJB, Metz JA. Contributions of dietary calcium and physical activity to primary prevention of osteoporosis in females.JAm Coll Nutr1993; 12: 378–385.Google Scholar
  44. 44.
    Anderson JJB. Dietary calcium and bone mass through the lifecycle.Nutr Today1990; 25(No. 2): 9.CrossRefGoogle Scholar
  45. 45.
    Calvo MS. Dietary phosphorus, calcium metabolism, and bone.JNutr1993; 123: 1627–1633.Google Scholar
  46. 46.
    Wyshak G, Frisch RE. Carbonated beverages, dietary calcium, the dietary calcium-phosphorus ratio and bone fractures in boys and girls.JAdolesc Health1994; 15: 210–215.CrossRefGoogle Scholar
  47. 47.
    Reiss E, Canterbury JM, Bercovitz MA, Kaplan EL. The role ofphosphate in the secretion of parathyroid hormone in man.J Clin Invest1970; 49: 2146–2149.PubMedCrossRefGoogle Scholar
  48. 48.
    Calvo MS, Kumar R, Heath H III. Elevated secretion and action of serum parathyroid hormone in young adults consuming high phosphorus, low calcium diets assembled from common foods.J Clin Endocrinol Metab1988; 66: 823–829.PubMedCrossRefGoogle Scholar
  49. 49.
    Calvo MS, Kumar R, Heath H III. Persistently elevated parathyroid hormone secretion and action in young women after four weeks of ingesting high phosphorus low calcium diets.JClin Endocrino! Metab1990; 70: 1334–1340.CrossRefGoogle Scholar
  50. 50.
    Portale AA, Halloran BP, Murphy MM, Morris CM Jr. Oral intake of phosphorus can determine the serum concentration of 1,25-dihydroxyvitamin D by determining its production rate in humans.J Clin Invest1986;77:7–12.PubMedCrossRefGoogle Scholar
  51. 51.
    Silverberg SJ, Shane E, Clemens TL, Dempster DW, Segre GV, Lindsay R, Bilezikian JP.J Bone Miner Res1986; 1: 383–388.PubMedCrossRefGoogle Scholar
  52. 52.
    Barger-Lux J, Heaney RP. Effects of calcium restriction on metabolic characteristics of premenopausal women.J Clin Endocrino! Metab1993; 76: 103.PubMedCrossRefGoogle Scholar
  53. 53.
    Kerstetter JE, Allen LH. Dietary protein increases urinary calcium.J Nutr1990; 120: 134–136.PubMedGoogle Scholar
  54. 54.
    Margen S, Chu J-Y, Kaufman NA, Calloway DH. Studies in calcium metabolism. I. The calciuretic effect of dietary protein.Am J Clin Nutr1974; 27: 540–549.Google Scholar
  55. 55.
    Hegsted MS, Schuette SA, Zeroed MB, Linkswiler HM. Urinary calcium and calcium balance in young men as affected by level of protein and phosphorus intake.JNutr1981; 111: 553–562.Google Scholar
  56. 56.
    Schuette SA, Linkswiler HM. Effects on Ca and P metabolism in humans by adding meat, meat plus milk, or purified proteins plus Ca and P to a low protein diet.JNutr1982; 112: 338.Google Scholar
  57. 57.
    Anderson JJB, Thomson K, Christiansen C. High protein meals, insular hormones and urinary calcium excretion in human subjects. In: Christiansen C, Johansen JS, Riis BJ, eds.Osteoporosis 1987.Copenhagen: Osteopress ApS, 1987, pp. 240–245.Google Scholar
  58. 58.
    Abelow BJ, Holford TR, Insogna KL. Cross-cultural association between dietary animal protein and hip fracture: a hypothesis.Calcif Tissue Int1992; 150: 14.CrossRefGoogle Scholar
  59. 59.
    Tylaysky FA, Anderson JJB. Dietary factors in bone health of elderly lactoovovegetarian and omnivorous women.Am J Clin Nutr1988; 48: 842–850.Google Scholar

Copyright information

© Springer Science+Business Media New York 1996

Authors and Affiliations

  • John J. B. Anderson

There are no affiliations available

Personalised recommendations