Summary
Primary prevention of osteoporosis involves achieving the full genetic potential for bone mass. Secondary prevention is concerned with protecting what bone mass a woman may have at her current age. Calcium plays an important role in both. Calcium requirement varies with stage of growth, with physiological drains (e.g., pregnancy and lactation), and with factors that influence absorption and excretory loss (e.g., gonadal hormone status and sodium and protein intakes). The evidence is strong that prevailing calcium intakes contribute to the low bone mass component of osteoporotic fragility and that increases in intake would reduce the osteoporotic fracture burden. At the same time it needs to be emphasized that bone health is a multifactorial affair and that meeting calcium requirements alone will neither guarantee optimal bone growth nor protect against bone loss if other critical factors are missing. For example, calcium affords only minimal protection against either immobilization or estrogen withdrawal bone loss. Thus, while assuring an adequate calcium intake remains a sound strategy, it cannot be considered a total preventive for osteoporosis.
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References
Heaney RP (1989) Osteoporotic fracture space: A hypothesis. Bone Miner 6:1–13
Lindsay R (1988) Sex steroids in the pathogenesis and prevention of osteoporosis. In: Riggs BL, Melton LJ III (eds) Osteoporosis: etiology, diagnosis, and management. Raven Press, New York, NY, pp 333–358
Kiel DP, Felson DT, Anderson JJ, Wilson PWF, Moskowitz MA (1987) Hip fracture and the use of estrogens in postmenopausal women. N Engl J Med 317:1169–1174
Weiss NS, Ure CI, Ballard JH, Williams AR, Daling JR (1980) Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen. N Engl J Med 303:1195–1198
Kreiger N, Kelsey JL, Holford TR, O'Connor T (1982) An epidemiologic study of hip fracture in postmenopausal women. AM J Epidemiol 116:141–148
Johnson RE, Specht EE (1981) The risk of hip fracture in postmenopausal females with and without estrogen drug exposure. Am J Public Health 71:138–144
Matkovic V, Kostial K, Simonovic I, Buzina R, Brodarec A, Nordin BEC (1970) Bone status and fracture rates in two regions in Yugoslavia. Am J Clin Nutr 32:540–549
Holbrook TL, Barrett-Connor E, Wingard DL (1988) Dietary calcium and risk of hip fracture: 14-year prospective population study. Lancet ii:1046–1049
Lau E, Donnan S, Barker DJP, Cooper C (1988) Physical activity and calcium intake in fracture of the proximal femur in Hong Kong, Br Med J 297:1441–1443
Cooper C, Barker DJP, Wickham C (1988) Physical activity, muscle strength and calcium intake in fracture of the proximal femur in Britain. Br Med J 297:1443–1446
LaCroix AZ, Wienpahl J, White LR, Wallace RB, Scherr PA, George LK, Cornoni-Huntley, J, Ostfield AM (1990) Thiazide diuretic agents and the incidence of hip fracture. N Engl J Med 322:286–290
Wasnich RD, Bonfante RJ, Yano K, Heilbrun L, Vogel JM (1983) Thiazide effect on the mineral content of bone. N Engl J Med 309:344–347
Kanis JA, Passmore M (1989) Calcium supplementation of the diet, I and II. Br Med J 298:137–140, 205–208
Cumming RG (1990) Calcium intake and bone mass: a quantitative review of the evidence. Calcif Tissue Int 47:194–201
Avioli LV, Heaney RP (1991) Calcium intake and bone health (editorial) Calcif Tissue Int 48:221–223
Heaney RP (1986) En recherche de la difference (P<0.05). Bone Miner 1:99–114
Leitch I, Aitken FC (1959) The estimation of calcium requirement: a re-examination. Nutr Abst Rev 29:393–407
Miller JZ, Smith DL, Flora L, Slemenda C, Jiang X, Johnston CC Jr (1988) Calcium absorption from calcium carbonate and a new form of calcium (CCM) in healthy male and female adolescents. Am J Clin Nutr 48:1291–1294
Miller JZ, Smith DL, Flora L, Peacock M, Johnston CC Jr (1989) Calcium absorption in children estimated from single and double stable calcium isotope techniques. Clin Chim Acta 183:107–113
Matkovic V, Fontana D, Tominac C, Goel P, Chesnut CC III (1990) Factors which influence peak bone mass formation: a study of calcium balance and the inheritance of bone mass in adolescent females. N Engl J Med (in press)
Davies KM, Recker RR, Stegman, MR, Heaney RP, Kimmel DB, Leist J (1989). Third decade bone gain in women. J Bone Min Res 4:S327
Garn SM (1970) The earlier gain and the later loss of cortical bone. Charles C Thomas, Springfield, IL
Baran D, Sorensen A, Grimes J, Lew R, Karellas A, Johnson B, Roche J (1989) Dietary modification with dairy products for preventing vertebral bone loss in premenopausal women: a three-year prospective study. J Clin Endocrinol Metab 70:264–270
Nordin BEC, Need AG, Chatterton BE Horowitz M, Morris HA (1990) The relative contributions of age and years since menopause to postmenopausal bone loss. J Clin Endocrinol Metab 70:83–88
Riis B, Thomsen K, Christiansen C (1987) Does calcium supplementation prevent postmenopausal bone loss? N Engl J Med 316:173–177
Ettinger B, Genant HK, Cann CE (1987) Postmenopausal bone loss is prevented by treatment with low-dosage estrogen with calcium. Ann Intern Med 106:40–45
Heaney RP, Recker RR, Stegman MR, Moy AJ (1989) Calcium absorption in women: relationships to calcium intake, estrogen status, and age. J Bone Min Res 4:469–475
Heaney RP, Recker RR, Saville PD (1978) Menopausal changes in calcium balance performance. J Lab Clin Med 92:953–963
Heaney RP (1989) The calcium controversy: a middle ground between the extremes. Public Health Rep S104:36–46
National Institutes of Health Osteoporosis Consensus Development Conference Statement (1984) JAMA 252:799–802
Riggs BL, Hodgson SF, O'Fallon WM Chao EYS, Wahner HW, Muhs JM, Cedel SL, Melton LJ (1990) Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. N Engl J Med 322:802–809
Ott SM, Chesnut CH (1989) Calcitriol treatment is not effective in postmenopausal osteoporosis. Ann Intern Med 110:267–274
Eaton SB, Konner M (1985) Paleolithic nutrition. A consideration of its nature and current implications. N Engl J Med 312:283–289
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Heaney, R.P. Lifelong calcium intake and prevention of bone fragility in the aged. Calcif Tissue Int 49 (Suppl 1), S42–S45 (1991). https://doi.org/10.1007/BF02555087
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DOI: https://doi.org/10.1007/BF02555087