Dietary Calcium and Bone Density in Adolescent Girls and Young Women in Europe

Abstract

The objective of this study was to investigate the association between dietary calcium intake and radial bone density among young women, over the whole range of intake and at different levels of calcium intake. The study design was a cross-sectional, observational multicenter investigation in six European countries. One thousand one hundred and sixteen healthy Caucasian girls aged 11-15 years and 526 women aged 20-23 years participated, after having been selected from larger population samples to represent a large range in calcium intake. Bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry at the ultradistal and middistal radius. Calcium intake was assessed with 3-day food records. Other potential determinants of BMD were measured by anthropometry or questionnaires. Mean calcium intake among the girls varied between 609 mg/day in Italy and 1267 mg/day in Finland; intakes for women were in a similar range. After adjustment for height, weight, and age at menarche for the women, and adjustment for age, height, weight, Tanner stage, and bone area for the girls, radial BMD at both sites did not significantly vary among quartiles of calcium intakes for both age groups. In multivariate linear regression, calcium was weakly positively associated with BMD at both sites in the girls (per 100 mg of calcium: ␤ = 0.57 mg/cm 2 , p = 0.03 for middistal BMD and ␤ = 0.56 mg/cm 2 , p = 0.01 for ultradistal BMD). For middistal BMD, the association was observed predominantly in premenarcheal girls. The associations were no longer statistically significant after full adjustment for all determinants of BMD, except again in pre-menarcheal girls. Radial BMD in the women was not associated with calcium intake, except after full adjustment for determinants of BMD, when ultradistal BMD became inversely associated with calcium intake (per 100 mg ␤ = −1.02, p = 0.03); this finding was due to results in one of the countries and not found in other countries. There was no evidence for a different relation between calcium and BMD at different levels of intake; although there was a positive association at calcium intake levels <600 mg/day, the interaction was not significant and there was no consistent trend over intake categories. These results do not support the hypothesis that dietary calcium is a determinant of peak BMD in European women, for a wide range of intake. This study does not provide evidence that Recommended Dietary Allowances for calcium should be increased. (J Bone Miner Res 1999;14:583-592)

The Effect of Nutrient Intake on Bone Mineral Status in Young Adults: The Northern Ireland Young Hearts Project

“…Another interventional trial by Johnston et al [30] suggested that additional dietary Ca would only a ect BMD in prepubertal children. Similar ®ndings have recently been reported by Kardinaal et al [8]. Failure to ®nd consistent associations between calcium and bone may also be attributed to high mean Ca intakes within this cohort.…”

“…Yet, despite extensive research, the calcium-bone relationship remains controversial. Calcium intake has been cited by many authors as a major contributor to increased bone mineral measures [6,28], whereas others have reported no association [7,8]. In the current study, Ca intakes reported by the females at adolescence showed a significant positive association with BMD (femoral neck) measured at young adulthood.…”

“…Although dietary Ca and its e ects on bone has received most attention, results to date have been inconsistent, with some studies demonstrating a positive association between high Ca intake and BMD [2,6], and others reporting no association [7,8].…”

Invited review: Dairy intake and bone health: A viewpoint from the state of the art

“…Among European girls, the mean calcium intake varied between 600 mg/d in Italy and 1,250 mg/d in Finland (Kardinaal et al, 1999). The intake of calcium in adult women was in a similar range.…”

Intakes of Calcium and Other Nutrients Related to Bone Health in Japanese Female College Students: A Study Using the Duplicate Portion Sampling Method

“…Despite an adequate Ca intake of young adults estimated by the Institute of Medicine to be 1,000 mg/day, the 1994 Continuing Survey of Food Intake of Individuals (CSFII) data and the Third National Health and Nutrition Examination Survey (NHANES III) showed the Ca intakes of women in their 20s in the United States to be only 647 (Standing Committee on the Scientific Evaluation of Dietary Reference Intakes 1997) and 768 mg/day (Bialostosky et al 2002), respectively. Average Ca intakes of young women aged 20-23 years in six European countries ranged from 680 to 1,236 mg/day (Kardinaal et al 1999). In comparison with these data, the Ca intakes of our subjects were much less; approximately half of that of young female populations with low Ca intake in Western countries.…”