Optimal Calcium Intake
National Institutes of Health
Consensus Development Conference Statement
June 6-8, 1994

Calcium and Health: Part 1   Calcium and Health: Part 2
Calcium and Health: Part 3   Calcium and Health: Part 4
Calcium and Health: Part 5
 
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Part 2
Introduction
It has been a decade since the 1984 Consensus Development Conference on Osteoporosis first suggested that increased intake of calcium might help prevent osteoporosis. Osteoporosis affects more than 25 million people in the United States and is the major underlying cause of bone fractures in postmenopausal women and the elderly.
 
Previous surveys have revealed that the U.S. population experiences more than 1.5 million fractures annually at a cost in excess of $10 billion per year to the health care system. Two important factors that influence the occurrence of osteoporosis are optimal peak bone mass attained in the first two to three decades of life and the rate at which bone is lost in later years. Adequate calcium intake is critical to achieving optimal peak bone mass and modifies the rate of bone loss associated with aging.
 
A number of publications have addressed the possible role of calcium intake in the prevention of disorders other than osteoporosis, including other bone diseases, oral bone loss, hypertension, and preeclampsia, a hypertensive disorder of pregnancy. The results of recent research investigating these issues indicate that the optimal amount of calcium intake may be greater than the amount consumed by most Americans. At the same time, the general public and scientists have been exposed to a body of information emphasizing the value of ensuring adequate calcium intake throughout life.
 
Calcium is an essential nutrient. Optimal calcium intake may vary according to a person's age, sex, and ethnicity. Other factors play a role in calcium intake, including vitamin D, which is needed for adequate calcium absorption. Many factors can negatively influence calcium availability, such as certain medications or food components. Optimal calcium intake may be achieved through diet, calcium-fortified foods, calcium supplements, or various combinations of these.
 
In view of the great public interest in nutrition and disease prevention, the scientific community has an obligation to integrate new data and to provide health care practitioners and the public with guidance, even though all of the necessary long-term studies may not have been completed. In some cases, the new data, however exciting, point to the need for further research rather than to specific recommendations. Future investigations in this rapidly expanding area of research will lead undoubtedly to more definitive information, which will provide the basis for new recommendations.
 
To address issues related to optimal calcium intake, the National Institute of Arthritis and Musculoskeletal and Skin Diseases together with the Office of Medical Applications of Research of the National Institutes of Health, convened a Consensus Development Conference on Optimal Calcium Intake on June 6-8, 1994. The conference was cosponsored by the Office of Research on Women's Health, Office of the Director; the National Institute on Aging; the National Cancer Institute; the National Institute of Child Health and Human Development; the National Institute of Diabetes and Digestive and Kidney Diseases; the National Heart, Lung, and Blood Institute; and the National Institute of Dental Research, all of the National Institutes of Health. Conference participants included experts from many different fields, including osteoporosis and bone and dental health, nursing, dietetics, epidemiology, endocrinology, gastroenterology, nephrology, rheumatology, oncology, hypertension, nutrition and public education, and biostatistics, as well as representatives from the public.
 
After 1-1/2 days of presentations by experts in the relevant fields and audience discussion, an independent, non-Federal consensus panel weighed the scientific evidence and formulated a consensus statement in response to the following six questions: What is the optimal amount of calcium intake? What are the important cofactors for achieving optimal calcium intake? What are the risks associated with increased levels of calcium intake? What are the best ways to attain optimal calcium intake? What public health strategies are available and needed to implement optimal calcium intake recommendations? What are the recommendations for future research on calcium intake?
 
The consensus panel prepared a draft report summarizing the evidence pertinent to the key issues regarding optimal calcium intake: