A specially constituted expert panel recently re-evaluated calcium intake based on new scientific date. This new report advised a change to adequate intake (A1) values rather than the more familiar Recommended Dietary Allowance (RDA). The A1 proposal was an attempt to move away from guidelines developed to prevent deficiency diseases and to move towards guidelines promoting overall health and prevention of chronic disease. The basis of the A1 guidelines was the level of intake in order to have adequate calcium retention in bone.
KEY POINTS ABOUT CALCIUM INTAKE :
- Supplementation may be necessary to achieve A1 guidelines.
- Calcium supplements should be taken with meals since increased gastric acid production with meals improves absorption.
- Absorption is more reliable, if calcium tablets are chewed.
- No more than 500 mg of elemental calcium should be taken at a time since excess calcium may not be absorbed sufficiently.
- Calcium should not be taken at the same time as iron supplements. Since the absorption of both calcium and iron may be adversely affected.
- There is no compelling evidence of the need to take magnesium or phosphate with calcium, or any other form of calcium other than carbonate or citrate.
- Certain preparations of calcium (e.g. bone, meal and dolomite) can have significant contamination with lead and other heavy metals. However, most commercial calcium preparations are tested to ensure they do not contain significant contamination.
- Some recent studies using calcium citrate have shown biochemical effects that suggest calcium may reduce some of the path-Physiological changes that age-related bone loss causes in elderly women.
- NEW CALCIUM REQUIREMENTS- 1997 ADEQUATE INTAKE (A)
|AGE||DAILY M. GRAM (MG) LEVEL|
Less than 18 years
Monitoring the patient’s response to therapy. While low bone mass is the best predictor of fracture risk, treatment decisions should be based on clinical evaluation, including risk factors, as well as BMD. Physical examination should include a measure of height in comparison to tallest remembered height. A loss of greater than 1.5 inches suggests silent compression fractures. Laboratory tests should include CBC, SMAC-20, ESR, and TSH. X-rays should be considered if the patient has back pain and/or height loss of greater than 1.5 inches.
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