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Title: Dietary calcium and serum 25-hydroxyvitamin D status in relation to bone mineral density among US adults

Author
item BISCHOFF-FERRARI, HEIKE - Harvard School Of Public Health
item KIEL, DOUGLAS - Harvard Medical School
item DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item ORAV, JOHN - Harvard School Of Public Health
item LI, RUIFENG - Harvard School Of Public Health
item SPIEGELMAN, DONNA - Harvard School Of Public Health
item DIETRICH, THOMAS - Boston University
item WILLETT, WALTER - Harvard School Of Public Health

Submitted to: Journal of Bone and Mineral Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/30/2008
Publication Date: 5/1/2009
Citation: Bischoff-Ferrari, H.A., Kiel, D.P., Dawson-Hughes, B., Orav, J.E., Li, R., Spiegelman, D., Dietrich, T., Willett, W.C. 2009. Dietary calcium and serum 25-hydroxyvitamin D status in relation to bone mineral density among US adults. Journal of Bone and Mineral Research. 24:935-942.

Interpretive Summary: Both calcium and vitamin D are important for the preservation of bone mass in adults. This study was done to determine whether the benefit of higher calcium intake to bone is dependent upon vitamin D status. The subjects in this study were 10,000 men and women age 20 and older who participated in the National Nutrition and Health Examination Survey. The subjects were classified according their blood levels of 25-hydroxyvitamin D and their self-reported calcium intake. We found that for the women, a higher calcium intake was associated with higher bone mineral density at vitamin D levels below 50 nmol/L but not at higher levels of vitamin D. Among men, no association of calcium intake with bone density was present (at any vitamin D level). In both women and men, higher levels of 25-hydroxyvitamin D were associated with higher levels of bone mineral density. In conclusion, vitamin D appears to be a stronger determinant of bone mineral density than calcium intake.

Technical Abstract: A higher calcium intake is still the primary recommendation for the prevention of osteoporosis, while vitamin D deficiency is often not addressed. To study the relative importance of dietary calcium intake and serum 25-hydroxyvitamin D (25(OH)D) status in regard to hip bone mineral density (BMD) in 4958 community-dwelling women and 5003 men age 20 years + from the US NHANES III population-based survey. Calcium supplement users and individuals with a prior radius or hip fracture were excluded. We calculated standardized means for BMD by quartiles of gender-specific calcium intake for three 25(OH)D categories (< 50, 50-74, 75+ nmol/l) among men and women separately controlling for other important predictors of BMD. Only for women with 25(OH)D status below 50 nmol/l , a higher calcium intake was significantly associated with higher BMD (p-value for trend: p = 0.005), whereas calcium intake beyond the upper end of the lowest quartile ( > 566 mg/d) was not significantly associated with BMD at 25(OH)D concentrations above 50 nmol/l. Among men, there was no significant association between a higher calcium intake beyond the upper end of the lowest quartile (626 mg/d) and BMD within all 25(OH)D categories. Among both genders, BMD increased stepwise and significantly with higher 25(OH)D concentrations(< 50, 50-74, 75+ nmol/l; p-value for trend: women <0.0001; men = 0.0001). Among men and women, 25(OH)D status appears to be the dominant predictor of BMD relative to calcium intake. Only women with 25(OH)D concentrations below 50 nmol/l appear to benefit from a higher calcium intake.