NAMS issues new position statement on calcium

Osteoporosis occurs most commonly in postmenopausal women, and the incidence increases with age. This concern has prompted the North American Menopause Society (NAMS) to issue a new evidence-based position statement on the role of calcium in peri- and postmenopausal women.

NAMS' executive director Wulf H. Utian, M.D., said, "Adequate calcium intake, typically 1,200 mg per day in the presence of adequate vitamin D status, has been shown to reduce bone loss in peri- and postmenopausal women and to reduce fractures in postmenopausal women older than age 60 with low calcium intakes."

According to the position statement, adequate calcium is considered a key component of any bone-protective therapeutic regimen. The statement goes on to say that calcium has also been associated with beneficial effects in several nonskeletal disorders, primarily hypertension, colorectal cancer, obesity, and nephrolithiasis.

Robert Heaney, M.D., John A. Creighton University professor, Creighton University, Omaha, who served on NAMS' editorial board, told Drug Topics, "The average American consumes far less calcium than is appropriate. Calcium is important, and pharmacists need to recognize that and encourage people to increase their consumption of calcium." Emphasizing that food is the best source of calcium, he said, "If you don't get calcium from food, you should get it from supplements." He also recommended that patients buy brand-name calcium supplements.

Heaney advised that adults consume 1,200 mg to 1,500 mg of calcium per day. "There is no harm if you go above that amount within limits, but the important thing is to get a fixed amount of calcium from some source," he said. Calcium has beneficial effects on multiple body systems, he said, and although "the effects tend to be small, they add up."

Heaney pointed to a study of the Dietary Approaches to Stop Hypertension (DASH) diet, funded by the National Heart, Lung & Blood Institute. "The study showed that if individuals are on a diet that is high in fruits and vegetables and three servings of low-fat dairy products a day, their blood pressure could be lowered as much as if they were on standard pharmacotherapy," he said.

Emphasizing that there are many factors that cause hypertension, Heaney cautioned, "Calcium is not a magic bullet, and we don't want to oversell calcium. All of the effects are going to be small, but they add up. If you have fewer cases of hypertension, stroke, and morbid obesity, you are much better off," he said.

Michelle Warren, M.D., medical director, Center for Menopause, Hormone Disorders, and Women's Health, reviewed the position statement for NAMS. She said that there is evidence calcium reduces certain kinds of cancer, particularly rectal cancer. "Calcium is very important, because as you get older, you don't absorb quite as much," she said, adding that as people age, they also become vitamin D-insufficient or deficient. "Vitamin D is extremely important, and it controls how much calcium you absorb. It's more important than we ever realized, and calcium is important as well. For older people, it becomes more important."

Finally, NAMS' statement calls for using a multidisciplinary approach that includes many health professionals to help educate and reinforce bone-health messages. They can serve as a valuable, cost-effective means to improving calcium intake and to providing education about nutrition strategies for optimizing bone health.

A copy of NAMS' position statement can be viewed at http://www.menopause.org/aboutmeno/consensus.htm.