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Calcium essential for bone health but excessive intake may be harmful

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Calcium helps to build strong bones, and insufficient calcium intake is thought to increase the risk of fracture, according to a new clinical guide from the European Menopause and Andropause Society (EMAS), published in the journal Maturitas.

But the guide also warns that a very high intake of calcium seems to provide no benefit and may even be harmful.

Antonio Cano of the University of Valencia, and other experts from around the world, noted that the recommended daily intake after menopause varies between 700 mg and 1,200 mg, depending on the endorsing society. Although calcium can be derived from either diet or supplements, the former source is preferred.

Good natural sources of calcium include green, leafy vegetables (but not spinach), nuts, seeds, dried fruit, tofu, tinned fish with the bones in, and dairy products like milk, yoghurt and cheese.

Intake below the recommended amount may increase the risk of fragility fracture, the experts wrote. However, there is no consistent evidence that calcium supplementation at, or above, recommended levels reduces this risk.

In fact, excessive intake of calcium, defined as higher than 2000 mg/day, can be potentially harmful. Some studies have raised concern about possible cardiovascular risk, dementia or even, paradoxically, fracture.

Most people should be able to get enough calcium through healthy eating, but this is not always the case, EMAS noted. For instance, diets in Southern Europe tend to have less dairy products than those in Northern European countries.

Data from the National Health and Nutrition Examination Survey (NHANES) database in the United States showed that less than one third of girls and women aged 9 to 71 consumed enough calcium. Supplements are poorly tolerated and therefore not usually taken long term.

Another reason for concern is the rates of over-prescription of supplements above the recommended upper level of 2,000 mg/day, with one study finding that 29% of supplements were over-prescribed.

Calcium is an essential part of the diet from childhood to old age, and an approximate assessment of intake should be part of routine health checks, EMAS said. Women, in particular, need to be more calcium-aware and mindful of calcium-rich foods.

“But more is not better, and women should be warned that intakes above the recommended levels may be useless or, although still debated, may cause harm,” the society stressed.

According to the National Osteoporosis Society, an estimated 3 million people in the UK have osteoporosis and around one in two women and one in five men over the age of 50 will break a bone as a result of the condition.