NAMS Board of Trustees. The role of calcium in peri-and postmenopausal women: 2006 position statement of The North American Menopause Society. Menopause: The J of The N American Menopause Society 2006;12(6): 862-877
The last evidence based consensus opinion of the North American Menopause Society (NAMS) was published in 2001. An expert panel of clinicians and researches in the field of calcium and women’s health followed evidence-based guidelines to make recommendations to the NAMS Board of Trustees.
Areas in the document that were addressed were calcium intake, menopausal status and calcium, target intake, calcium sources, calcium benefits, and calcium levels. Here are selected highlights from that document:
Calcium intake
Adequate calcium intake, in the presence of adequate vitamin D, has been shown to reduce bone loss in peri- and postmenopausal women as well as reducing fractures in postmenopausal women older than 60 who have low calcium intakes. Calcium also enhances the anti-resorptive effects of hormone therapy (HT) in postmenopausal women. Adequate calcium is an important aspect of any treatment regimen for women with osteoporosis.
Menopause status and calcium
Whatever age menopause occurs, the requirement for calcium increases. Calcium absorption and renal calcium conservation are both estrogen dependent and both decline in hypo-estrogen states.
Calcium amounts and sources
The target for calcium intake for most postmenopausal women is 1,200 mg/ day. Adequate vitamin D status is currently defined as a serum level of 30 ng/mL or more of 25-hydroxyvitamin D. It is recommended that foods be the primary source of calcium.
Dairy products are among the better sources of calcium due to the amount of calcium contained in a serving, ease of absorption, other nutrients in the dairy products and the affordable cost. One serving of a dairy product contains between 300 mg to 400 mg per serving, depending on the product. Calcium supplements and calcium fortified foods are available in order to reach the daily target amount. Calcium is best to take with meals and not more than 500 mg at a time to achieve maximal absorption. Calcium bioavailability varies from product to product and consumers are encouraged to confirm consistent bioavailability of a product.
Recommended daily elemental calcium intake for peri-and postmenopausal women:
Institute of Medicine
Aged 31-50 [1,000 mg]
Aged 51 and older [1,200 mg]
National Institutes of Health
Premenopausal women aged 25-50 [1,000 mg]
Postmenopausal women younger than age 65 and using estrogen therapy 1,000 mg
Postmenopausal women not using estrogen therapy [1,500 mg]
All women aged 65 and older [1,500 mg]
Osteoporosis Society of Canada
Menopausal women [1,500 mg]
Calcium benefits
Calcium is beneficial in protection of bone mass and slowing of bone loss, small risk reduction of colorectal cancer, hypertension, renal calculi, PMS and obesity.
Calcium levels
No accurately sensitive tests are available to assess calcium deficiency. The focus should be on the recommended guidelines and to encourage women to consume adequate calcium and/or take calcium supplements. The laboratory test for serum vitamin D is available to diagnose those women who are vitamin D deficient and thus more likely to be deficient in calcium.
The average daily dietary consumption of calcium is far below the recommended amount to achieve optimal bone health. Health care providers are encouraged to be more vigilant in advising peri- and postmenopausal women regarding calcium intake.
