Review article
Calcium and vitamin D

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Calcium

Human physiology is adapted to the high calcium diet that prevailed during primate and hominid evolution. This is evidenced in the fact that at primitive calcium intakes, net calcium absorption (defined as the difference between oral intake and fecal output) in adults averages only 10% to 11%, renal calcium conservation is weak, and dermal losses are unregulated. Thus, for a 25-mmol intake, net calcium absorption is only about 2.5 mmol, half of which is spilled into the urine during the very

Vitamin D

Vitamin D is an uncertain nutrient: It is not a normal constituent of most foods but is typically produced endogenously by a cutaneous photosynthetic reaction, in which solar UV radiation converts 7-dehydrocholesterol into pre-vitamin D3 (which then rapidly isomerizes in the skin to cholecalciferol [vitamin D3]). Nutrient or not, vitamin D is essential for optimal physiologic functioning. Cholecalciferol is stored bound to D-binding protein, is slowly converted to 25(OH)D3 in the liver, and is

Prevention

A very large body of studies, summarized in detail elsewhere [25], demonstrates that augmented calcium intakes increase bone acquisition during growth, slow age-related bone loss, and reduce fragility fractures in the elderly population. Moreover, there is general agreement that a high peak bone mass is strong protection against low bone mass and its associated fragility late in life [26]. During adolescent growth, almost 40% of adult bone mass is potentially accrued [27]. A number of

Therapeutic support

The development and deployment of potent bone-active agents for the treatment of osteoporosis raises a question about the mineral intake that is optimal for support of the ability of such agents to add bone to the skeleton. Such bony augmentation requires an absorbed calcium intake greater than the sum of urinary and skin losses, and it is likely that recommended maintenance intakes may not be fully adequate for this purpose. Although it is evident that calcium is consumed in bone building,

Calcium

The best source of calcium is food, principally dairy products or fortified foods that have established the bioavailability of their added calcium. The reason for the preference for food is that bone health is not a mononutrient issue. High intake of protein [46], [47], potassium [48], magnesium [48], and phosphorus [49] contribute to bone health directly or augment the effect of their calcium content. Dairy foods, particularly milk and yogurt, are the best and most economical way to get all of

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      Fig. 2 Association of serum 25(OH)D level and intestinal fractional calcium absorption [modified to improve the clarity; with permission, Heaney, R.P, 2008] [25]. Most recent reports have supported the minimum desirable serum 25(OH)D level, between 28 and 32 nmol/L (70–80 ng/mL) [28–31]. This is in contrast with the 2010 IOM report that suggested the adequacy of serum vitamin D levels of 20 ng/mL [32,33].

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