In many countries, bone health may be at risk due to low calcium intake

IOF map of global dietary calcium intake
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An International Osteoporosis Foundation online map reveals low levels of dietary calcium intake in many countries and regions. This is a concern for public health, as it could lead to poor bone health.

The online IOF Global Map of Dietary Calcium Intake in Adults, launched by the International Osteoporosis Foundation (IOF) in 2018, reveals that many populations are not getting enough calcium in their diets. The objective of this novel educational resource is to draw attention to the problem of inadequate calcium intake, and to mobilize health care authorities worldwide to develop appropriate strategies to address the issue in regions where intake is critically low.

The Map reflects the findings of a 2017 IOF study*, which found:

  • There is wide global variation, with some regions having a remarkably low calcium intake compared to others. Across the 74 countries included in the Map, the average dietary calcium intake among adults varies from a low of 175 mg/day in Nepal to a high of 1233 mg/day in Iceland.
  • Countries in Asia, Africa and South America mostly have low calcium intakes, ranging between about 400 and 700 mg/day.
  • In China and India, the world’s most populous countries, the average intake is shown to be only 338 mg/day and 429 mg/day respectively.
  • Countries with average calcium intake greater than 1000 mg/day are all in Northern Europe.
  • Large variation within regions, such as in Latin America, was also found. For example, Colombia has an average intake of only 297 mg/day, in contrast to 805 mg/day in Mexico.

Why is sufficient dietary calcium intake of importance to public health?

Calcium is a major component of bone, accounting for between 30-35% of its mass and much of its strength. Low calcium intake has been linked to lower bone-mineral density, which increases the risk of osteoporosis and fractures.

The amount of calcium needed varies at different stages of life. Calcium requirements are especially high in teenagers due to the rapid growth of the skeleton, and in seniors, whose ability to absorb calcium declines. In older adults, bone loss occurs at a rate of about 1% per year, resulting in calcium loss of approximately 15 g per year.

While calcium recommendations vary in different countries, 800-1000 mg/day is generally advised for healthy adults, with higher amounts recommended for teenagers, postmenopausal women, the elderly, and people with osteoporosis.

Foods rich in calcium include all dairy foods (milk, yoghurt, cheeses), certain vegetables (e.g. broccoli or kale); whole canned fish with soft edible bones such as sardines; some nuts; calcium-set soy products (tofu, soy milk); and some mineral waters.

Increasing calcium intake throughout the lifespan is an important strategy to improve bone health and IOF encourages people of all ages to meet their calcium intake requirements by consuming a variety of calcium-rich foods. For people who may not be able to get enough calcium through their diets, calcium supplementation may be needed to reach the intake requirement of 800 to 1,000 mg/day. This is particularly important for older adults who do not consume enough calcium-rich foods. In this population group, calcium supplementation combined with vitamin D, may lower the risk of broken bones.

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1. IOF Global Map of Dietary Calcium Intake, and related resources, available at https://www.iofbonehealth.org/facts-and-statistics/calcium-map
 * Balk, E.M., Adam, G.P., Langberg, V.N. et al. Global dietary calcium intake among adults: a systematic review. Osteoporos Int (2017). 28(12), 3315-24 
https://doi.org/10.1007/s00198-017-4230-x

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