In the March/April Issue of Menopause, The North American Menopause Society (NAMS) published “The Role of Calcium in Peri- and Postmenopausal Women: Consensus Opinion of The North American Menopause Society,” which found adequate calcium intake is important for all women, particularly those who are peri- and postmenopausal. Citing calcium’s definitive role as a promoter of good bone health, NAMS also credited the mineral for being beneficial in many other ways. According to the consensus, “It is clear that adequate calcium intake has implications that encompass a woman’s overall health.”

NAMS, which is North America’s leading nonprofit organization dedicated to promoting the health of women as they approach menopause and beyond, decided to create their consensus opinion on calcium, due to the substantial interest in both the medical and lay press regarding its role in osteoporosis and several other chronic diseases, including hypertension and colon cancer.

The organization established a goal to review the published medical data and develop an evidence-based consensus opinion to address issues related to the role of calcium in peri- (the time immediately preceding menopause when symptoms begin, plus one year after menopause) and postmenopausal woman. NAMS followed the general principles established for evidence-based guidelines, as well as appointed a panel of recognized calcium experts who assisted the NAMS Board of Trustees in developing the final consensus opinion.

Among their key findings, adequate calcium intake (in the presence of adequate vitamin D intake) has been shown to:

• Contribute an important aspect to the comprehensive skeletal health program for peri-and postmenopausal women. Both calcium and vitamin D were found to be essential components of osteoporosis therapy together with all antiresorptive agents (e.g., estrogen replacement therapy, hormone replacement therapy, selective estrogen-receptor modulator, or bisphosphonates).

• Provide some chemoprotective properties against colorectal cancer. A recent review of epidemiological studies concluded that high calcium intake appeared to decrease proliferation of colorectal epithelial cells and lower the risks for colorectal adenoma.

• Offer a beneficial effect on hypertension. Analyses of pooled data from calcium intervention trials in hypertensive women have concluded that supplemental calcium intake significantly lowers blood pressure.

The consensus opinion found that most experts support the published recommendations for daily calcium consumption from either the National Institutes of Health (NIH) or the National Academy of Sciences (NAS). The NIH recommends 1,000 mg/day for women aged 31-50 and 1,200 mg/day for women 51 and older. The NAS recommends 1,000 mg/day for premenopausal women aged 25-50 and postmenopausal women younger than age 65 using estrogen replacement therapy (ERT); 1,500 mg/day for postmenopausal women not using ERT and all women older than age 65.

According to the consensus opinion, there are three categories of calcium sources: foods, calcium-fortified foods and supplements. Dairy products, such as milk, cheese and yogurt provide approximately 70 percent of the total calcium intake of postmenopausal women. Good non-dairy food sources of calcium include almonds, dried beans, canned sardines and salmon. Easily available calcium-fortified foods include fruit juices, cereals, bread and nutrition bars.

Among the calcium supplements, calcium carbonate was confirmed to contain the highest percentage of elemental calcium (40 percent), which is the total calcium dose in a supplement. Calcium carbonate products were found to be less expensive than other types of calcium supplements, and the most widely-used.

The NAMS Consensus Opinion concludes that while much is known about the role of calcium in peri- and postmenopausal women, additional research is needed to further the understanding of the nutrient. The organization recommends studies be conducted in the following areas to:

• Determine the optimal calcium intake during various stages of peri- and postmenopause.

• Determine the optimal calcium requirements in different ethnic populations and the appropriate functional indicator for each.

• Measure the long-term effects of calcium intake on bone remodeling.

• Examine the dose-response relationships between varying calcium intakes combined with antiresorptive agents regarding efficacy on bone loss and/or fractures.

• Evaluate the long-term effects of increased calcium intake on the incidence of colorectal cancer.

• Further define the role of calcium in the prevention of obesity and hypertension.

The development of “The Role of Calcium in Peri- and Postmenopausal Women: Consensus Opinion of The North American Menopause Society” was supported by an unrestricted educational grant from GlaxoSmithKline, makers of TUMS Calcium for Life supplements.