The role of calcium in peri- and postmenopausal women: consensus opinion of The North American Menopause Society

Objective: The North American Menopause Society (NAMS) established a goal t o review the published medical data and develop an evidence-based consensus opinion regarding the role of calcium in peri- and postmenopausal women. Design: In building this consensus opinion, NAMS followed the general princ iples established for evidence-based guidelines. As part of that process, N AMS appointed a panel of clinicians and researchers acknowledged to be expe rts in the field of calcium. Their advice was used to assist the NAMS Board of Trustees in developing this consensus opinion. Results: Adequate calcium intake (in the presence of adequate vitamin D int ake) has been shown to prevent bone loss and reduce fracture risk in peri- and postmenopausal women. Although calcium is not as effective as antiresor ptive agents (e.g., estrogen, selective estrogen-receptor modulators, or bi sphosphonates), it is an essential component of antiresorptive agent therap y for osteoporosis. Calcium has also been associated with beneficial effect s in several nonskeletal disorders, primarily hypertension, colorectal canc er, obesity, and nephrolithiasis, although the extent of those effects and mechanisms involved have not been fully explored. Estimates of adequate int akes of calcium for peri- and postmenopausal women are based on evidence re lating to osteoporosis prevention. At least 1,200 mg/day of calcium is requ ired for most women; levels greater than 2,500 mg/day are not recommended. To ensure adequate calcium absorption, a daily intake of 400-600 IU of vita min D is recommended, either through sun exposure or through diet or supple mentation. Since no accurate test to determine calcium deficiency exists, c linicians should focus instead on ensuring that a woman consumes enough cal cium to meet the recommended levels. Conclusion: Although the most definitive role for calcium in peri- and post menopausal women is in bone health, it is clear that adequate calcium intak e has implications that encompass a woman's overall health. Based on the av ailable evidence, a strong statement can be made regarding the importance o f ensuring adequate calcium intake in all women, particularly those in peri - or postmenopause.