This Valentine’s Day Send Your Athlete “Forget-Me-Nots” Enriched with Calcium: The Forgotten Mineral Of Bone Health.
It has long been recognized that a significant portion of Americans fail to obtain sufficient calcium from their diet. Despite the well-known prevalence of Vitamin D deficiency, calcium deficiency appears to be equally problematic. As Cormick states, "In most low and middle-income countries, daily calcium intake falls well below recommendations; however, inadequate intakes are also observed in specific demographic groups such as adolescents in high-income countries." This data holds particular significance given the critical role of bone integrity formation during adolescence.
It's crucial to note that blood calcium levels alone do not provide a comprehensive indicator of bone mineralization. Individuals with osteoporosis may exhibit normal blood calcium levels, whereas DEXA (dual-energy X-ray absorptiometry) scans can accurately assess levels of bone mineralization. DEXA, a low-dose imaging study, provides valuable insights into bone health, often supplemented by trabecular bone scores (TBS), which further elucidate bone integrity. Could DEXA scans and TBS analysis prove beneficial in preventing stress fractures among athletes, similar to their use in seniors and individuals with malabsorption issues affecting bone health? Researchers are actively investigating this possibility. A recent study has been published demonstrating variations in bone scores based on the type of routine exercise or sport, suggesting that optimal bone density and quality may vary across different body regions depending on factors such as age, sex, and athletic pursuits. (I have reached out to the lead researcher of this study and will provide updates on the research's implications.)
Calcium Absorption:
Calcium absorption is not straightforward. While calcium citrate may offer better absorption compared to calcium carbonate, taking calcium carbonate with food can enhance absorption, as this form relies on stomach acidity. Elderly individuals with reduced stomach acidity and those taking antacids may benefit from alternative forms of calcium supplementation.
Optimal calcium absorption occurs at doses of less than 500 mg at a time, whether from food or supplements; doubling up on tablets may not be the solution. Achieving adequate dietary calcium intake without relying solely on dairy can be challenging. Become adept at reading food labels to assess your calcium intake, and consider supplementation if your dietary intake falls short.
According to the NIH Office of Dietary Supplements, the Recommended Dietary Allowance (RDA) for calcium for males and females aged 9-18 is 1,300 mg daily, while for ages 19-50, it is 1,000 mg/day. However, when determining daily calcium requirements, particularly concerning athletes and stress fracture risk, consult with your healthcare provider. Research indicates that female athletes who consume more than 1500 mg of calcium experience a significant reduction in stress fractures. Moreover, in Navy recruit volunteers, a daily intake of 2000 mg calcium and 800 IU of vitamin D substantially decreased the risk of stress fractures.
The overarching theme emphasizes that while normal ranges serve as a foundation, establishing ideal ranges tailored to individual needs based on factors such as athletic demands or gender is paramount. Work closely with your healthcare team to align your nutritional intake with your physiological requirements, and may your DEXA and TBS scores ever be in your favor.
- Dr. Goodbender
References
Cormick, Gabriela, Belizan, Jose M. Calcium intake, and health. Nutrients. 2019 Jul; (7): 1606.
Beat Knechtle, Zbigniew Jastrzebski, Lee Hill, Pantelis T Nikolaidis. Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures - A Narrative Review has lent some good insight into this subject. Medicina (Kaunas). 2021 Mar 1;57(3):223. Doi.
NIH office of dietary supplements. https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/
Heinio L, Nikander, R., Sievanen, H. Association between long-term exercise loading and lumbar spine trabecular bone score (TBS) in different exercise loading groups. J Musculoskelet Neuronal Interact. 2015 Sep; 15(3): 279-285.
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