recognition. As recent as 30 years ago it was thought
weak and broken bones was an unavoidable conse-
quence of growing old.
In 1984 a Consensus Development Conference on
Osteoporosis, held by the National Institute of Health
(NIH) in the US, highlighted the need for more infor-
mation on the prevention and treatment of osteopo-
rosis. This led to the establishment of the National
Osteoporosis Foundation (NOF) US in 1985, fol-
lowed the United Kingdom (UK) National Osteopo-
rosis Society (NOS) in 1986 both of which are now
members of the much larger IOF, based in France,
formed in 1998. In 2004, the first US Surgeon Gener-
al’s Report on Bone Health & Osteoporosis listed
vitamin D, calcium and exercise, as the three essential
elements for optimal bone health. The importance of
diet was further highlighted in 2006, by a report from
the IOF ‘‘Bone Appetit:the role of food and nutrition
in building and maintaining strong bones’’, which
shared its title with the theme of World Osteoporosis
Day.Calcium and osteoporosis
Research on recommended calcium intakes has
focussed on either meeting requirements or on opti-
mising bone density. Also calcium requirements for
adults vary between geographic regions and cultures
because of differing dietary, genetic and lifestyle fac-
tors, including physical activity and sun exposure. As
such Calcium requirements vary from country to
country.In 1997, the American calcium guidelines were set
significantly higher, than the previous recommenda-
tions set in 1989, following a 1994 National Institute
of Health (NIH) conference on calcium intake. They
recommended that calcium intakes in young people be
increased to maximize peak bone mass and protect
against osteoporosis. Calcium levels increased from
1,200 to 1,300 milligrams (mg) per day for adolescents
and teens. Adults had an increase of 200mg to 1,000mg
daily, while adults after 50 years were increased to 1,200
mg daily, 400 mg more than previously recommended.
In 2005, the United States Department of Agri-
culture (USDA) Dietary Guidelines for Americans
increased the dairy serving for the first time from 2–3
a day to three a day (1 serving is approximately equal
to 300 mg of calcium) since they were first published in- This was to meet the higher recommended cal-
cium intakes.
In contrast some other developed countries have
lower recommended levels for example in the UK the
1998 recommended daily intakes are 550mg for chil-
dren age 7 to 10, 800mg–1,000mg for age 15 to 18
ranges and 700–800mg for adults aged 19 to 50. The
NOS also recommends 1200mg for those with osteo-
porosis. The UK Cambridge Bone Study, still on
going in 2007, is determining whether young people
aged 16 to 18 should increase calcium intakes to 1000
mg a day. In France for age 15 to 18, 1,200mg is
recommended and in Nordic countries for boys the
range is from 900mg.
Despite the higher recommendations surveys indi-
cate that actual calcium intakes are often inadequate.
According to the US National Health and Nutrition
Examination Survey III (NHANES 1988–1994) all
age groups, with the exception of young children,
have an intake lower than the recommended level.
The UK 2000 National Diet and Nutrition Survey
(NDNS) of British young people aged 4 to 18, indi-
cated only one in four girls is eating at least three
portions of dairy products daily.
As a result of multiple factors influencing calcium
requirements, in 2007 there is no single internationally
accepted recommended calcium intake. In countries
where osteoporosis is common, such as Western Euro-
pean, America and Canada and Japan, calcium
intakes are based on the 2002 Food and Agriculture
Organisation (FAO) and World Health Organization
(WHO) recommendations.
Vitamin D and osteoporosis
Vitamin D is important for the development and
maintenance of bone. It helps the body absorb calciumCalciumU.S. Recommended FAO and WHO
Dietary Allowance recommendations
Age (mg/day) (mg/day)
Children 1–3 yrs. 500 500
Children 4–6 yrs. 600
Children 4–8 yrs. 800
Children 7–9 yrs. 700
Children 9–13 yrs. 900
Children 10–18 yrs. 1,300
Adolescents 14–18 yrs. 1,300
Adults 19–50 yrs. 1,000
Adults 19–65 yrs. 1,000
Adults 50 yrs. 1,200
Adults 65 yrs. 1,300
Post-menopause women 1,300
FAO Food and Agriculture Organization
WHO World Health Organization
mg milligram(Illustration by GGS Information Services/Thomson Gale.)Osteoporosis diet