title: Calcium intake, bone mineral density, and fragility fractures: evidence from an Italian outpatient population.
abstract: This study was performed in 1000 adult Italian subjects to focus on the effects of dietary calcium intake on bone health. A higher fracture risk appears to be associated with a reduced calcium intake. An adequate daily calcium intake is recommended to counteract osteoporotic fractures.
  
  
  OBJECTIVE
  The principal aim of the present study was to focus on the effects of dietary calcium intake on bone mineral density (BMD) and fragility fractures in a representative sample of an adult Italian outpatient population.
  
  
  METHODS
  The study group consisted of 1000 consecutive adult Italian subjects [838 women (F) and 162 men (M)] referred to the Bone Metabolic Diseases Unit for the evaluation of their bone metabolism. Daily dietary calcium intake was assessed using a specific food frequency questionnaire (FFQ). Other evaluations included fracture risk, lumbar and femoral BMD, heel ultrasound, fragility fractures, plasma concentration of parathyroid hormone ([PTH]) and 25-hydroxy-vitamin D ([25(OH)D]), and urinary calcium.
  
  
  RESULTS
  Only 10.4% of the subjects (n = 104; 71 F and 33 M) had a daily calcium intake adequate for adults (≥1000 mg/day). No correlation was found between calcium intake and BMD. The transition from a daily dietary calcium intake <400 mg/day to a daily dietary calcium intake ≥400 mg/day was associated with a reduced fracture probability ratio at any site [from 42 to 21% (p < 0.05)]. Subjects with one or more vertebral fractures had a significantly lower dietary calcium intake (<400 mg/day) than did subjects without vertebral fractures, and they practiced physical activity only occasionally (p = 0.030).
  
  
  CONCLUSIONS
  Daily dietary calcium intake is lower than the recommended daily intake in an Italian ambulatory population, and a higher fracture risk appears to be associated with a reduced calcium intake. An age-adequate daily calcium intake, combined with regular physical activity, is strongly recommended in order to counteract fragility fractures.
authors.affiliation: Bone Metabolic Diseases Unit, Department of Surgery and Tra﻿nslational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Vannucci
authors.affiliation: Bone Metabolic Diseases Unit, University Hospital AOU-Careggi, Largo Palagi 1, 50139, Florence, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Masi
authors.affiliation: Department of Neurosciences, Psychology, Drug Research, and Child Health (section of Psychology), University of Florence, Via di San Salvi 12, 50139, Florence, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gronchi
authors.affiliation: Bone Metabolic Diseases Unit, Department of Surgery and Tra﻿nslational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Fossi
authors.affiliation: Bone Metabolic Diseases Unit, Department of Surgery and Tra﻿nslational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Carossino
authors.affiliation: Bone Metabolic Diseases Unit, Department of Surgery and Tra﻿nslational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy. marialuisa.brandi@unifi.it.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Brandi
mesh_terms: D000328:Adult; D015519:Bone Density / Q000187:drug effects*; D002136:Calcium, Dietary / Q000032:analysis*; D015930:Diet Records; D015444:Exercise; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000209:etiology*; D010045:Outpatients; D010281:Parathyroid Hormone / Q000097:blood; D012307:Risk Factors; D016103:Spinal Fractures / Q000209:etiology*; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D002136:Calcium, Dietary; D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: Bone mineral density; Calcium intake; Fragility fractures; Physical activity