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You are required to produce report analysing how a named nutrient or family of nutrients may impact on the occurrence of a specific health problem.  Your topic must be chosen from the list below:

Calcium as a means of reducing risk of low bone mass;

Vitamin C and the prevention of cancer;

Iodine and neurological impairment.

  1. Your report should cover the following areas:
  2. How the named nutrient or family of nutrients might affect the pathological processes leading to the development of the health problem including a review of relevant laboratory studies;
  3. Epidemiological evidence for a relationship between nutritional status in respect of the named nutrient or family of nutrients and the occurrence of the health problem.
  4. Any potential adverse effects of increasing intake of the nutrient or family of nutrients.
  5. Conclusions and recommendations regarding intake of the named nutrient or family of nutrients.

Roles of Calcium in Bone Health

Bones comprises of living tissues with blood supply and active metabolism, though they might appear to be lifeless structure (Ross et al,2011). Stronger bones are essential part of good health hence can be formed from healthy diet as well as exercises. Bones form an integral part of our skeletal structure and support bodies. Bones stores minerals especially calcium. Calcium stored in bones of a human body is broken down during the process of lifetime by mean of a process known as resorption and then builds newer bones. As age progresses old bones are broken down faster compared to making of newer bones, leading to net loss in bones. Bone loss can often lead to low bone density commonly known as osteopenia (Ominsky et al, 2011). Further weakening of the bones leads to osteoporosis. Osteoporosis can lead to further complications such as bone fractures and minimal trauma. Osteoporosis is a disease whereby bones become weak and have increased susceptibility to fractures and are more likely to break. Calcium has been seen as a mineral whose continuous substitution might result in reducing risks of suffering from low bone mass. External intake of calcium is known to have several other benefits as well that might prevent loss of bone mineral density (Bender, 2016). The scope of the discussion concerns dietary calcium as a way for reducing low bone mass. The nutrients pathological process that can give rise to complex health problem is undertaken along with epidemiological evidence and adverse effects of calcium is analysed here.

  • To evaluate links between dietary calcium intake and low bone mass
  • To understand the various roles performed by calcium as soft tissue roles and homeostatic control mechanism
  • To evaluate bone turnover cycle and concept of coupling
  • To understand number of supplementation trials

Bone is composed of collagen, which is a complex protein that consists of a flexible framework. Along with collagen, bones also comprises of calcium phosphate and calcium carbonate that provides the hardened structure of the bones along with its strength and flexibility. Loss of Calcium or lower presence of the mineral in the bone and blood stream might pose serious health risks as well as complications. Low density of calcium in bones might lead to lower bone mass. More the levels of calcium present in bone more stronger and healthier will they be. Calcium is considered the most sample mineral in the body with 99% of calcium being in blood and teeth, rest 1% is present in muscles, blood and soft tissues such as organs, nerves and so on. This 1% has a major role in our health helping in muscle contractions and relaxation, blood clotting, nerve functioning, immune defense and blood pressure. Below are some of the roles that are catered to by calcium;

  1. Maintaining body structure: Calcium combines with phosphorus to form bones by making them hard and resistant to decay. Consuming enough calcium helps maintain strong bones later in life.  
  2. Soft Tissue Roles: Calcium comprises of 70% of bone weight and 99% calcium in the body is the bones. Calcium provides muscles to contract normally as deficiency can lead to create cramps and spasm. It allows blood to clot in cases of wound or cut. Presence of calcium allows nerve message to be passed across the nervous system across other parts of the body.

    Remaining part of calcium floats around in the bloodstream in which it is responsible for varied types of functions. Calcium has other pathological functions as well as it is responsible for nervous system impulses, contraction of the heart muscles and in clotting of blood.
  • Homeostatic Control Mechanism: Calcium helps regulate blood pressure, as low calcium intake has been seen to be associated high blood pressure. Role of calcium has been found to be major in homeostatic control mechanism. Calcium reduces risks of colon cancer and many other forms of cancers. It allows fat binding and bile acid in large intestines. It prevents excessive growth of cells in intestines. During childbirth, calcium plays an important role of simulating contraction of the uterus and also supports formation of milk. Its other pathological implications include functioning of various enzymes and hormones within the body.
  • Adverse effects on bone: Absence of calcium can have adverse effects on bone, leading to weakening and causing breakage. Deficiency of calcium might lead to severe consequences on the body.

Process of Bone Remodeling

Calcium is an essential nutrient that that forms basic building blocks for bones. Calcium not only provides strength to bones but also renders them with flexibility that allows bones to sustain injuries (Cao, 2011). Bones can absorb various strength blows and other injuries and prevents such harm from reaching internal organs that are much weaker to sustain such injuries. Calcium being a critical nutrient that supports health bone structure need to be constantly supplied to the body. Pathological significance of calcium is significant as it is known to affects various controls and support healthy bone structure. Loss of calcium is greater compared to its absorption procedure, after the age of 30 calcium deficiency can easily occur. Calcium deficiency is said to be a condition when presence of calcium is insufficient or it is not being utilized in a proper manner. An average diet can lead to calcium deficiency (Kendler et al, 2010).

Bone turnover cycle is considered as a continuous process and occurs at an average rate of 3.6% per year amongst healthy adults. Bone turnover cycle has double rate in children. Bone turnover provides formation and resorption process released during the time of remodeling. They are considered markers that have allowed understanding physiology, clinical applications and maximizing optimizing analysis process. It complements bone mineral density by managing osteoporosis. 


Figure 1: Stages of Remodelling

Bone comprise of dynamic tissue of cells and extracellular matrix encompassing organic (35%) and inorganic (65%) molecules. Organic matrix within bone comprises of type I collagen (90%) along with non-collagenous proteins as osteocalcin (OC), proteoglycans and glycoproteins. Inorganic calcium and phosphate lead to formation of hydroxyapatite crystals which mineralize in the organic matrix. There are three types of bone cells that are engaged I n remodeling as osteoblast, osteocytes and osteoclasts.

The concept of coupling involves bone resoption and bone formation along with basic multicellular units. Resoption through the process of osteoclasts is undertaken by generating osteoblasts along with bone-forming activity that provides continuity replacement to loss of bone. Coupling involves interaction with wide range of cell types along with control mechanism. Bone remodeling occurs at multiple sites in an asynchronous manner.


Figure 2: Bone Coupling

When calcium is ingested by the body, first it gets absorbed in the small intestine from where it enters into the bloodstream, then finally reaching bones and teeth. Presence of Vitamin D in the body aids in the efficient absorption of calcium (Peacock, 2010). Vitamin D also allows calcium to be transported from digestive systems to the blood and bones. Another mineral that permits calcium to be more completely absorbed into the body and be utilized is optimal amounts of phosphorus. Thyroid glands and parathyroid glands secretion allows maintaining of appropriate levels of calcium equilibrium in the blood levels. All these regulatory mechanism helps in maintaining optimum levels of calcium in the body. In case calcium is mildly absent in the bloodstream or bones, it might lead to various complications and diseases as osteoporosis. In case faulty metabolism of calcium occurs in the childhood, it might lead to rickets. Deficiency of calcium can lead to graver consequences as hypertension and colorectal cancer.

Epidemiological Evidence of Calcium's Impact on Bone Health

In case calcium is severely absent from blood levels or bones, it might be treated as  hypocalcemia, which is referred to as reducing calcium in bloodstream levels below a certain range (Bone et al, 2011). Absence of calcium beyond certain range has its own clinical manifestation and might have severe pathological significance. A condition known as tetany is said to develop that includes tingling around fingertips and mouth, numbness, painful spasm and aches. All these symptoms respond to treatment of calcium that can be detected clinically. Clinical findings of calcium deficiency reveal a rare manifestation and are either reflected through parathyroid hormones or vitamin D in the body.          

Various factors contribute towards loss of bone or lowered levels of calcium resulting in lower bone mass. After a certain age more bone is resorbed by the body than it is formed. Multiple factors determine ways in which old bone is resorbed and formation of new bones takes place. Age has been deemed to be a leading factor that causes loss to bones and lowers their bone mass, another prominent factor being diet. Bones are generally added during childhood as well as during teenage years. It is at this time that bones become stronger, heavier and denser. Until bone mass reaches its peak, formation of bones continues till the age of 30. However after the age of 30 bone resorption overtakes new bone formation, this results in fast loss of bone mass and bone density.  Bone loss in women happens at a fast rate compared to men mostly after menopause (Bender, 2014). Factors that pace up loss of bone mass and density are having diet that have low quantities of calcium in them, smoking, not exercising and taking medication as corticosteroids (Langdahl et al, 2012). Men are also at higher risks from osteoporosis but experiences loss of bone later in their lives as well. Early detection of bone loss is critical and important for arriving at the steps to prevent osteoporosis from taking place. Effective prevention and treatment can only take place in case the individual is aware regarding risks facing them of osteoporosis. Ways in which bone solidness can be tested is by bone mineral density (BMD) that has capability to measure solidness and mass of bones.         

Calcium along with Vitamin D is considered to be critical nutrients for bone health and their maintenance. In cases of patients facing bone loss, calcium and Vitamin D care is provided for the purpose of optimal care (Chen et al, 2012). However, research shows that women being at greater health risks from loss of calcium and approximately 90% women might not be getting enough calcium with 50% women receiving treatment for   bone loss might have inadequate amounts of Vitamin D. Osteoporosis is the most eminent clinical complication arising from mal-absorption of calcium in the bloodstream. Though osteoporosis have a number of pharmacological treatments that can enhance bone mass by reduction in risks from fractures. The treatment has been seen to be successful by providing sufficient amounts of Vitamin D and Calcium supplements. The US Surgeon General has provided a pyramid approach for the purpose of treating bone related diseases. According to the approach, preventing falling down, with maintaining adequate quantities of vitamin D, physical activity and calcium provide the base of the pyramid for individual facing bone diseases. At the second tier of the pyramid includes methods aimed at treating secondary causes that leads to osteoporosis. The third tyre includes pharmacotherapy.

Clinical Manifestation of Calcium Deficiency

Calcium levels being low in the blood stream or bone might impose various challenges in the human body (Drake et al, 2012). Clinical and pathological implications might be epidemiologically verified. Osteoporosis has become a significant public health issue that has effects on morbidity and mortality. Till recently calcium and vitamin D had been overlooked by health practioner and patients as an integral factor. Calcium leads to creation of bone mass, leading to healthier bone structure and system. Calcium levels is said to achieve its peak by the 30s. In young stage and as adults physical activity along with adequate supplements of calcium and vitamin D intake is suggested for maintaining proper cellular functions and body structure. Calcium as earlier established is an essential component for bone mineral as well as extracellular fluid (ECF) or plasma. A calcium balance dictates bone resoption and increasing levels of plasma. Calcium is primarily excreted through kidneys and feces. Calcium intake is best suggested by daily dietary intake of high calcium containing foods. Dairy sources provide adequate calcium sources. Other sources of calcium include mineral waters with calcium enrichment and other naturally occurring bio-calcium sources. Individuals who do not acquire necessary amounts of calcium through their dietary intake need to take additional amounts of calcium for meeting dietary guidelines. Research and studies provides that an average American does not even meet the lower ends of calcium intake suggested. Whereas women at the age of 40 intakes almost half of the calcium that is suggested for dietary intake. Especially in postmenopausal women, calcium intakes were found to be significantly low as compared to other women.

Readily available calcium supplements in the market can add to necessary calcium required by an ordinary human body. The most commonly available natural calcium supplements are calcium citrate and calcium carbonate (Rizzoli et al, 2010). These supplements are used almost all over the world and have particularly high levels of absorption rates when taken with food. Calcium supplements have effectively shown to prevent osteoporosis fractures in postmenopausal women. Calcium artificial intake can reduce risks considerably between 25% to 70% for osteoporosis. Trails of studies shows up to 30% reduction in risks of fractures by taking in 1000 mg/day of calcium. Elderly French women were studied for number of hip fracture rates, which found almost 43% reductions in nonvertebral fractures (Reid, Bolland & Grey, 2014).

Calcium is regarded as an essential component for healthy bones and plasma levels within the body. In absence of necessary dietary calcium taken, supplements of calcium need to be obtained. However, drug supplements have certain potential to inter act with other prescriptions (Devlin, 2011). It has been observed that Calcium supplements have a tendency to reduce levels of drug digoxin in the body. Further there might be risks of hypercalcemia in case of interaction of Calcium and vitamin D supplements. Such supplements are known to increase fluroquinolones, levothyroxine, as well as other antibiotics of the tetracycline family as well as phenytoin. In case these drugs are administered at the same time there might be risks of decreased absorption.   

Approaches for Treating Bone Loss and Osteoporosis


Figure 3: Recommended Dietary Allowance (RDA)

A meta-analysis conducted across 29 studies with 63,000 individuals revealed calcium and calcium along with Vitamin D could be used for preventing of fractures and bone loss. Treatment with calcium is associated with 12% reducing in risks associated with bone loss (Lips et al, 2010). Supplements with calcium and vitamin D was considered to be essential for treating cases of bone loss and osteoporosis in adults over the age of 50 years. Safe Upper Limits have been specified and included in table that includes dietary recommendations for calcium. WHI reported results of calcium and vitamin D supplementation along with risks of fractures that included 36,000 healthy postmenopausal women, who received daily doses of 1000mg calcium carbonate and 400units of vitamin D. The study conclusion revealed significant improvement in bone mass and bone mineral density, but such clinical trials did not depict any improvement in rate of fractures.


Analysing relevant literatures and pathological implications of calcium provides various integral information related to the mineral. The mineral is considered to be a critical component for stronger bones. In case of absence of appropriate amounts of calcium in bones several clinical complications might arise that might lead to serious medical implications. Though deficiency of calcium is not an irreversible condition but it might be viewed as a critical component that regulates functioning within a healthy human body. Meaning that absence of calcium might lead to other complications that will further need to be treated. Therefore, it is necessary to maintain appropriate levels of calcium. Treating medical conditions amongst individuals facing medium to severe calcium deficiency can be done with providing calcium supplements. A vital recommendation for all patients facing such deficiency includes treatment with calcium and vitamin D supplements such as to maintain adequate amounts of balance of the nutrients in the body. Recommendations for all supplements available need to be reviewed such as to provide with best possible supplement available in the market.          


Bender, D., 2014. An introduction to nutrition and metabolism. CRC Press.

Bender, A.E., 2016. Dictionary of nutrition and food technology. Elsevier.

Bone, H.G., Bolognese, M.A., Yuen, C.K., Kendler, D.L., Miller, P.D., Yang, Y.C., Grazette, L., San Martin, J. and Gallagher, J.C., 2011. Effects of denosumab treatment and discontinuation on bone mineral density and bone turnover markers in postmenopausal women with low bone mass. The Journal of Clinical Endocrinology & Metabolism, 96(4), pp.972-980.

Cao, J.J., 2011. Effects of obesity on bone metabolism. Journal of orthopaedic surgery and research, 6(1), p.30

Chen, M., Pan, A., Malik, V.S. and Hu, F.B., 2012. Effects of dairy intake on body weight and fat: a meta-analysis of randomized controlled trials–. The American journal of clinical nutrition, 96(4), pp.735-747.

Devlin, T.M., 2011. Textbook of biochemistry. John Wiley & Sons,

Drake, M.T., Murad, M.H., Mauck, K.F., Lane, M.A., Undavalli, C., Elraiyah, T., Stuart, L.M., Prasad, C., Shahrour, A., Mullan, R.J. and Hazem, A., 2012. Risk factors for low bone mass-related fractures in men: a systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism, 97(6), pp.1861-1870.

Kendler, D.L., Roux, C., Benhamou, C.L., Brown, J.P., Lillestol, M., Siddhanti, S., Man, H.S., Martin, J.S. and Bone, H.G., 2010. Effects of denosumab on bone mineral density and bone turnover in postmenopausal women transitioning from alendronate therapy. Journal of Bone and Mineral Research, 25(1), pp.72-81.

Langdahl, B., Binkley, N., Bone, H., Gilchrist, N., Resch, H., Rodriguez Portales, J., Denker, A., Lombardi, A., Le Bailly De Tilleghem, C., DaSilva, C. and Rosenberg, E., 2012. Odanacatib in the treatment of postmenopausal women with low bone mineral density: five years of continued therapy in a phase 2 study. Journal of Bone and Mineral Research, 27(11), pp.2251-2258.

Lips, P., Bouillon, R., Van Schoor, N.M., Vanderschueren, D., Verschueren, S., Kuchuk, N., Milisen, K. and Boonen, S., 2010. Reducing fracture risk with calcium and vitamin D. Clinical endocrinology, 73(3), pp.277-285.

Ominsky, M.S., Stouch, B., Schroeder, J., Pyrah, I., Stolina, M., Smith, S.Y. and Kostenuik, P.J., 2011. Denosumab, a fully human RANKL antibody, reduced bone turnover markers and increased trabecular and cortical bone mass, density, and strength in ovariectomized cynomolgus monkeys. Bone, 49(2), pp.162-173.

Peacock, M., 2010. Calcium metabolism in health and disease. Clinical Journal of the American Society of Nephrology, 5(Supplement 1), pp.S23-S30.

Reid, I.R., Bolland, M.J. and Grey, A., 2014. Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. The Lancet, 383(9912), pp.146-155.

Rizzoli, R., Bianchi, M.L., Garabédian, M., McKay, H.A. and Moreno, L.A., 2010. Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly. Bone, 46(2), pp.294-305.

Ross, A.C., Manson, J.E., Abrams, S.A., Aloia, J.F., Brannon, P.M., Clinton, S.K., Durazo-Arvizu, R.A., Gallagher, J.C., Gallo, R.L., Jones, G. and Kovacs, C.S., 2011. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. The Journal of Clinical Endocrinology & Metabolism, 96(1), pp.53-58.

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