Motivating Women to Use Supplemental Calcium

Abstract & Commentary

By Mary Elina Ferris, MD, Clinical Associate Professor, University of Southern California. Dr. Ferris reports no financial relationship to this field of study.

Synopsis: Women who do not take supplemental calcium frequently need more education, and state they would be positively influenced by their physician's recommendations.

Source: Tyler CV, et al. J Am Board Fam Med. 2008;21:293-299.

In order to help understand why American women persistently have suboptimal calcium intake, the Cleveland Clinic Ambulatory Research Network was used for a nested cross-sectional patient survey of women aged 20 to 64 years old visiting 6 community family health centers. At each site 95% of eligible women agreed to participate, yielding 185 respondents of whom 43% had never used calcium supplements. The mean age of current users was 48 years old, and for non-users 40 years.

The primary reason stated for non-use was a lack of basic knowledge about the importance of calcium. Only 8% stated cost, convenience or taste as obstacles, and 4% blamed side effects such as constipation or upset stomach. Among the non-users, 40% were taking a daily multivitamin, compared to 80% of the users. They also differed from calcium users by being less likely to have a family history of osteoporosis, and less likely to take time for physical exams.

Non-users indicated they would be influenced by their doctor's recommendation: 96% of them agreed that they were "very likely" or "somewhat likely" to use calcium supplements if this occurred.

Commentary

Once again we see here the power of the personal physician's recommendation to influence health behaviors. Although this outpatient-based survey involves small numbers, it does attempt to capture the real-life situation in clinical settings. We know that calcium intake is crucial to preserve bone mass (and possibly other disease prevention), and we also know that achieving the minimum recommended daily intake is apparently very difficult for American women. Fully 75% of women of all ethnic groups had lower than recommended daily intakes of calcium in the last national survey.1

These findings provide further evidence that "brief office-based counseling strategies" are crucial for promoting calcium supplementation that may prevent major future disease. If a personal motivator can be identified, such as a family member with osteoporosis, success may be even higher. Since surveys indicate that 3-4 daily servings of dairy products are needed to meet minimum daily calcium requirements, promotion of calcium supplements remains our best hope of meeting this need.2 This article suggests that daily doses of 500mg of elemental calcium (best absorbed from calcium citrate), combined with 200 IU vitamin D, should be strongly encouraged during routine office visits.

References

1. Arab L, et al. Ethnic differences in the nutrient intake adequacy of premenopausal US women: results from the Third National Health Examination Survey. J Am Diet Assoc. 2003;103:1008-1014.

2. Fulgoni VL 3rd, et al. Determination of the optimal number of dairy servings to ensure a low prevalence of inadequate calcium intake in Americans. J Am Coll Nutr. 2004;23:651-659.