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Tuesday, 6 October 2026dailybeirut.com
Health
A new study reveals that younger postmenopausal women and those undergoing breast cancer therapy consume less calcium than recommended in Italy.
Patients at risk of bone loss, particularly women undergoing endocrine therapy for breast cancer, frequently fail to meet daily calcium requirements. A recent investigation published in the journal Nutrients indicates that younger postmenopausal women assessed for bone fragility often consume amounts below Italian recommendations. The average intake among women receiving adjuvant endocrine therapy (AET) also remained insufficient, highlighting a critical gap in nutritional support for those vulnerable to osteoporosis.
Maintaining bone health relies heavily on dietary sources such as milk, dairy products, vegetables, seafood, dried fruits, cereals, plant-based milks, and calcium-rich waters. Guidelines from the Italian Society for Osteoporosis, Mineral Metabolism and Skeletal Diseases (SIOMMMS) recommend 1,000 mg/day for postmenopausal women on hormone replacement therapy and men aged 50 to 65. Higher targets of 1,200 mg/day apply to postmenopausal women not receiving such therapy and men over 65.
Researchers evaluated 132 individuals—122 females and 10 males—at the Division of Endocrinology, Azienda Ospedaliero-Universitaria delle Marche, between January 2020 and December 2021. Participants were referred to the Osteoporosis and Bone Metabolism Diseases outpatient clinic. Dietary habits were assessed using a seven-day food frequency questionnaire based on the International Osteoporosis Foundation (IOF) Calcium Calculator, validated by SIOMMMS.
The study team recorded comorbidities, previous fragility fractures, osteoporosis etiology, and densitometric and biochemical parameters. Blood measurements included serum calcium, phosphorus, parathyroid hormone (PTH), 25-OH-cholecalciferol (25(OH)D), bone alkaline phosphatase (bALP), and C-terminal telopeptide of type 1 collagen (CTX). Dual-energy X-ray absorptiometry (DXA) scans determined bone mineral density (BMD) at the lumbar spine and proximal femur.
Vertebral fractures were identified via quantitative vertebral morphometry or morphometric thoracolumbar radiography, while non-vertebral fractures were noted through anamnesis. Fragility fractures were defined as those occurring without sufficiently severe trauma. Minor osteoporotic fractures affecting the clavicle, ribs, tibia, fibula, and pelvis were distinguished from major fractures involving the vertebrae, femur, forearm, or proximal humerus.
Women comprised 92% of the cohort, all either postmenopausal or undergoing ovarian suppression due to AET. The mean age was 65 years. Over 43% had severe osteoporosis with at least one fragility fracture, and nearly 41% faced increased risk. Approximately 65% of patients evaluated for secondary osteoporosis were receiving AET for breast cancer.
The overall mean daily calcium consumption was 959 mg. Younger women with postmenopausal osteoporosis averaged 848 mg, while those with normal BMD consumed 631 mg/day. Participants without fragility fractures averaged 906 mg, and those assessed for secondary osteoporosis consumed 900 mg. Differences across these subgroups did not reach statistical significance and are considered trends rather than established group differences.
Among women receiving AET, average intake was 854 mg/day. Twenty-seven of the 35 women in this subgroup (77.1%) consumed less calcium than recommended. This shortfall is significant because certain AET drugs reduce estrogen production or modulate estrogen receptor (ER) signaling. Estrogen supports bone formation via osteoblast activity and limits resorption by osteoclasts.
The authors did not determine specific reasons for low intake among AET recipients but hypothesized that concerns about dairy consumption might play a role. While AET can improve survival outcomes, it is associated with increased risks of osteoporosis and fractures. Breast cancer remains a leading cause of cancer-related mortality among women globally, with ER-positive cases commonly treated with AET.
The study’s cross-sectional design, single-center nature, small subgroup sizes, and lack of multivariable analysis limit the generalizability of findings. Associations reported should be viewed as hypothesis-generating. Total calcium intake could not be calculated due to unavailable supplement doses. Data on vitamin D doses, AET duration, time since diagnosis, cancer stage, recurrence, and glucocorticoid exposure were incomplete.
The researchers emphasize the need for individualized nutritional assessment and counseling. Enhancing awareness may help patients at risk of osteoporosis meet calcium requirements through suitable dietary sources, including selected low-fat and fermented dairy products.
