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Background: Bone mineralization can be influenced by genetic factors, hormonal status, nutrition, physical activity and body composition. The association of higher calcium (Ca) intake or Ca supplementation with better bone mineral density (BMD) remains controversial. Furthermore, it has been speculated that maintaining long-term adequate Ca intake rather than having a brief supplementation period is more effective. The aim of the study was to prospectively analyse the influence of adequate Ca intake on BMD at 7 years of age in European children., Methods: Data from the Childhood Obesity Project were analysed in a prospective longitudinal cohort trial. Dietary intake was recorded using 3-day food records at 4, 5 and 6 years of age. The probability of adequate intake (PA) of Ca was calculated following the American Institute of Medicine guidelines for individual assessments, with FAO, WHO and United Nations University joint expert consultation dietary recommendations. Children were categorised as having high Ca PA (PA >95%) or not (PA <95%). At 7 years, whole body (WB) and lumbar spine (LS) BMD were measured in the Spanish subsample by dual-energy x-ray absorptiometry. Internal BMD z-scores were calculated; BMD below -1 z-score were considered to indicate osteopenia, and BMD z-scores below -2, "low bone mineral density for age"., Results: BMD was measured in 179 children. Ca intake at 6 years was positively correlated with LS BMD at 7 years (R = 0.205, p = 0.030). A Ca increase of 100 mg/day explained 19.4% (p = 0.011) of the LS BMD z-score variation, modifying it by 0.089 (0.021, 0.157) units. Children with Ca PA >95% at 5 and 6 or from 4 to 6 years of age showed higher BMD z-scores at the LS and WB levels than children with Ca PA <95% (p < 0.001 and p < 0.05 for LS and WB BMD, respectively). Ca PA >95% maintained over 2 years explained 26.3% of the LS BMD z-score variation (p < 0.001), increasing it by 0.669 (0.202, 1.137). PA >95% maintained over 3 years explained 24.9% of the LS BMD z-score variation, increasing it by 0.773 (0.282, 1.264). The effects of Ca adequacy on WB BMD were similar. Children with PA >95% over 2 years had an Odds ratio of 13.84 and 12 for osteopenia at the LS and WB levels, respectively (p = 0.001)., Conclusions: Long periods of adequate Ca intake in childhood increase BMD and reduce osteopenia risk. The Childhood Obesity Project clinical trial (CHOP) was registered at clinicaltrials.gov as NCT00338689., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

History will probably describe this as a significant era for osteoporosis management, which has recently shifted from the laboratory and research clinic into mainstream clinical practice. It is timely, therefore, to provide practice guidelines for clinical use in this area; they must be developed carefully, however, so as to ensure that they are generated from reliable data. Furthermore, in current circumstances, management not only must be effective but also must aim for cost minimization; this is a difficult area in which little information is available. Also, in light of increased knowledge about skeletal medicine, complex cases should be considered for referral to an expert. The diagnosis of osteoporosis centers on two main steps: the identification of patients at risk and the estimation of bone density at two skeletal sites to help in ascertaining future fracture risk. At present, the main question in this approach centers on identifying the risk level threshold at which bone density should be evaluated. Although it is generally agreed that anyone with an atraumatic osteoporotic fracture will benefit from bone density estimation, the exact risk level for other, less easily defined indicators (e.g., cigarette smoking) is unclear. Once the diagnosis of osteoporosis is made, the cause must be elucidated by appropriate biochemical and imaging techniques. Appropriate therapy varies with the cause and level of risk. Although many treatments are currently available, including pharmacologic intervention, dietary changes, and exercise, they must be selected and adapted according to the needs of the individual patient, a process requiring both skill and patience.